This month’s blog was inspired by recent conversations with a few dear families struggling to get a good night’s sleep and wondering what to do with toddlers who have firmly decided that their pacifiers are here to stay!

Every parent knows that good sleep helps keep the entire family happy. Yet children move through so many stages. From infancy to toddlerhood, childhood, and eventually the teenage years, with each stage bringing its own developmental milestones and parental adventures.

This blog is especially for our dear toddler parents: the ones navigating daycare and preschool, juggling work schedules and precious time together, caring for other children, or perhaps welcoming a new baby into their toddler’s once-familiar world.

In the middle of all those changes, a beloved pacifier can represent comfort, security, and a reliable way to settle into sleep. So, when the time comes to say goodbye to the binky, we want to honor what it has meant to the child while helping the whole family move gently toward the next stage.

If your toddler is deeply attached to their pacifier, you are certainly not alone. Let’s talk about why little ones love their binkies, when the habit may begin to affect their developing smile, and my gentle five-step approach to a happy pacifier graduation.

Why do babies love pacifiers?

Infants are born with a natural desire to suck, and many an ultrasound has captured a baby happily sucking a thumb or finger in utero. Suckling not only serves to satisfy the need for comfort but also has an important role in oral development by stimulating the mouth, tongue, and palate, as well as motor development of the oral musculature and the cranial nerves.

This oral stimulation during the first year of life provides important information to the developing nervous system promoting oral motor skill development necessary for feeding. Nonnutritive sucking, such as pacifier use, can also promote calming and self-regulation.

Why do babies love pacifiers?

Infants are born with a natural desire to suck, and many an ultrasound has captured a baby happily sucking a thumb or finger in utero. Suckling not only serves to satisfy the need for comfort but also has an important role in oral development by stimulating the mouth, tongue, and palate, as well as motor development of the oral musculature and the cranial nerves.

This oral stimulation during the first year of life provides important information to the developing nervous system promoting oral motor skill development necessary for feeding. Nonnutritive sucking, such as pacifier use, can also promote calming and self-regulation.

When should children stop using a pacifier?

Pacifiers can be very helpful during infancy. As children grow, however, a persistent sucking habit can begin to influence the way their teeth, palate, and bite develop. Something else also happens as infants grow into toddlerhood: it becomes increasingly difficult to take away a pacifier that they have become accustomed to.

The American Academy of Pediatric Dentistry explains that pacifier use beyond 18 months may begin to affect the developing mouth and bite. In a 2025 systematic review and meta-analysis by Chong Gao, Miaoran Wang, Hairong He, He Lei, and Liqin Mei, the researchers found that prolonged nonnutritive sucking was associated with an increased risk of anterior open bite development

The AAPD recommends helping children discontinue nonnutritive sucking habits by 36 months of age. Fortunately, many of the early bite changes associated with pacifier use can improve when the habit is discontinued early enough.

This does not mean that the pacifier must disappear in one dramatic evening. Every child is different and every family is unique. We can honor the comfort it has provided while lovingly guiding the child toward pacifier independence.

Why is it hard for some toddlers to let go of the pacifier habit?

The first is biological. Toddlers continue to enjoy the calming and pleasurable sensation that sucking provides. We all know how challenging it can be to convince a toddler that something so comforting might eventually become problematic!

The second reason is rooted in familiarity and habit. We humans are creatures of habit, and toddlers are no different. When something brings pleasure and soothing and becomes woven into a child’s daily and nightly routines, making a change means gently addressing all of those layers: the physical enjoyment, the emotional comfort, and the familiar ritual.

Can parents Simply take the pacifier away?

Absolutely. Some parents choose a direct approach: call in the “Binky Fairy,” say goodbye to the pacifier, and tough it out through a few difficult nights. While this can certainly get the job done, it is not the best fit for every child or every family. Other parents find themselves negotiating with a very determined toddler and feeling a little lost when it comes to their options.

Because I am a fan of baby steps and gentle guiding, I find that it helps to first acknowledge the reasons behind a toddler’s attachment to the binky and to know that there is light at the endless pacifier tunnel! I recently made a little video for parents demonstrating the gentle method I have shared with families for years. The idea is not to suddenly take away something your toddler deeply loves. Instead, we gradually make the pacifier a little less satisfying until your child is ready to let it go.

While this method has worked for many families over the years, I always like to note that it’s meant for an older toddler who is ready for saying goodbye to the pacifier and not for a young infant. It’s also important to choose a pacifier that is in good condition and inspect it carefully before every use.

Dr. Reem’s Gentle Five-Step Binky Method

Step 1: Gather the Pacifiers

Pacifiers tend to multiply! Begin by gathering them all and keeping only one or two. This prevents your toddler from simply finding another perfect binky when the first one begins to change.

Step 2: Make One Tiny Opening

Using clean manicure or paper scissors, make a very small opening at the very tip of the pacifier nipple.

This releases the suction and allows the nipple to begin collapsing. The pacifier is still familiar, but it no longer feels quite the same.

Step 3: Give Your Toddler Time

Allow your child a few nights to become accustomed to that first small change. There is no need to rush.

Some children lose interest surprisingly quickly. Others need a little more time, reassurance, and cuddling before they are ready for the next step.

Step 4: Gradually Shorten the Tip

After a few nights, trim away another very small portion of the nipple. Continue gradually, allowing your toddler time to adjust between each change.

You might gently and playfully notice together that the binky is getting smaller and that perhaps those growing toddler teeth have been very busy!

The important thing is that this does not feel like something precious has been abruptly taken away. The pacifier simply becomes less and less satisfying to suck.

Step 5: Celebrate Binky Graduation

Continue the gradual process until very little of the nipple remains and your child is no longer interested in using it.

Then celebrate!

Your toddler has reached an important little milestone. A favorite stuffed animal, bedtime story, special cuddle, or small “binky graduation” ritual can help replace the comfort the pacifier once provided.

Happy pacifier graduation!

What age should I begin weaning my toddler off the pacifier?

According to the American Academy of Pediatric Dentistry, recommends that nonnutritive sucking habits be discontinued by age 3. Toddlers suckling a binky after 18 months  may affect oral structures.

Is it okay to begin cutting the tip off of his pacifier?

Yes, as long as you are using clean scissors, making sure there are no rough edges and inspecting it routinely.

How long will this take?

Depending on your child, and how fast they adjust to the changes. There is no right or wrong time to wean your child off of a pacifier. Give your child time, patience, reassurance, and love.

What if my child gets upset or throws a tantrum?

Your child may become upset or have a tantrum. There is no need to rush the process, try spending extra time with them and giving extra love and support.

Does thumb-sucking have similar effects as a pacifier?

Yes, thumb-sucking can cause similar issues as a pacifier can, such as malocclusion and palate changes. However, it can be harder to stop a thumb-sucking habit, because the thumb or finger cannot be taken away as easily as a pacifier can. Similar methods of gentle support, reassurance and keeping the hands busy can help.

Can pacifier use affect my toddler’s speech?

Pacifier use may have an effect on the speech development of some children, especially if used frequently throughout the day. However, the evidence on this topic is limited so it is hard to say for sure. Some Studies have shown that frequent daytime pacifier can possibly affect speech problems in some children, but more research is needed.

What can you suggest as a comfort to my toddler who will no longer have his pacifier?

A stuffed animal, or a small blanket, or favorite toy can help comfort your toddler as they learn to give up their pacifier. Having something to cuddle and snuggle with during naps and bedtime can help ease the transition.

How can I help my child stop using a pacifier?

Nurture your child through every step of the way and give them lots of reassurance, patience, and love. Help them celebrate their achievements by giving lots of praise as they go through the pacifier weaning process. You can also reward their accomplishments by giving them an activity or something they enjoy. saying goodbye to pacifier can be a a challenging transition for any child, but the whole family will definitely be proud of the achievement.

 

Schedule your child’s first dental visit today! Contact us here.

Guiding smile development is a lot like gardening. You must weed, water, and tend. But, with time, you get to see the blossoms bloom and the joy shine. Naturally, we all want to care for our homes and gardens in the healthiest way possible.

This is why the word holistic resonates, especially with parents. We gravitate toward natural products, good nutritional practices and healthcare that is thoughtful about procedures, materials, and technology. But holistic pediatric dentistry is more than a checklist of biocompatible materials or minimally invasive therapies. The heart of pediatric care begins with nurturing wellness from a whole-person perspective.

That’s why I prefer the term whole-istic or integrative pediatric dentistry. Just like our integrative pediatric medicine colleagues, it is our responsibility, as oral healthcare providers caring for children, to look at root causes of dental issues by evaluating a child’s diet, sleep habits, and airway development through the broader lens of the mouth-body connection. It is also equally important to do this in a warm, compassionate environment that fosters wellness education, which leads to independence and empowerment.

Pediatric Specifics

Let us be honest, kids are not great matches for lengthy procedures, repetitive treatment visits, or care when they do not understand why they need it. Gentle efficiency with children is not just a necessity: it is how they learn to relax and feel safe in a healthcare setting. Being mindful of true priorities, goals, and what each child can comfortably tolerate is how we honor the children we care for.

Being mindful seems to be a place where I like to hang out as much as I can. Throughout my career, I have aimed to practice mindfulness while not overthinking matters. Being raised with a heightened sense of responsibility and accountability has made this path an everyday learning experience. But it has also allowed me to attentively care about every aspect of our practice.

Smiles Evolution, My Evolution

When I launched Smiles in West Los Angeles in 2008, I had several years of experience working as a pediatric dental associate in the Los Angeles area, in addition to years of experience launching international practices. My training at the University of Southern California prepared me well for all aspects of pediatric dentistry in addition to early orthodontics, both of which I incorporated into the offices that I founded. However, returning to the West LA area and building a new practice in a location that was full of orthodontists made me wonder what services I should offer.

 

Every day, I had an orthodontic colleague knocking on my door asking to collaborate. How could I tell these lovely colleagues that I valued early orthodontics and practiced it successfully? How could I authentically articulate to parents that comprehensive early care was best offered in a space that cared for young children’s dental needs under one compassionate umbrella rather than sectioning services and energies?

Answering those questions would take a decade of time and endless hours of communication and facilitation. Referring families to orthodontic offices did not mean that parents would not seek my opinion about the options that they were offered by different practitioners.

I also spent much of my time calling these colleagues, reviewing cases, coordinating restorative care and proposed extractions, respectfully navigating whether teeth could possibly be kept, or explaining to parents why removing teeth might be a treatment they would want to consider.

In a nutshell, I was going way beyond what my energy would comfortably allow and sometimes, after all these efforts, I was seeing results that could have been different had the case been handled in a more comprehensive way. I was also struck by how much time busy parents spent traveling from office to office and continuously wondered how we could further facilitate their children’s dental care.

Launching Smiles Orthodontics

It took ten years of quietly watching, participating and contemplating before I decided it was time to stop shrinking and to offer the full scope of whole-istic pediatric dental care I knew my team and I were able to offer. I kindly informed my orthodontic colleagues, one by one, of our intention to start an orthodontic component at Smiles and began building it thoughtfully in keeping with the vision that I always held.

One of the main accelerators of this project was that my own children were approaching the age of early orthodontic needs and I wanted to be the one providing their orthodontic care as well as covering their pediatric dental needs. Since I have always treated every child at Smiles as my own, the evolution of offering orthodontic services to all our Smiles clients was natural.

 

 

The “Whole-istic” Vision

What I aimed to set up in 2018 was an orthodontic component that lived inside of our already thriving integrative pediatric dental practice. While most offices use a separate software system, scheduling system and even hire separate team members when they add specialty services to their practices, my vision was to have a central database that would allow us to view children from a whole-istic viewpoint, addressing all of their needs in one comprehensive treatment plan rather than having multiple sectioned appointments. The goal was to enhance child comfort and respect parental and family time.

Since we already had our established sedation suite offering nitrous oxide inhalation sedation, oral sedation, and in-office deep sedation, we were able to embed orthodontic treatments within restorative care sessions, as well as offer comforting sedation options to kids who needed gentle assistance getting orthodontic appliances delivered.

Building the Team

Education is a Smiles hallmark. My team and I are constantly learning new skills, gaining more experience, assembling innovative technologies, or getting certified in a new skill. We supported our pediatric dental assistants who were eager and ready to train to become orthodontic assistants throughout the certification process. This way, our team could toggle back and forth between whatever services each child or teen needed.

 

 

As for the doc “think tank,” I wanted to build an in-house presence, moving all the phone conversations of the past years to in-office, in-person collaborative treatment planning to help every child or teen that we treated. While I love early orthodontics, we still needed a board-certified orthodontist to join our team to offer a full orthodontic perspective.

In addition, a second pediatric dentist to support our pediatric care would allow me to be a connector between both specialties to bring our whole-istic vision to life. What we have set up is a workflow that creates ease, clarity, and focus. Our dual-certified assistants capture data and assist with examinations. Our doctor team collaborates to outline treatment plans and review options with parents.

The Technology

State-of-the-art technology is what keeps Smiles at the leading edge of what we do. However, what we strive to emphasize is the appropriateness and mindfulness of its use. The goal is to serve each child safely with these technologies. Efficiency, ease, and comprehensiveness are key.

Imaging devices that reduce radiation exposure, quality digital oral scanners that completely bypass traditional oral impressions, CAD/CAM technologies and chairside manufacturing/3D printing were each carefully and meticulously chosen for our young clients. These technologies continue to evolve and have been a cornerstone of the level of care that we offer at Smiles.

Experience Is the Best Teacher

Nothing has taught me more in my practice than being at the receiving end of care and personally sitting in the parental seat. My own children demonstrate to me what other parents experience at home when it comes to navigating the hours after dental appointments. In 2020, I carefully chronicled the early orthodontic care I provided for my daughter and continue to do the same for my son, who is currently completing his early care.

I humbly share the results with families that are embarking on similar journeys. I know firsthand the differences that parents can note between their children in terms of handling dental care, allowing parental assistance or overcoming stumbling blocks. I find that these experiences have made me a much more compassionate provider.

It always helps to give parents the benefit of the doubt and to offer a listening ear when they have struggles that need solutions. After all, the goal we all want to reach, including the kids, is a successful and beautiful outcome.

Putting The Bow on The Package

To explain the Smiles approach to whole-istic and integrative dental care, I will start by saying that it is about age-appropriateness and family readiness. It also allows us to preserve valuable information over time and enhance communication between specialties.

In keeping with American Academy of Pediatric Dentistry (AAPD) recommendations, we are proponents of age-one dental visits. The first years of care are dedicated to maintaining and nurturing oral health. These early visits also allow us to review oral habits, growth changes, and dental expectations with parents.

As children approach their mixed dentition years, jaw and orthodontic corrections can be navigated according to the American Association of Orthodontists (AAO) and international, evidence-based guidelines.

This timeline also includes placement of protective sealants on the permanent molars, and we often combine pediatric dental care with delivering early orthodontic appliances in one visit rather than having families return for an additional visit. Inhalation sedation with nitrous oxide or oral sedation, when needed, can make visits super smooth and easy for children.

For younger children with extensive restorative or surgical needs, combination care can be coordinated with deep/IV sedation. Children needing tooth extractions, teens needing surgical exposures of unerupted teeth, and children with special needs benefit from our in-house sedation suite and our compassionate anesthesiologist’s care.

Our CO₂ Solea laser shines in these circumstances, facilitating soft and hard tissue surgical procedures and often easing post-operative recovery. Furthermore, these children can receive comprehensive pediatric dental and orthodontic care in one sedation session to cover all their needs, significantly reducing their overall treatment time and enhancing the successful outcome of their care.

Infancy and prevention → habits and growth observation → mixed dentition and orthodontic evaluation → coordinated treatment when appropriate.

One Data Bank and One Think Tank

If I were asked about my favorite part of what we have built at Smiles, it would be the global organizational aspect of our practice. Like a well-organized garden, we can tell the story of every child we see with universal imaging and a tracking system that allows us the continuity of care that true whole-istic care requires – a model that ultimately gives children continuity, comfort, trust, and the opportunity for their smiles to develop thoughtfully. I hope we can share this with more lovely families like yours.

If you would like to learn more about Dr. Reem’s approach to integrative, holistic pediatric dentistry and orthodontics at Smiles in West Los Angeles, please contact our office. We’d love to hear from you.

Schedule your child’s first dental visit today! Contact us here.

Introducing PrintiSmile

I’m honored and deeply blessed to spend my days caring for children.

Every so often, a colleague who treats adults asks me, “How do you do it?”

My answer is always the same.

How could I not?

Children are magical. They are curious, resilient, surprising, and wonderfully authentic. Every day they remind me to slow down, laugh, wonder, and see the world through fresh eyes. Truthfully, I’m guilty of enjoying their company more than adults most of the time.

Because I care for children, I care to see the world through their eyes. When a child loses a front tooth after trauma or infection, I don’t just see a missing tooth. I see a little person who deserves to smile confidently, laugh freely, and continue growing without unnecessary treatment.

I also feel deeply for the parents who entrust me with their most precious gift. As a mother myself, I honor the emotions that parents hold. If my own toddler lost a front tooth and was about to start preschool without it, I know my heart would ache too.

Those moments remind me that we’re not simply replacing teeth. We’re caring for children, supporting families, and helping preserve the confidence that comes with a joyful smile.

It was this perspective that inspired PrintiSmile, a gentle, digitally designed approach to replacing missing primary front teeth that have either been traumatized and lost or are infected and cannot be saved.

What is PrintiSmile:

Unlike the traditional fixed pediatric anterior partial, which relies on metal bands cemented to the primary molars and a stainless steel wire framework to support an anterior pontic, PrintiSmile is a metal-free, resin-based, 3D-printed prosthesis supported by a proprietary digital workflow created specifically for young children. With its minimal, esthetic design, PrintiSmile embraces the principles of minimally invasive pediatric dentistry while respecting a child’s growth and development. It is adhesively bonded to the adjacent primary incisors, eliminating the need for posterior metal bands or wire frameworks while remaining clear of the midpalatal growth center. By combining digital technology with personalized care, each prosthesis is fully customized to the individual child, offering a gentle, modern approach to replacing missing primary front teeth.

Although the prosthesis shares conceptual similarities with adhesive anterior bridges used in adults, its design, digital workflow, and clinical application are fundamentally pediatric-driven, taking into account primary tooth morphology, child behavior, growth and development, and minimally invasive treatment principles.

Who Can Benefit from PrintiSmile?

PrintiSmile is designed for very young children who have lost one or more primary front teeth due to trauma, infection, or other causes. A child may be a candidate once the adjacent primary incisors have erupted, regardless of whether the primary molars have fully erupted.

This is typically a child who would otherwise spend several years without a front tooth before the permanent successor is expected to erupt.

I often tell parents that PrintiSmile was created for children younger than kindergarten age. By the time many children enter kindergarten, losing a front tooth has become a celebrated milestone among their peers. They proudly compare their “missing tooth smiles” and eagerly await visits from the Tooth Fairy.

Toddlers and preschoolers experience tooth loss differently. They are often too young to understand why their smile has changed, and parents may worry about the effect on their child’s confidence during some of their earliest social experiences.

The purpose of PrintiSmile is not simply to replace a missing tooth—it is to preserve smile confidence during those formative years. Once a child is emotionally comfortable with a missing front tooth and views it as a normal part of growing up, a prosthesis may no longer be necessary.

PrintiSmile can be used to replace one or two missing primary incisors. When both central incisors are missing, two independent prostheses are fabricated rather than a single appliance spanning the midline. This design philosophy preserves the natural separation across the midpalatal growth center while providing an esthetic and minimally invasive tooth replacement.

The PrintiSmile Workflow

To me, this is where the magic happens—watching a digital design come to life.

First Clinical Scenario: A Child Presents with a Missing Front Tooth

A child comes in with a primary front tooth that has already been lost due to trauma or extracted because of infection.

Step 1: A Quick Digital Scan

The appointment begins with a digital intraoral scan, which I perform personally with the child in a comfortable knee-to-knee position. It’s simply a quick pass of a small camera to capture the information I need to design the PrintiSmile prosthesis.

I also record the child’s bite but intentionally do not scan the lower arch. There is no need to ask a young child to cooperate any longer than necessary. My goal is to gather only the information I truly need while making the experience as effortless as possible.

Step 2: A Customized Digital Design

Once the scan is complete, the family is free to go have fun…

…while I have my own kind of fun.

Using CAD software, I digitally design a custom PrintiSmile prosthesis specifically for that child.

Step 3: Family Smile Preview

One of my favorite moments is inviting the family back to review the digital design before it is printed. Together, we look at their child’s future smile on the screen, discussing the shape, size, and overall appearance of the prosthesis. If there is anything they would like adjusted, this is the perfect opportunity to make those changes.

Once the family approves the design, it is ready for fabrication.

Step 4: Bringing the Design to Life

The PrintiSmile prosthesis is fabricated in our Sunshine Smiles Studio, our in-house digital design and 3D printing studio, where advanced technology, artistry, and attention to detail come together to transform a digital design into a custom prosthesis made exclusively for your child.

Once printed, the prosthesis undergoes careful post-processing, including washing, post-curing, finishing, polishing, and glazing to create a smooth, lifelike surface that is both beautiful and comfortable. Every PrintiSmile prosthesis is individually designed, fabricated, and hand-finished specifically for one child.

Step 5: A New Smile

By the time the family returns a few hours later, a customized PrintiSmile prosthesis is ready for delivery.

Delivery is once again performed in the comfortable knee-to-knee position.

We gently clean the teeth, isolate the area with gauze, and adhesively bond the PrintiSmile prosthesis to the adjacent primary incisors using composite resin.

Second Clinical Scenario: When an Extraction Is Needed

Our first priority is always to save a child’s natural tooth whenever possible. However, when a primary tooth cannot be saved because of trauma or infection, we plan the extraction and delivery of the PrintiSmile prosthesis during the same visit whenever feasible.

Our goal is for the child to never experience the emotional impact of losing a front tooth.

Before the appointment, I digitally remove the tooth from the scan data and complete the prosthesis design, allowing everything to be ready before the child arrives for treatment.

Once the family approves the digital design, the prosthesis is fabricated in our Sunshine Smiles Studio and prepared for delivery.

During the operative visit, whether performed with local anesthesia, nitrous oxide, oral sedation, IV sedation, or general anesthesia, depending on the child’s individual needs, the tooth is gently removed, and the PrintiSmile prosthesis is immediately bonded into place.

The child never experiences a missing front tooth. Neither do their parents.

Caring for Your Child’s PrintiSmile

To help keep your child’s PrintiSmile looking and functioning at its best, we recommend the following:

1. Be gentle with the appliance.
   PrintiSmile is fabricated from a durable, biocompatible 3D-printed resin. While strong enough for everyday function, it is different from natural tooth structure. Please discourage your child from biting directly into very hard foods, chewing on toys, or biting on sippy cups or other hard objects.
2. Let us know if you notice any changes.
   If the PrintiSmile becomes loose, chipped, or damaged, please contact our office. Because the prosthesis is bonded as an additive restoration without altering your child’s natural teeth, minor chips or damage to the appliance should not harm the underlying teeth.
3. Brush as usual.
   PrintiSmile should be brushed along with your child’s natural teeth using a soft toothbrush and fluoride toothpaste. Good oral hygiene will help keep both the prosthesis and the surrounding teeth healthy.
4. Designed with growth in mind.
   One of the unique advantages of PrintiSmile is that it respects your child’s natural growth and development. As the permanent teeth begin to erupt, the prosthesis can be easily trimmed or removed to allow the adult teeth to emerge naturally.
5. Share your experience.
   If PrintiSmile has made a difference for your child and family, we would love for you to share your experience with others. Your story may help another family discover a gentle option they never knew existed.

 

Long-Term Outcomes

As with any new innovation in dentistry, we are carefully following our PrintiSmile cases over time to better understand long-term clinical performance, durability, retention, and overall patient outcomes.

Innovation is not a destination, it is a journey. Every child we treat teaches us something new. Each PrintiSmile case contributes to the ongoing refinement of the design, digital workflow, and clinical technique, helping us continue to improve care for future children and families.

At the same time, it is important to recognize that all treatment options for replacing missing primary front teeth require ongoing observation. Traditional fixed anterior partials have long been monitored for debonding, appliance movement, fracture, and the need for repair or replacement as children grow and develop. PrintiSmile is no different in that respect.

Routine follow-up appointments allow us to evaluate the prosthesis, monitor oral health, and make any necessary adjustments while ensuring that natural growth and tooth eruption continue as expected.

As a pediatric dentist, educator, and lifelong student, I believe every innovation carries with it the responsibility to observe carefully, document honestly, and continue learning. My hope is that PrintiSmile will not only restore little smiles today, but also contribute to the growing body of knowledge in digital pediatric dentistry for years to come.

Schedule your child’s first dental visit today! Contact us here.

A few days ago, I had the opportunity to sit down with Louis, one of our Smiles Champions and a collegiate athlete, to learn more about life on a competitive sports team. What made the conversation especially meaningful is that I have cared for Louis since he was a toddler. Looking through old photographs, I was reminded of just how quickly childhood passes. One moment, we are celebrating a first dental visit; the next, we are discussing college athletics, training schedules, life as a young adult and 16 years of dental care!

 

Our conversation covered the tremendous amount of support athletes receive from coaches, trainers, sports medicine physicians, nutritionists, and strength and conditioning teams. But also highlight an area that is often overlooked: Dental health.

Sports Medicine and Dentistry: A Natural Partnership

Today’s athletes understand that peak performance requires attention to every aspect of health. Sleep, nutrition, hydration, strength training, recovery, and mental wellness all play a role in helping athletes perform at their highest level. Oral health should be no different.

Dental pain, untreated decay, gum inflammation, infections, breathing concerns, jaw discomfort, and dental trauma can all affect an athlete’s comfort, confidence, and overall well-being. While these issues may not always be visible on the field or court, they can have a significant impact on quality of life.

 

During our interview, Louis described the resources available to him as a collegiate athlete. His team places a strong emphasis on physical conditioning, recovery, nutrition, and overall wellness. Interestingly, he noted that while athletes often receive active support in many areas of healthcare, dentistry is not always a major component of the program. Fortunately, we’ve got him covered.

A Comprehensive Athlete Wellness Screening

 

When Louis visited our office last week, we approached his care much like a sports medicine evaluation.

Our assessment included:

• Comprehensive dental examination
  • Digital radiographic imaging
  • Intraoral scanning (IOS)
  • Intraoral photography and documentation
  • Evaluation of existing restorations and dental health
  • Assessment of oral hygiene and preventive needs
  • Discussion of sports participation and injury prevention

By combining digital imaging, photography, and 3D scanning technologies, we are able to create a detailed record of an athlete’s oral health while minimizing discomfort and maximizing efficiency. These records also serve as valuable baseline documentation should a sports-related injury ever occur.

Custom Protection for Growing Athletes

One of the most exciting aspects of modern sports dentistry is the ability to create fully customized sports guards and protective appliances. Using digital workflows and 3D printing technology in our in-house digital lab, we can design and fabricate sports guards tailored specifically to an athlete’s smile.

Studies have documented that custom sports guards show higher comfort and acceptance by the athletes that wear them. Typically, these appliances are pressure-formed over a dental model. The ability to personalize sports guards with custom colors and designs makes them even more appealing to younger athletes, helping encourage consistent use and long-term protection. Interestingly, many of our teen athletes are requesting clear sports guards. Teens that have had orthodontic aligner therapy seem to like the idea of a clear appliance more than a colored one.

However, with our SprintRay 3D printing ecosystem, and newly avialable sports guard resins, we have further evoloved this process into directly printing our sports guards using CAD/CAM design technology and digital workflows. Designing the appliances digitally allows for efficiency and exceptional fit and accuracy. Louis received two 3D printed sports guards. One in clear resin and another in a bright red color.

Our digital workflow includes:

• Digital oral scanning
  • Computer-aided design CAD
  • 3D printing
  • Finishing and customization
  • Final fit verification

Supporting the Whole Athlete

Collegiate athletes like Louis need to receive support for their overall health and performance. From nutrition and recovery to mental wellness and physical conditioning. We aim for dental care to be part of this whole-body approach.

The mouth is not separate from the body. Oral health influences overall health, comfort, confidence, communication, and quality of life. As sports dentistry continues to evolve, we have an opportunity to collaborate more closely with athletes, families, coaches, trainers, and sports medicine professionals to support health in a comprehensive and meaningful way.

When we think about athletic performance, we should think beyond muscles and conditioning. We should think about the whole person.

Looking Ahead

Looking through Louis’s childhood photographs while preparing this article, I was struck by how closely healthcare and human connection are intertwined. The images tell a story that spans years, from a young boy sitting in the dental chair to a disciplined collegiate athlete pursuing his goals.

Watching our patients grow from toddlers into accomplished young adults is one of the greatest privileges of my profession. Supporting athletes like Louis through preventive care, digital health monitoring, injury prevention, and custom sports guard fabrication is simply one extension of that journey.

Louis is now 19. We look forward to continuing to care for him for two more years before we graduate him to a general practice. At that time, we will have a complete file of accurate digital records that can serve as a basis for his oral health for years to come. I’m closely following his athletic becoming and we are all cheering him on.

Schedule your child’s first dental visit today! Contact us here.

For the last several years, I have been exploring how to thoughtfully adapt leading-edge technologies, many of which has significantly reshaped adult dentistry, into solutions that are translatable to growing mouths and ever-evolving dentitions. My driving force has been a deep belief that children deserve the same level of innovative and personalized care that we expect for ourselves as adults.

The Pediatric Dental Experience: Why Digital Care Matters for Kids

 

The dental experience truly lies at the heart of pediatric dentistry. When we care for children, we are actively shaping their perspectives and ultimately influencing their lifelong beliefs about dental care.

Throughout my career in pediatric dentistry, I have continuously reflected on how we can create experiences that feel more comfortable, more compassionate, and more joyfully memorable for children and families. Technology has increasingly become a valuable tool in helping us move toward that goal.

 

Digital workflows now allow us to visualize more clearly, reduce chair time in many situations, improve communication with families, and create increasingly customized solutions for growing smiles. For children especially, these advancements can transform not only the treatment itself, but also the emotional experience surrounding it.

What Does the Word “Workflow” Mean?

A workflow is a step-by-step, repeatable process designed to create consistent and favorable outcomes. In many ways, it is similar to following a recipe when cooking or baking.

Dentistry itself is highly systematic in nature and depends on carefully organized clinical processes that dental teams train on and follow closely each day to help ensure safety, precision, and quality care.

Digital workflows are the sequence of steps used to create a digitally designed dental solution using a CAD/CAM approach. CAD stands for Computer-Aided Design, while CAM stands for Computer-Aided Manufacturing. Together, these systems allow clinicians to digitally design and then physically manufacture restorations through either milling or 3D printing technologies.

The Digital Lab

Because we manage the CAD/CAM process from A to Z at Smiles, we are able to create highly customized dental solutions in-house within our digital lab.

Our manufacturing process is designed to be clean, organized, and OSHA-driven. Using digital data captured through intraoral scanners means that the entire design process occurs virtually. Fabrication follows a similarly controlled workflow, with restorations being printed, washed, post-processed, and carefully evaluated before anything is ever tried in or delivered clinically to a child or teenager.

What Can Be Printed?

The possibilities within dental 3D printing are vast and continue to expand rapidly. Today, digital workflows can be used to fabricate dental models, retainers, night guards, sports guards, and various forms of crowns and veneers.

At Smiles, I have also been carefully exploring and validating several pediatric innovations of my own, including:

• PrintiSmile — a growth-friendly esthetic smile solution designed for toddlers and young children
• Smile Keeper — an esthetic space maintainer concept
• Smile Forward — a fully customized orthodontic protraction headgear workflow

Each of these concepts has been developed with the same guiding philosophy in mind: creating more comfortable, thoughtful, minimally invasive, and emotionally supportive experiences for growing children and teenagers.

Keeping Dentistry Fun

One of the main reasons we keep our printers visible within our bay area is because they are wonderful conversation starters and give us the opportunity to share what we do at Smiles with children and families. Kids are completely fascinated by the 3D printing process, and we absolutely love explaining it to them!

We also enjoy printing custom toys and prizes for our visitors (special requests can even be placed in advance ). What better way to engage children in modern pediatric dentistry than by allowing them to see innovation come to life right before their eyes?

Schedule your child’s first dental visit today! Contact us here.

A Thoughtful Beginning

Mariana’s maxillary incisors presented with enamel hypoplasia, with areas of missing enamel that affected both appearance and light reflection. Early on, I restored her teeth using glass ionomer and composite, creating a solution that was appropriate for her stage of growth and development.

As Mariana grew, and especially after starting orthodontic aligner therapy, her smile began to evolve. With improved tooth positioning came an opportunity to revisit her original goal and refine her smile in a more comprehensive and lasting way.

Understanding the Foundation: Biology First

Before moving into esthetic enhancement, we carefully evaluated the gingival architecture.

Using a combination of intraoral scanning with the DEXIS IOS and clinical bone sounding, I assessed the position of Mariana’s CEJ and the available keratinized gingiva. This allowed us to determine how much soft tissue could be safely adjusted to enhance tooth display while preserving biological width.

A conservative laser gingival recontouring was performed with our Solea laser to expose the incisors to their full potential, creating a balanced and harmonious foundation for the next phase of treatment.

Before laser gum recontouring

Immediately after laser gum recontouring

Designing Before Doing

With the tissue architecture optimized, we transitioned into digital smile design using Exocad Software.

 

We designed a proposed smile and translated that into a physical mock-up that Mariana could try in her own mouth. This step is invaluable. It allows patients to experience their future smile before any definitive treatment is performed.

Tooth Dress-Up: A Collaborative Process

During the mock-up phase, we turned the experience into something interactive and fun.

We progressively modified the trial smile, allowing Mariana and her mother to visualize different options:

• Six veneers
• Then four
• Then two

At each stage, we paused, observed, and took photographs. This allowed them to fully understand how each option would look and feel.

Ultimately, Mariana chose to move forward with six maxillary anterior veneers, with a very clear preference: she wanted them to feel natural and not bulky.

Six trial veneers

Four Trial veneers

Two trial veneers

A Truly Conservative Approach

Respecting her wishes and prioritizing tooth preservation, we designed no-preparation veneers, meaning no removal of natural tooth structure was required.

The restorations were carefully thinned to achieve a delicate, natural appearance. Final refinements and polishing were completed by hand to ensure a soft, lifelike finish.

 

A Smile That Feels Like Her

Mariana and her family loved the result. More importantly, the smile felt like hers—enhanced, not altered.

This case reflects what is possible when we combine:

• Respect for biology
• Digital precision
• Conservative restorative principles
• And true collaboration with teen and family

 

In the end, this is what modern teen dentistry is about. Not just creating beautiful smiles, but doing so in a way that honors growth, preserves structure, and empowers the patient every step of the way.

Final smile

2018 and 2026

Schedule your child’s first dental visit today! Contact us here.

Jedi, 2008 and 2026

How Do Pediatric Dentists Care for a Child’s Smile?

In communities like ours in West Los Angeles, parents are deeply engaged in their children’s health and education. They want to understand their options and to be part of the decision-making process. I value this partnership deeply, because the best treatment plans are developed when healthcare providers and families work together with a shared understanding of a child’s needs and goals.

As an educator at the University of Southern California (USC) and a fellow of the American Acadmy of Pediatric Dentistry (AAPD), my conversations with parents and my clinical practices are rooted in what we call evidence-based care, a concept advanced by physician David Sackett. He explained it as the integration of scientific evidence, clinical expertise, and the values of the patient and family. This last pilar that Dr. Sackett described is the most important one because every family has its uniqe structure, needs and desires. These values play a major part in decisions making and treatment planning.

 

A New Way to Visualize Growing Smiles

At the same time, dentistry continues to evolve. New technologies such as digital scanning, 3D visualization, and digital design are giving clinicians new ways to study developing smiles with remarkable clarity. However, although these technologies are becoming mainstream in general dentistry, they have yet to truly change pediatric dental care.

As a true advocate for child wellbeing, I am passionate about introducing new technologies to our profession in ways that honor kids and make their dental visits smoother and easier. I also believe in the increased educational value that these technologies can offer our families. When parents, and kids, can understand what we are seeing, they can better relate to the findings and make clearer decisions on how they would like to move through any needed care. Communication builds trust and improves the whole family’s overall experience.

How Do Healthcare Practitioners Adopt New Technologies?

The sociologist Everett Rogers described how innovations are adopted by practitioners over time. Not every clinician will jump on board from the start. New ideas begin with early adopters and, as evidence grows, become part of everyday care.

• Innovators – a small group of clinicians who explore new technologies early and carefully
• Early adopters – experienced providers who begin using these approaches thoughtfully in practice
• Early majority – a larger group that adopts the technology as evidence and experience grow
• Late majority – clinicians who adopt once the approach becomes widely accepted and well-established
• Laggards – those who prefer to wait until a method has been used successfully for many years

This gradual process helps ensure that new technologies are studied, refined, and used responsibly before becoming part of routine care. Digital dentistry is currently moving through these stages, as clinicians continue to learn, evaluate, and integrate these tools in ways that best serve their patients.

Whole-Child Health

If I were to describe the philosophy of our practice, Smiles Pediatric Dentistry & Orthodontics, the first thing that comes to mind is our ture belief in wellness as a birthright. Our goal as healthcare professionals needs to be focused on the belief of wellness rather than illness. Health researchers describe this perspective as the idea of “Salutogenesis”, a model of care focused on supporting health, resilience, and wellbeing described by medical sociologist, Aaron Antonovsky in the late seventies. The word comes from Latin:

• “salus” = health
• “genesis” = origin

This translates to: “The origin of health” or “How health is created.”

In pediatric dentistry, this means looking beyond the teeth and caring for the whole child, recognizing that oral wellness is and essential part of total body wellbeing. A successful outcome is not just a restored tooth, but a child who feels comfortable in the dental setting and grows into an adult that values their oral health.

Where Innovation Meets Evidence, And Evidence Meets Patient care

Every major advancement in dentistry begins as an innovation. Today, digital dentistry is part of that same continuum. Innovation initiates progress, and evidence follows. Within this evolution, and in alignment with Dr. Sackett’s evidence-based model, we must create space for patient and family values.

Clinical data, no matter how robust, must be interpreted within the context of the individual. Decisions about one’s body ultimately belong to the patient—or to their parents, in the case of children. Over time, research helps refine how and when innovations are best applied, guiding us toward more thoughtful and effective care.

Technology, when used with intention, should support the principles of salutogenesis—promoting comfort, reducing stress, and fostering a sense of wellbeing during the dental experience. Because in the end, it is never just about the technology. It is about the child.

The Goal Has Always Been the Same

Despite all advances, the goal remains the same: gentle, thoughtful care that supports both the health and confidence of every child and teen that we are priviliaged to care for.

Goals for every child and teen visiting Smiles:

– comfort and emotional experience
– long-term oral health
– supported growth and development
– family involvement in care

When innovation, evidence-based care, and whole-child health come together, they create meaningful, lasting outcomes in addition to changing the future dental outlook for an entire population.

Give your child a comfortable, positive dental experience with care designed around their growth, health, and confidence at Smiles Pediatric Dentistry & Orthodontics.

Contact us today to schedule your child’s visit.

Knowledge Welcomes Confidence and Empowerment

As a pediatric dentist, I have received many calls from frantic parents whose children have bumped their teeth at home, at school, or while playing sport. My heart goes out to the parents of toddlers who turn their heads for a split second only to hear a loud thud followed by explosive cries. I think of parents receiving a call from school informing them that their child has had an accident on the playground. And of course, the young athletes in the middle of a game who get hit by balls, elbows, or even feet.

The purpose of writing this is primarily to reassure parents that they are doing their best. As much as we love and protect our children, they will experience their own journeys. Our role is to remain informed, supportive, and calm and to trust in modern, evidence-based dental care when it is needed most.

My hope is that this blog serves as a quick, practical reference for what to do during a dental trauma emergency: how to respond, how to comfort your child, and how to understand the appropriate timeframe for management based on decades of scientific research that have shaped today’s state-of-the-art pediatric dentistry.

Most importantly, I hope it offers reassurance in that our children are resilient, and with, gentle and attentive care, they can return to oral health and well-being.

How To Manage Dental Injuries 

In moments of trauma, parents are suddenly confronted with uncertainty. They are not only trying to comfort their child but are also searching for answers. The good news is that there are a few key actions that significantly improve outcomes. These steps are simple, easy to remember, and can be implemented immediately.

Emergency calls to our office at Smiles Pediatric Dentistry & Orthodontics are always given priority. These calls are essential in guiding parents in real time. Immediate communication allows us to assess the situation, determine the urgency, and provide clear next steps.

Teledentistry has become an especially valuable tool in these circumstances. Virtual assessment allows us to evaluate kids quickly wherever they are, guide first-line management, and coordinate appropriate follow-up care. Just as importantly, it offers reassurance at a time of uncertainty. Parents and children benefit from knowing they are supported with presence, knowledge, and compassion.

Many dental trauma incidents can be managed outside of the emergency room. When a call comes in, one of the first decisions we review is whether medical evaluation is necessary. If we determine that the injury was purely dental in nature, we efficiently shift gear into the prompt management of the trauma to help ensure the most positive outcome.

If there is concern for head injury, loss of consciousness, nausea, dizziness, or significant soft tissue trauma, medical care must come first because every child’s overall well-being always takes priority. When children do present to the emergency room, medical triage appropriately takes priority. Soft tissue injuries may require suturing. Imaging and neurological evaluation take time. These essential steps can inadvertently delay time-sensitive dental intervention. However, early dental triage, even if coordinated alongside medical care, is both possible and beneficial.

The Evidence Behind Modern Dental Trauma Care

All of us in the pediatric dental profession hold a special place in our hearts for the father of modern dental traumatology, Dr. Jens Andreasen. His evidence-based work, spanning more than six decades, has not only stood the test of time but continues to serve as the foundation for how we diagnose, triage, and manage dental trauma today.

As a child who personally experienced dental trauma, Dr. Andreasen new firsthand what a child goes through when they deal with a dental injury. He dedicated his career to understanding what happens to injured teeth, and more importantly, how to save them. His research taught us something powerful: when teeth are handled properly and treated quickly, they can often be preserved. He helped establish the timeframes that matter, the safest ways to stabilize injured teeth, and why careful follow-up is essential to ensure long-term healing. Much of what we know today about managing knocked-out, displaced, or fractured teeth comes directly from his life’s work.

The International Association of Dental Traumatology (IADT) guidelines are grounded in this body of evidence and have been adopted by the American Academy of Pediatric Dentistry (AAPD). When these principles are followed, outcomes improve significantly.

Primary vs Permanent Tooth Injuries: Why Management Differs

Another important distinction we make during every trauma call is the age of the child and whether the injured tooth is primary (baby) or permanent. This information is important because it not only helps guide parents and children through the experience in an age-appropriate way, but it also directly influences how the injury is managed. Treatment decisions differ significantly depending on whether the affected tooth is primary or permanent.

Clinical management must consider anatomy, stage of root development, and long-term prognosis. It is important to understand that certain interventions that are necessary for permanent teeth may not be appropriate for primary teeth. Protecting the developing permanent tooth is always a priority when managing trauma to primary teeth.

Types of Dental Injuries:

Dental trauma can present in diverse ways, depending on how the tooth is injured:

• Enamel fractures – minimal crown fractures involving only the outer white layer of the tooth.
• Enamel-dentin fractures – moderate crown fractures that extend deeper into the tooth structure but do not expose the nerve.
• Complicated crown fractures – fractures that involve pulp (nerve) exposure and often require more urgent intervention.
• Crown-root fractures – fractures that extend below the gumline, often at an angle, and may affect both the visible portion of the tooth and the root.
• Luxation injuries – injuries in which a tooth is displaced from its normal position in varying degrees or directions. These include concussion (tender but not loose), subluxation (loose but not displaced), extrusion (partially pulled out), lateral luxation (pushed sideways), and intrusion (pushed deeper into the socket).
• Avulsion – a tooth that has been completely knocked out of the mouth.

 

How Are Dental Injuries Managed?

Accurate diagnosis requires careful clinical examination and dental imaging (x-rays) assessment. Once all the information has been gathered, a thoughtful, evidence-based, and age-appropriate plan is followed.

Treatment decisions are guided by:

-The age of the child

-Stage of root development (a brand-new tooth vs one that has been in the mouth for years)
-Presence or absence of pulp (nerve) exposure
-Degree of mobility or displacement
-Dental imaging findings

 

What To Expect for Management of Dental Injuries

Injury Type	Primary Tooth Management	Permanent Tooth Management
Crown fracture (chipped tooth)	Sharp edges are smoothed or the tooth is restored as needed. Pulp (nerve) vitality is monitored over time.	If the fragment is available, it may be reattached. Otherwise restored with bonding. Pulp (nerve) vitality is monitored.
Complicated crown fracture (pulp exposure)	Pulp therapy may be indicated depending on stage of development. Extraction may be considered if prognosis is poor.	Vital pulp therapy preferred in immature teeth. Root canal therapy may be indicated in mature teeth.
Crown-root fracture	Tooth assessed for restorability. Extraction may be required depending on fracture extent.	Requires stabilization and possible root canal or periodontal management depending on fracture depth.
Luxation injury (displaced tooth)	Often managed conservatively. Monitored closely for healing and impact on permanent successor.	Repositioning often indicated. Flexible splinting per IADT guidelines. Long-term pulp (nerve) monitoring is essential.
Avulsion (knocked-out tooth)	Avulsed primary teeth are not replanted. Space management or restorative options may be discussed.	Time-sensitive emergency. Tooth should be replanted immediately when possible. Stabilization required. Root canal therapy often necessary.

 

What Parents Should Do Immediately After Dental Trauma

For any dental injury, try to stay as calm as you can. Comfort and reassure your child, then contact your pediatric dentist as soon as possible. Even injuries that appear minor should be evaluated to ensure proper healing and to prevent long-term complications.

Quick Guide Steps:

1. Gently clean your child’s lips and gums with a clean gauze or cloth.
2. Locate any fractured fragment and store it in water or saline.
3. If a permanent tooth is knocked out, handle it only by the crown, never the root. Try to gently reposition it into the socket and seek immediate care.

5. If you are unable to reposition the tooth, placing it in a “save-a-tooth” kit https://www.saveatooth.com/ or in milk is the next best option.
6. If a primary tooth is knocked out, keep it for dental evaluation but do not attempt to replant it. Primary teeth are not replanted to avoid damage to the underlying developing permanent tooth.
   7. Contact your dentist promptly for evaluation.

What Parents Should Do: Immediate first steps you can take before professional evaluation

Injury Type	What Parents Should Do – Primary (Baby) Tooth	What Parents Should Do – Permanent Tooth
Crown fracture (chipped tooth)	Look for the fragment to bring to your dentist. Store it in water or saline.	Look for the fragment. Store it in water or saline (not milk).
Complicated crown fracture (pulp exposure)	Avoid biting into foods. Avoid hot or cold foods and touching the injured area. If a fragment is present, store it in water or saline.	Avoid biting into foods. Save the fragment in water or saline if available.
Crown-root fracture	Do not manipulate the tooth. Keep your child comfortable. If a fragment is present, store it in water or saline.	Do not manipulate the tooth. Avoid biting on it. If a fragment is present, store it in water or saline.
Luxation injury (displaced tooth)	Do not attempt to reposition at home. Offer soft foods only.	Do not force the tooth back unless instructed. Avoid biting on it.
Avulsion (knocked-out tooth)	Do not replant. Apply gentle pressure with gauze if bleeding. Bring the tooth with you for evaluation.	Pick up the tooth by the crown only. If dirty, gently rinse with milk or saline (do not scrub). Replant immediately if possible or store in milk. Seek care within 60 minutes.

 

The Importance of Follow-Up

Dental trauma management extends beyond the initial treatment. Follow-up evaluations are needed to assess the vitality of the tooth and the continued root integrity. Standard intervals often include assessments at 6–8 weeks, 6 months, and 1 year, with extended monitoring when indicated.

Prevention: The Best Treatment Is Protection

While modern dentistry allows us to manage trauma conservatively and effectively, prevention remains the most powerful intervention.

Recent collaboration between the International Association of Dental Traumatology (IADT) and the American Society of Dentistry (ASD) reflects a shared emphasis on prevention as an integral component of trauma care. This alignment highlights the importance of evidence-based protective strategies for children and adolescents engaged in athletics. With more kids involved in athletics, especially with major athletic events approaching in Los Angeles, protective measures must evolve alongside clinical innovation.

As an active member of the ASD, I remain very focused on streamlined fabrication of sports mouthguards, exploring advancements in digital workflows, material science, and precision 3D fabrication. Custom 3D printed sports guards provide superior fit, comfort, and protection compared to stock alternatives. Studies have proven that when properly fabricated and worn consistently, they significantly reduce the incidence and severity of dental injuries.

When Replacement Is Needed: Innovative Pediatric Solutions:

While prevention remains the most powerful strategy, some injuries result in tooth loss or structural damage that requires restorative intervention.

For very young patients, esthetic options for lost primary incisors were historically limited. In many cases, families were told to simply wait for the permanent teeth to erupt. Today, digital dentistry allows us to offer thoughtful alternatives.

In our practice, we utilize digital workflows to fabricate conservative, esthetic solutions for young patients — including PrintiSmile, a custom-designed 3D printed pediatric anterior restoration.

Unlike traditional removable appliances or aggressive preparations, PrintiSmile allows for:

• Precise digital design
• Minimal intervention
• Age-appropriate esthetics
• Efficient chairside delivery

For children navigating early childhood social development, restoring the appearance of a front tooth can support confidence, speech development, and overall well-being. Digital pediatric dentistry allows us to restore both biology and self-confidence.

Clinical Case: Uncomplicated Crown Fracture in a Teen Athlete

When life presents unexpected challenges, thoughtful care can turn a stressful moment into a positive outcome.

A teen athlete presented with an uncomplicated crown fracture of a maxillary central incisor following trauma. Because he was undergoing Invisalign therapy at the time of injury, his aligner tray was utilized as a precision positioning guide during fragment reattachment.

This allowed accurate adaptation of the rebonded fragment while preserving natural anatomy. The result achieved excellent esthetics with minimal intervention, demonstrating the value of prompt evaluation and conservative treatment planning.

If your child has experienced a chipped, displaced, or knocked-out tooth, contact Smiles Pediatric Dentistry & Orthodontics for expert pediatric dental trauma care. Our team provides treatment to protect your child’s smile and help prevent long-term complications.

Contact us to schedule an appointment or book a consultation through our website.

Frequently Asked Questions About Pediatric Dental Trauma

What should I do if my child knocks out a permanent tooth?

Pick up the tooth by the crown only. Reinsert the tooth immediately into its socket, if possible, or store in milk and seek care within 60 minutes.

Should I replant a baby tooth that was knocked out?

No. Primary teeth should not be replanted due to risk to the developing permanent tooth.

Can a chipped tooth fragment be rebonded?

Yes. If preserved properly in water or saline, many permanent tooth fragments can be successfully rebonded.

How long can a tooth stay out of the mouth?

Prognosis declines significantly after 60 minutes of dry time. Immediate action improves survival.

Does my child need a mouthguard for sports?

Yes. Custom sports mouthguards significantly reduce the incidence and severity of dental injuries.

References

Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth.
International Association of Dental Traumatology (IADT) Guidelines for the Management of Traumatic Dental Injuries.
American Society of Dentistry (ASD) Collaborative Guidance on Trauma Prevention and Protective Fabrication.

How comfort, education, and emotional intelligence shape lifelong dental health

Dentistry for children is far more than a technical procedure. It is a whole-body experience that integrates physical sensation, emotion, memory, and trust. For me, it becomes part of each child’s health story, and I aim wholeheartedly to make that story as easy, joyful, and empowering as possible. This mindset naturally leads to a pursuit of anything that can soften the dental experience and mindfully usher it forward.

In this blog, I set out to write about local anesthesia, often considered the “magic wand” of modern dentistry. Yet as I began writing, I realized that while I am deeply grateful for the technologies we seamlessly integrate at Smiles Pediatric Dentistry & Orthodontics, local anesthesia has never been the centerpiece of care in my practice. Rather, it is one of many tools used thoughtfully to support wellness, safety, and long-term health. I also wanted to express appreciation for the health leaders who paved the way for humane procedures, not only through scientific discovery, but through philosophy.

The First Breakthrough: Cocaine and Local Anesthesia

In 1884, Carl Koller, an ophthalmologist, demonstrated that cocaine could block nerve sensation when applied locally. Although his work focused on eye surgery, the implications were immediate and profound. Dentistry quickly recognized the potential. For the first time, pain could be controlled locally without rendering the patient unconscious. This discovery marked the beginning of modern, humane dentistry. However, cocaine’s toxicity and addictive potential made it unsuitable for widespread, long-term use.

The True Foundation of Modern Dental Anesthesia: Procaine (Novocaine)

In 1905, Alfred Einhorn synthesized procaine, later marketed as Novocaine. This moment is arguably the true birth of modern dental anesthesia.

Procaine was significantly safer, non-addictive, predictable, and effective for dental procedures.

Novocaine allowed dentistry to move out of an era of endurance and into an era of intentional comfort. For the first time, pain control could be integrated thoughtfully into routine dental care, including care for children.

An Important Perspective: Anesthesia as a Tool, not a Philosophy

Even as local anesthesia transformed dentistry, early pediatric dental pioneers such as Dr. Evangeline Jordan emphasized something essential: pain control alone does not create gentle care. She focused on prevention, education, emotional safety, and trust. She understood that a child’s experience of dentistry is shaped not only by sensation, but by meaning and by what follows afterward. This distinction remains essential today.

Why This History Matters Today

Local anesthesia is one of the greatest gifts to dentistry. It allowed care to become humane, precise, and ethical. But it was never meant to replace communication, education, emotional intelligence, or respect for a child’s nervous system.

Why Local Anesthesia Can Be Challenging for Children

Although local anesthesia is safe and effective, it can introduce challenges for pediatric patients, including anticipatory anxiety, fear of numbness, prolonged post-operative sensations, and lip or cheek biting injuries following lower-arch procedures. When poorly timed or insufficiently supported, these experiences can shape a child’s perception of dentistry for life.

A Philosophical Alignment with Dr. Evangeline Jordan

I agree deeply with Dr. Jordan’s philosophy and find that it continues to resonate with today’s approach to child oral care, as well as with current best practices outlined by the American Academy of Pediatric Dentistry (AAPD).

 

Local anesthesia is a wonderful and indispensable tool, but we would all still prefer complete health over a disease process that requires intervention, no matter how gentle that intervention may be. Dr. Jordan did not promote aggressive procedural completion, nor did she center anesthesia as the foundation of care. Our primary goal must be health preservation, practicing the concept of salutogenesis, coined by sociologist Aaron Antonovsky. Rather than asking “What causes illness?” salutogenesis asks, “What creates health?”

Education as Care: Empowering the Child 

As pediatric dentists, we are stewards of oral health education and empowerment. This role may be even more important than treating dental disease, because it promotes the end of the cycle of unwellness. When children understand why something is needed in an age-appropriate way, are encouraged to notice how their bodies feel, and are invited to communicate their needs, this fosters emotional intelligence — something the age of artificial intelligence can never replace.

Education and communication must also extend to parents before care even begins. Well-intending parents may unintentionally add an emotional layer by asking, “Does it hurt?” or saying, “I know this is uncomfortable.” These statements can weave a parent’s own dental experiences into their child’s perception of the visit.

I’ve learned to speak with parents thoughtfully before rendering any treatment. While my team engages the child with prizes, movies, and conversation, I take time to explain what is needed, what options exist, what reactions they might notice, and how care can be delivered successfully. I also clarify what I can reasonably accomplish, when we might pause, and when a different modality, including further sedation options, may be more appropriate.

After many years in pediatric dentistry, I have learned this essential truth: when we unite with parents around the goal of loving a child and giving them the best experience possible, everything flows more naturally.

Once parents are comfortable, my true client — the child — can be informed gently and age-appropriately about what to expect, how to communicate their needs, and how to participate in their own care. Above all, they receive a generous sprinkling of honoring and love to ensure safety and trust.

The Evolution of Gentle Anesthesia Delivery

STA Single Tooth Anethesia System

Soan Electronic Dental Anesthesia Device

Since opening in 2008, Smiles Pediatric Dentistry & Orthodontics has used computerized anesthesia delivery systems to improve comfort. Early adoption of single-tooth anesthesia technology allowed us to deliver controlled, gentle, and ultra-localized anesthetic. Today, the SOAN unit continues this evolution with enhanced precision, ergonomics, and thoughtful design. These devices not only feel better, but they also look better and often appear non-threatening to children.

The Role of Exceptional Topical Anesthesia

Topical anesthesia is often underestimated. When applied correctly with time, isolation, and intention, it can significantly reduce discomfort and support minor procedures, sometimes reducing the need for injectable solutions. While topical, these gels must still be respected in terms of dosage and application. I truly find them indispensable and make a point to apply them personally, rather than delegate their application to team members.

I like to place the topical exactly where I want it to work and am very careful to avoid it spreading in the child’s mouth. I do this by covering the area with a slightly moistened gauze. This allows the gel to work effectively and remain localized, since tasting topical anesthetic does not create the pleasant experience we aim to provide.

 

Moistening the gauze allows for gentle removal and helps prevent it from adhering to the delicate oral mucosa. Topical anesthesia is especially wonderful for removing exfoliating primary teeth with utter ease and delight for children, and it is often one of the most rewarding requests our young clients make, because it ensures a visit from the tooth fairy.

 

The Solea Laser and the Anesthesia-Free Option

Solea laser technology has allowed many dental treatments to be performed without needles, numbness, or drills. The pulsing of the laser acts on the pain-gate mechanism, dramatically reducing uncomfortable sensations. That said, comfort requires thoughtful planning, not simply the goal of avoiding anesthesia. Compassion and communication remain the cornerstones of a comfortable dental visit.

Sedation as Part of a Thoughtful Spectrum 

True customization includes sedation options, when appropriate. These range from nitrous oxide and oxygen to oral sedation and deep (intravenous) sedation or general anesthesia for complex cases. The goal is not avoidance of anesthesia or sedation, but the right support at the right time for the right child.

The Stewardship Responsibility 

Pediatric dentists are stewards of how children perceive healthcare for life. A single overwhelming experience can leave a lasting imprint. Our responsibility extends beyond completing treatment to protecting trust, confidence, and emotional well-being. Gentle dentistry is about doing what is right — thoughtfully, compassionately, and through a wellness-centered lens. By integrating education, emotional intelligence, modern technology, individualized anesthesia planning, and when appropriate, sedation, we support not only oral health, but lifelong well-being.

“When to Nudge Mother Nature” as a Pediatric Dentist

As an early oral healthcare provider, I ask myself with every family encounter if I offered  guidance and value, whether I over- or under-recommended pediatric dental and early orthodontic care, and if the family fully understood my recommendations or if I could do more to allow the conversation to fully resonate. This inner dialogue stems from a deep desire to do good and to honor the oath and responsibility of health caregiving. After years of practicing, I have wisely come to realize that compassionate care is far from a one-size-fits-all model. It is beyond individualized care. It is an in-depth, on-going and ever-evolving conversation that is constantly remodeling based on new parameters, growth trajectories and general family life. In simple terms, it is a day-by-day adventure.

Do we have to do anything?

No parent wants to put their child through unnecessary procedures. Operative and restorative medical and dental treatments are a considerable experience to undergo for a family. As wise stewards of the trajectory of each child’s lifetime dental experiences, we, pediatric dentists have much to consider.

Since pediatric dentistry is truly about health, then the next evolution isn’t simply better tools. It is earlier presence, gentler guidance, and a shift from fixing problems to organizing development. The tenant of “do no harm” is really at the core of this matter. There are times when this translates to “let well enough be”. Other times, it means “clear the path now to allow the easier path to unfold”

Whole-Body Pediatric Dental Health

I recently had the honor of taking on the role of Chapter 2 liaison for The American Academy of Pediatrics (AAP) at the California Society of Pediatric Dentistry (CSPD). This role called to me because it bridges the professions of pediatric dentistry and pediatric medicine, and studies ways to enhance collaborations. As an educator at Herman Ostrow School of Dentistry of USC, conversations with residents often delve into the concept of whole-body health and how we can hold hands with our medical colleagues to provide a comprehensive approach to general wellness. In my mind (and heart), the compass constantly points to small, micro changes at earlier timelines. Guiding new parents on infant oral health is at the core of this dialogue.

When pediatric dental care begins

When I welcomed my first born, my beautiful daughter, Isabel Ida Haddad, I entered into motherhood as a right of passage. It was as if the whole reason for my being was suddenly beautifully validated. I found a calm and nurturing space at UCLA’s Birth Place. with a warm group of new mothers coming together to learn about breastfeeding and infant care. I was treading gently on these new grounds but felt that new mothers like me, were often overwhelmed with information and instructions. All of us were fully committed, but many desperately needed support systems. When the group heard of my profession, they began asking questions about infant oral care and were most appreciative for the information that I was able to provide. Through this group, I not only gained new families at Smiles, I realized that new parents are receptive to oral care information early on and enriched my life with life-long connections that I truly cherish.

The Opportunities Pediatric Dentists Don’t Talk About Enough

New parents are full of questions:

• When should I start caring for my baby’s mouth?
• Is teething problematic or normal?
• What happens if my toddler falls and hits a tooth?
• When do habits become harmful?
• When do we actually need to see a dentist?

Too often, there is no clear entry point for these questions. Families are left to Google, social media, or wait until something feels “wrong enough.” By the time they arrive at a dental office, dentistry becomes reactive instead of nurturing or preventative.

From “Risk-assessment/management” to “Path clearing”

I prefer to practice dentistry from a lens of health rather than risk predictions. I value being a mindful observer of health and of the dental development process. Like carefully tending a growing garden, there are times that we need to prune, trim and replant to allow for true balance and beauty to manifest. In these instances, I see myself as a path clearer and someone who helps growing systems find their way back to natural harmony, when development veers off course.

The specialties of pediatric dentistry and early orthodontics need not alarm families into action, nor impose recommendations as dogma. We need to be storytellers of development. Furthermore, we need to be mindful that the story of growth is ever evolving. Our profession needs to support biology, compassion, and trust.

Honoring human biology

Life’s pace is rapidly excellerating. We can certainly all resonate with how fast everything is moving in our day-to-day lives. Everything is expected sooner and demands more efficiency. To hold thoughtfulness is a skill that requires fostering in today’s world. Like physical activity, the mind needs daily training to slow down and take in the moment. The undeniable advances in AI and its projected path in the next few years, cannot be overlooked. We can, indeed, find solutions with a click of a button, yet we must remember that we still remain biologically human. This is a tender time for humanity. Finding the balance between what we want our bodies to do and what they are biologically capable of, all while maintinaing a positive and healthy state of mind requires pause, gentleness, and wisdom.

 

The future paths coincide

Imagine a world where families receive:

• Collaborative, “whole-istic” anticipatory guidance in the first year of life
• Simple at-home testing kits that help customize the fostering of well-being
• Coaching on habits, feeding, eruption, and oral hygiene
• Matching with caring providers (both pediatric medical and pediatric dental doctors)
• Virtual (human and AI-empowered) points of service
• Reassurance after a fall or dental trauma
• Facilitation when in-person care is needed

Home-based, virtual care matters

In 2019, we reshaped our lives due to the global pandemic. One of the most challenging experiences of modern times also brought forward new ways of living, communication, expectation and innovation. Because people couldn’t meet in person, new ways of connecting quickly began emerging. Many of these modalities quickly became mainstream as meetings moved to online platforms and telemedicine surged.

At Smiles, we started with asking families to text/email photos of their children’s mouths and then moved to teledentistry communications. I personally found this type of communication to be so helpful in triaging emergencies and guiding parents on how to handle bumps, falls and incidental dental occurrences. At the same time, this new era of dental communications needed to be organized, structured and validated in terms of transparency, legality and expectations in order to honor both providers and receivers. Once, this structuring formed a solid foundation, the true power of virtual communications began to really shine.

 

Where pediatric virtual care shines

A virtual conversation in the convenience of a family’s home has the potential to become:

• A first touchpoint for infant oral health
• A trusted guide for new parents
• A calm, accessible place for questions before concern escalates
• A reassuring “baby step” to the first dental visit, which helps set expectations
• A beautiful bridge between home and in-office care, not a replacement for it

Los Angeles is a vast metropolis with much to offer, but supportive, in-persons communities may not be readily accessible to everyone. For example: Mothers recuperating from post-partum challenges may not be able to participate in such meetings. In such instances, a virtual offering is not only supportive, but also essential. An encounter like this promotes health, compassion nurturing, and whole-body care before any treatment even comes into question.

What about early orthodontics?

Every day at Smiles, we get to see firsthand how collaborative pediatric dental care and early orthodontic guidance change lives. Our collaborative approach is based on integrating both specialties into combined, comprehensive, and time-saving visits.

• Early arch development reduces later complexity
• Early education builds lifelong trust
• Early intervention can be gentle, not invasive
• Yes, kids with loose baby teeth can start care. In fact, it is a good time to start orthodontics because one of the main goals of early care is to facilitate the eruption of all permanent teeth.

Pediatric dentistry should function as an ecosystem

• Virtual guidance
• Home-based education
• In-office excellence
• Biological respect
• Family-centered decision-making

If we are to promote oral health, we need to plan on arriving earlier and supporting families where they live. We need to focus on guiding development rather than reacting to breakdown. And we need to shift from thinking that we are here to fix dental problems to believing that we are here to support nature, organize growth and clear paths. The tools are already here. It is up to us to use them with intention.