Up to what age are they accepted in pediatric dentistry. Dentistry of childhood: important points. But sometimes parents get rejected literally at the threshold of the dental office, and this fact may be due to several reasons.

When visiting doctors of pediatric practice, the presence of parents or a legal representative is mandatory. After examining the child, the doctor will ask a series of questions, talk about the diagnosis, recommended treatment and preventive measures. But the doctor can sometimes ask adults to leave the office, or even refuse to treat the baby in their presence.

When is a dentist's action justified and when is it not?

Getting to know the dentist

Parents should go to the dentist's office with their children, regardless of their age. The only exception is when the child is over 15 years old.

Children and adolescents under 18 years of age are considered patients of the pediatric dentistry department.

The need for the presence of the mother is justified by several aspects.

Before starting treatment, the dentist will ask a series of standard questions:

• Allergy to medicinal substances and other negative reactions when taking them. Whether symptoms of a food or seasonal allergy appeared.
• The state of health of the child: the presence of chronic diseases of internal organs. It is known about the relationship between diseases of the internal organs and the state of the oral cavity, which is especially pronounced in diseases of the digestive tract.
• How did pregnancy and childbirth go? Complications of pregnancy, past illnesses, prescribed medications, nutritional errors affect the health of the baby's teeth and gums.
• type of feeding. Children who receive artificial feeding are at risk for the formation of caries and other diseases of the maxillofacial region in general.
• Timing of teething.

An analysis of the answers to these questions allows you to get a complete picture of the dental status of children. They are also used to draw up a treatment plan and preventive measures.

In addition, children are not always able to describe the symptoms that bother them due to embarrassment, fear, mental and physical development, and even age.

Therefore, it is the parents - or legal representative - who tell the dentist about the disturbing symptoms, help the baby answer the questions:

1. Disturbing complaints: when they appeared, what preceded them. If we are talking about the occurrence of pain, the duration of its existence, what measures were used to stop it.
2. Fever, accompanying symptoms.

Depending on the proposed diagnosis, the doctor asks a number of leading questions, the answers to which will depend on the further course of research and treatment.

If a child says that the toothache has passed on the threshold of the dental office, there is no reason for joy. This does not mean that the disease went away on its own, but only that it turned into complications.

After collecting an anamnesis and complaints, the stage of direct examination follows, in which the presence of the mother is also mandatory.

During this process, the on-site doctor indicates problems in the oral cavity:

• : it is known that about 40% of patients are not even aware of the presence of problems and the need for orthodontic treatment.
• Frenulums of the oral cavity: there are three of them, and their shortening, which requires surgical assistance, can provoke the development of various pathologies, including bite.
• Caries, the presence of its complications.
• Mucosal changes.
• The level of hygiene skills.

In the future, the dentist draws up a treatment plan, which must be agreed with the parents, recommendations are given for visiting other doctors, etc.

Therapeutic manipulations

Children 3 years of age should be treated exclusively in the presence of adults, with only a few exceptions when sterile conditions are required.

In the dental chair, the baby is in the arms of the mother or father.

Treatment of children older than 3 years is carried out in the presence of parents, but with its own characteristics: if it is a surgical operation, then the mother may be present in the office, but be at a distance. For some operations and conditions, the presence of parents in the office is prohibited.

If we talk about the therapeutic reception, then there are three options for finding one of the parents in the office:

1. Mother in a chair with a child: the dentist can give this type of treatment based on the age of the baby, the characteristics of his behavior or physical condition. One of the parents acts as a guarantor of the child's adequate behavior in the chair, and, if necessary, will constrain the child's movements. When treating children diagnosed with autism, Down syndrome, mental retardation, cerebral palsy and other movement disorders, treatment takes place with the obligatory presence of the mother.
2. mother next to child A: Children after 5-6 years old can sit in the dentist's chair on their own, and the mother can play the role of a dental assistant. The close presence of parents in the office gives the kids a sense of security and safety. The specific position of the mother and her role is determined by the dentist, the main thing is not to interfere with the treatment.
3. Mother in the office, but out of sight of the baby. Dentists can ask the mother to get out of sight of the baby with his capricious behavior. In the absence of "spectators" the hysteria stops.

Treating young children is very difficult. This is explained not only by physiological characteristics - but rather by behavioral ones. Parents should help the doctor, adequately respond to requests and comments.

Treatment of children without the presence of parents

Dental treatment in children without the presence of parents can be carried out after 3-5 years, but subject to several fundamental conditions:

• The child independently answers the doctor's questions, his behavior is not satisfactory.
• The dentist observes the baby for a long time, a trusting relationship has developed between them, and there is no fear.

Even considering these facts, the transition to self-administration should be gradual and smooth. At first, the mother controls the behavior of the baby, being next to the chair, then - out of sight.

If the child feels comfortable, you can leave the office for a while, supposedly fill out paperwork or talk on the phone, and then leave the office altogether and not return.

Refusal to treat a child

According to Federal law, each patient has the right to choose his own doctor for the purpose of receiving medical services.

But sometimes parents are refused literally at the threshold of the dental office, and this fact may be due to several reasons:

1. Busy work schedule and lack of time.
2. Difficult physical and mental condition of the child: some dentists refuse to treat children diagnosed with cerebral palsy, severe congenital pathologies or diseases, Down syndrome, autism spectrum disorders. But they give directions or recommendations for treatment in specialized centers.
3. Insufficient qualification of the specialist. The main task of the doctor is to cure, to help the patient. Sometimes you have to deal with complex cases, the treatment of which requires experience and in-depth knowledge. Refusal in this case is beneficial for the patients themselves.
4. Redirection to narrow specialists in the field of dentistry. Despite the fact that dentists are trained in all specializations, and even the therapist knows how to perform surgical operations. Sometimes treatment and examination by a specialized specialist is required;
5. Inappropriate behavior of the child.

If children are prone to tantrums during treatment, the doctor may ask to leave the office. Parents should use this time to their advantage: to calm the child - and start all over again.

If, after several unsuccessful attempts at treatment, the behavior of children has not changed, the dentist may completely refuse further treatment.

The laws of the Russian Federation define cases when a doctor's refusal to treat will be considered unlawful.

Article 124 of the Criminal Code of the Russian Federation "Failure to provide assistance to the patient": the doctor does not have the right to refuse treatment:

• In the presence of conditions associated with a threat to life. This definition includes acute surgical pathologies, life-threatening injuries.
• If the threat to life was realized during a dental appointment: the appearance of acute allergic reactions, the inhalation of dental instruments - for example, in the treatment of root canals, etc.

Toothache, symptoms of stomatitis and even some types of injuries are not life-threatening conditions, therefore - do not fall under this article!

The dentist cannot "leave" the child during treatment. For example, after the examination, a treatment plan was drawn up, the doctor began to implement it: treatment of periodontitis with a technique in several visits. But on the second or third visit, the dentist refuses to accept a small patient - and such actions are illegal.

The only exception is special circumstances at the dentist. But even in this case, another specialist of the clinic should deal with the treatment of the child.

Separately, it is worth consecrating the problem of parents' refusal of treatment.

There are many reasons why parents may refuse a particular treatment method.

1. Firstly, these are imaginary fears about the danger of a particular treatment method or the imposition of one's own treatment tactics. The most striking example: complications of caries of a milk tooth, the dentist insists on treatment in order to preserve it and prevent bite pathologies, parents are removed. The final decision remains with the parents, the doctor can only indicate the possible consequences and let him sign the appropriate papers, removing all responsibility from him.
2. The second, no less common situation is the identification of complications in the course of treatment. Given the anatomical and physiological characteristics of teeth in children, it is sometimes difficult to conduct a complete diagnosis.

If we consider children's practice, then the boundaries between the forms of caries are erased. In babies, there is practically no difference between superficial and medium caries, and with deep caries, the first changes in the tooth pulp are noted - “initial” inflammation.

How long have you been working (clinic "Zubryonok")?

Our children's clinic "Zubrenok" was one of the first clinics in Moscow, which in 2002 began the development of specialized care for children and adolescents.

What is the easiest way to find your clinic?

On foot. From m. Chertanovo, South exit. Walk down Balaklavsky Prospekt, on the opposite side of the metro, towards the Aerobus shopping center.
- by car. Turn to Balaklavsky Prospekt from Varshavskoye Shosse, first floor of a residential building, after the Rus auto parts store. You can park in the parking lot of the store.
On the clinic's website in the "Contacts" section there is detailed information on how to reach us on foot from the metro or by car.

Why should parents be present at the first appointment?

Parents must be present at the appointment, since only they, being the legal representatives of the child, decide on the choice of treatment method; its value.

Is it possible for a child to come to the first appointment with a grandmother / grandfather / aunt / uncle / nanny, etc.

It is possible if the accompanying person has a notarized power of attorney from both parents that it is this accompanying person who will represent the legitimate interests of the child and make a decision on his treatment.
It is possible, the initial visit is a consultation that does not involve any manipulations. On the next visit, when treatment is to take place, the legal representative of the child must be present (which is confirmed by a passport and birth certificate) so that there are no disagreements about the method of treatment. Informed consent for treatment is signed. By law, only a legal representative can do this.

Why do I need to present a passport and birth certificate?

The law obliges us, service providers, to make sure that the adult with whom the child came is his parent or legal representative.

Who works best with young children?

All doctors of the clinic have special training in the field of child psychology and are able to establish contact with children. You just have to choose a convenient day, time and, if desired, the gender of the doctor.

If the child is afraid, how is the treatment?

We have doctors who always try to find an approach to the child, play with him and persuade him to undergo treatment. It may take several visits to the clinic for the child to get to know the doctor and the clinic successfully.
If it is not possible to establish contact with the child or he already has a negative experience of dental treatment, then you can try the following options:
- sedation (the child is injected intramuscularly with a drug that relieves fear, excitement, tension. The drug is used only for these purposes and is approved by the Russian Ministry of Health). The child is conscious; some children become drowsy; some continue to cry but do not resist treatment. It is impossible to know in advance how the drug will work. The dosage of the drug is selected depending on the weight of the child. The procedure is performed by an anesthesiologist, who first determines the absence of contraindications to the use of the drug, and then monitors the child's condition during treatment;
- anesthesia (the child is put into a state of sleep using Sevoran gas). The child does not feel pain, does not remember what was done and how; treatment is carried out in a supine position, which allows you to comply with all technological conditions of treatment and do the entire amount of work: treatment; removal; prosthetics. If necessary, after the extraction of teeth, you can take impressions for the manufacture of a replacement prosthesis.

Do you have a psychologist?

At the moment we do not have a psychologist. However, the doctors of the clinic have special training in the field of child psychology and are able to find an approach to any child.

If the child is a little sick, should I bring him to the appointment?

You should not bring your child to the appointment. It is necessary to completely cure the child. If the child has a cold, he will act up or it will be difficult for him to breathe through his nose, which may provoke the urge to vomit. You should not bring a child with herpes, even if several days have passed since its appearance, as a relapse and exacerbation of the disease is possible.

Is there a discount for low-income / large families?

There are no separate discounts. We have a single system of discounts for everyone.
There is a cumulative discount that starts after the first appointment, and weekday discounts: 20% from 9:00 to 15:00 and 10% from 15:00 to 21:00.

Therapy

How much will a milk/permanent tooth treatment cost?

The cost of dental treatment depends on its condition. It is impossible to say even approximately, since the cost consists of many parameters that can only be determined by a doctor and only after a preliminary diagnosis. You can see the approximate cost of treatment for each of the diagnoses on our website in the "Prices" section. There are prices for individual manipulations, which may be part of the service "Treatment of a milk / permanent tooth".

What kind of anesthesia do you use? How is it going?

The clinic uses anesthetics of the articaine series in dosages specially selected according to the weight and age of the child; hypoallergenic.
Anesthesia is carried out with disposable (individual) syringes (injectors). The injection site is also treated with an anesthetic so that the child does not feel the injection. Anesthetic in the form of a pleasant-tasting and smelling gel. Spray can also be used. The need for this or that means for anesthesia is determined by the doctor.

What is "manual tooth preparation"? At what age is it shown and how much does the service cost?

Manual preparation increases the cost of caries treatment by 1790 rubles. In the course of work, an individual set of tools and a special gel are used to dissolve carious tissues in order to scrape them out more easily. The procedure takes about 10-15 minutes. Then the tooth is filled.
The procedure is good because there is no noise, vibration, unpleasant odors and sounds, as in traditional burr work. In addition, this procedure is painless, since hand instruments do not touch living tissues, removing only non-viable ones. The quality of such processing is similar to that of boron. But time - longer. There are no age restrictions for such cavity treatment. It can be used in any patients who are afraid of pain, the dentist, in children who first came to the doctor in order not to cause discomfort.

What method is used to treat caries in the clinic?

If the filling of the cavity under the term “treatment” is meant, then first the cavity is cleaned in one of the following ways: ultrasound / air-kinetic method (without boron; air jet under pressure and special powder) / manual method (special tools and gel to dissolve carious tissues )/borami. Doctors use special burs that can wear off when the treatment reaches the level of healthy tissue. These are disposable burs. They can only remove dead (carious) tissue. All these methods are used in order not to damage healthy tooth tissues.
Then the cavity is sealed. The material for filling is selected depending on the condition of the child's dental tissues. This is determined by the doctor and preliminarily tells the parent what determines the choice of material.
Correctly, by “treatment” we understand the elimination of the cause of caries - a systemic disease of the body. To do this, a pediatrician works in the clinic, who helps to establish the cause of metabolic disorders in the child's body.

What material do doctors work with?

Materials used for filling teeth are imported; photopolymerizable and not only. The choice of materials is made by the doctor depending on the condition of the child's dental tissues, as they perform a healing function.

What is the guarantee for a seal?

Sealing warranty from 3 to 6 months; is extended every 3-6 months during the entire period of observation of the child in the clinic. The condition for the extension of the guarantee is the completion of the treatment with an individual course of prevention; repetition of the course of prevention after 3/6 months (according to indications).
The duration of the primary guarantee depends on the activity of caries in the child - the number of carious cavities. With multiple caries - this is 3 months; with a small number of carious cavities and good hygiene - 6 months; if the filling is the only one and hygiene is good - 1 year.
The repetition of prevention courses is aimed at strengthening tooth enamel; improved hygiene; inactivation of cariogenic flora (microbes that cause caries); improving oral health (which indirectly affects the health of the child as a whole). If you follow the preventive program, you do not need to retreat your teeth; repair fillings and treat new caries. The guarantee for treatment can be maintained during the entire period of childhood.

How much does a front tooth restoration cost?

Within 10,000 rubles (including isolation of the working field with a rubber dam; necessary anesthesia, etc.). But the final cost of the work can only be determined by the doctor and only upon its completion. At the consultation, the doctor will draw up a treatment plan and a preliminary estimate; agrees it with you, and also indicates which options (both upward and downward) are possible during the course of treatment.

Do you use general anesthesia/general anesthesia?

Yes. Our clinic has an anesthesia department equipped with the most modern anesthesia equipment. Experienced anesthesiologists-resuscitators work; there is a rehabilitation ward (day hospital), where the child is being restored under the supervision of a pediatrician and other medical staff. It is possible for parents to be present in the rehabilitation ward. There is a movie on our website in the "Services/Treatment under Anesthesia" section or in the "For Patients/Videos" section that will help answer many of your questions.

Surgery

How much does it cost to remove a milk / permanent tooth and what does it depend on?

Removal of a milk tooth costs from 1520 rubles; permanent - from 2770 rubles. The cost depends on the type and amount of anesthesia needed; complexity of removal (which is associated with the condition of the tooth and its anatomical features). You may need a variety of medicinal "inserts" in the hole (after removal) with the effect of anesthesia; hemostatic; anti-inflammatory (the choice is always individual and is made by the doctor, depending on the need). In our clinic, this procedure is performed by certified dental surgeons.

At what age should a child have a dissection of a shortened frenulum of the tongue? What is it for?

The dissection of the frenulum of the tongue is done even in the hospital, when the child cannot clasp the nipple of the mother's breast. This leads to nervousness of the child, as he quickly gets tired when sucking and does not gain the required weight.
If, for some reason, this manipulation was not done in the hospital, it must be carried out in the first weeks of life. In our clinic, pediatric dentists master this quick and painless manipulation for the baby.

Is there any warranty period?

None of the surgical procedures in pediatric dentistry provides for a warranty period - the procedure is performed at the same time and does not require re-intervention. If a second consultation with the doctor is required, it will be carried out. In general, the rules for the provision of clinic services include patronage by medical workers of their patients - until complete recovery.

Hygiene

Why do you need to visit a hygienist if the child's teeth are all right?

Visiting a hygienist - a specialist in the field of dental prophylaxis - is necessary regardless of whether there are problems with the teeth or not. This should be done every six months, and possibly more often (on the recommendation of a doctor). On the teeth of a child, plaque accumulates daily, which eventually turns into dense dental deposits that cannot be cleaned with a toothbrush. Under this plaque, the process of softening the enamel and the appearance of caries occurs. Therefore, it is necessary to regularly remove plaque, diagnose tooth enamel and latent caries so that the teeth are healthy and do not have to be treated in the future.

How much does an initial visit to a hygienist cost?

4200 rub. It includes diagnostics of the quality of cleaning (visible for the child and the parent); training in hygiene rules and rules for monitoring its implementation; professional oral hygiene (with a brush and a special paste, which is selected depending on the condition of the teeth or a sandblaster (for older children - adolescents); laser diagnostics of initial caries and its latent forms; consultation on the selection of hygiene products (paste; rinse aid; brushes); consultation on healthy eating.

Plates for one jaw cost from 13920 to 16420 rubles. After consulting an orthodontist and making a decision on treatment with plates, a 100% prepayment must be made, since the plates are made in the laboratory. Their production starts only after the advance payment has been made.

And we also have metal , ceramic and lingual braces.

Why not a fixed payment for braces?

In our clinic, advance payments are not made for the entire period of treatment, since it proceeds differently for everyone and prepaid manipulations may not be necessary. This allows parents to control their spending.
The cost of the bracket system is fixed in the price list and changes only with the next change of the price list associated with an increase in the purchase prices of brackets, about which all visitors are notified through the site in advance. The rest of the manipulations are very individual, and we do not see the need for advance payments.

What is myofunctional therapy? In which case is it shown?

The main goal of myofunctional therapy is the prevention and correction of impaired muscle functions, the elimination of bad myofunctional habits, the elimination of crowding of teeth and the correction of occlusion.
You can read more detailed information on our website in the Services/Myofunctional Therapy section.

Is there a warranty period for orthodontic treatment?

The warranty period is established after the end of the retention period of one year. This issue is also discussed in detail during a consultation with an orthodontist, as orthodontic treatment has its own nuances.

It is not necessary to delay the first visit of the child to the dental clinic: it is important that the acquaintance with the doctor begins not with treatment, but with a preventive examination - this is how you can lay the foundation for a long-term friendship.

For a modern children's clinic, all the little things are important: the presence of a comfortable playroom and a room where small patients can relax after treatment under anesthesia, a wide selection of toys - not simple, but dental ones, which will help to involve small patients and patients in the treatment process. Doctors and nurses in a children's clinic wear brightly colored overalls so as not to evoke unpleasant associations with a white coat in a child. Even the specific smells of medicines in the children's clinic are trying to be removed. An aquarium with fish, a TV with cartoons, coloring books and sketchbooks - all this will help the child to relax and feel comfortable. In a situation where a large amount of assistance is required, children undergo dental treatment in their sleep, for which the clinic has a full-fledged anesthesia room.

What is the difference between dental treatment for children and adults?

Of course, the main difference is the age of the patient. Children perceive any sensations very acutely, and one bad experience with a dentist can lead to the fact that in the future it will be difficult to seat the child in a chair and persuade him to open his mouth. Therefore, the personality of the doctor is of great importance - the ability to establish contact with the child, to show genuine interest in him, attention to all the little things.

Dental treatment for children is carried out in a playful way, but at the same time, the doctor performs all the manipulations as quickly and painlessly as possible. In the presence of multiple caries and other problems that create a large amount of work, the doctor may recommend, in the absence of contraindications, to carry out. After all, even the most calm and contact little patients get tired of sitting in a chair for a long time, which negates the positive impressions of visiting a dental clinic.

Baby teeth are another important difference between pediatric and adult dentistry. Parents are often mistaken that milk teeth do not need to be treated - they will fall out soon anyway (another version of this delusion: it is better to immediately remove a sick milk tooth - let a new one grow as soon as possible). In fact, the treatment and preservation of milk teeth is very important. Why?

Firstly, with the premature removal of a milk tooth, a shift in the dentition will begin: neighboring teeth will shift towards the missing one, and a permanent tooth may grow incorrectly. Secondly, under the milk teeth are the rudiments of permanent ones (they are laid even in the prenatal period), and deep caries that hit the milk tooth can go deeper and affect the permanent tooth.

Problems with teeth in children require an immediate response, as inflammatory processes develop very quickly: yesterday the child felt fine, but today he suffers from toothache and high fever. In this case, you need to contact the clinic for treatment as soon as possible, and not try to relieve the pain and temperature at home.

Prevention is the most important

For children even more than for adults, prevention is important: you need to visit at least twice a year, without waiting until the child begins to complain of a toothache. Timely detection of caries will allow you to avoid future problems with your teeth and carry out treatment quickly and painlessly.

Often, as a preventive measure, pediatric dentists recommend sealing fissures, protecting the weak enamel of the chewing surface of the teeth. Fissures - depressions, pits on chewing surfaces - become breeding grounds for bacteria. Thin enamel and the inability to clean these recesses with a brush and paste leads to the rapid development of caries.

In addition to carrying out preventive and therapeutic procedures, the doctor must teach the child how to properly care for the oral cavity. Parents often have questions about how to instill the right habits in their son or daughter - and a dentist will help here, who will tell you how to help your child learn to brush their teeth regularly.

06-10-2009

The developers of the document hope that the new rules will ensure the safety of patients and doctors, and especially children.

Now you can not treat children in dental offices for adults. Medical institutions are required to equip separate blocks for minors with their own reception and bathroom.

Treating children is unprofitable
However, according to Murmansk experts, the new sanitary rules worsen the situation of pediatric dentistry. Today, doctors and heads of medical institutions have no motivation to provide dental care to children. It is much easier for a doctor to cure an adult at a paid appointment than to persuade a child not to be afraid of a dentist's tool.

In addition, due to the lack of a clear regulatory framework, insurance companies pay medical institutions only for the “adult” work of doctors if they have a diploma in general practice dentistry.

- Therefore, today only children's dentists work with children (there are 6 of them in the city) and dentists of the old school, who have a specialized secondary education. But there are also few of them, and many of them are already over 60,” notes the chief city dentist Emma Tolmacheva. - On the other hand, adolescents aged 15-17, who are considered children by law, and therefore are served in pediatric dentistry, can be treated in adult clinics. After all, boys and girls are already physiologically formed. For example, athletes of two meters height, students, working or even young mothers come to us. And they serve with kids. These guys already have a passport and the right to sign consent for medical intervention. So why not relieve our children's dentists by transferring teenagers to adult clinics?

By the way, now many paid clinics in the city will probably not accept children - most of them will not equip a separate room for children.

Change patients and gloves
The new document also stipulates a number of requirements for the placement of the clinics themselves, the decoration of their premises, equipment, microclimate and lighting. For example, if there are several dental chairs in one office, they must be separated by opaque partitions at least one and a half meters high. According to experts, this part of the rules is feasible for newly built clinics. But not for those who work for many years in adapted premises.

In addition, in dental clinics, each employee must have at least three sets of sanitary clothing, and the doctor must use new rubber gloves for each patient. And the dentist during the treatment of the patient should not take notes, touch the phone, and also eat and use cosmetics in the workplace.

Relieve toothache ... mushrooms
Most Murmansk residents try to get free dental care not in private clinics, where prices are quite high, but in ordinary clinics at the place of residence. To get to the doctor, patients have to "catch" numbers sometimes for several days. As doctors joke, they can take a breath only two months a year - in August and September, when Murmansk residents are busy harvesting mushrooms and berries.

“In order to solve the problem of queues now, we would have to at least double the number of doctors,” notes Emma Tolmacheva. “Under the current conditions, this is unrealistic. In addition, today, doctors in the treatment of adult patients have to disentangle the consequences of imperfect technologies of the 80-90s. In addition, public dental clinics have a social responsibility by participating in the program of preferential dentures. Thus, for 8 months of 2009, 5,852 residents of Murmansk have already received such assistance in the amount of 43.8 million rubles. These are war and labor veterans, home front workers, the disabled, rehabilitated, as well as ordinary pensioners.