Dental Services

Smiling boy and girl at Hoku Smiles Kapaa

PEDIATRIC DENTISTRY

The dental visit at Hoku Smiles

The American Academy of Pediatric Dentistry (AAPD) recommends that your child visit the dental office when the first tooth comes in and no later than their 1st birthday. 

Everyone at Hoku Smiles wants your child to have a happy dental visit and a healthy smile for life. Talk to your child about the visit, let him/her know that the pediatric dentist is a friend who will help and explain every step of the visit. 

Use Simple terms to describe the experience and avoid using negative words like “blood”, “needle”, “pull tooth” or “pain”. 

Baby dental exam

This visit is very simple, we focus on meeting the patient and the family, we ask questions that will help identify the risk for cavities and focus on prevention. 

The baby will lay on their parent’s lap while we examine their mouth quickly and gently, we will show the parent how to brush the baby’s teeth and we will look out for any early signs of problems. 

Before you leave we will inform you of any findings and any early treatment that might be needed. We will also answer your questions, discuss diet, lifestyle and oral health recommendations to help protect your baby’s oral health. 

Child/Teenage dental exam

During the following appointments we continue to focus on prevention, evaluation of your child’s dental development, and early detection/treatment of oral problems.  Our goal is to transition your child to sitting on the dental chair on their own, this may require some help from parents.  We proceed to examine the outside and inside of their mouths, we will take the needed digital X-rays to evaluate areas that cannot be seen. Then the teeth will be cleaned and polished. A thin layer of fluoride treatment will be carefully applied twice per year to help reduce the risk of dental cavities with the parents consent.  We will then continue to discuss diet and oral hygiene recommendations, explain any findings and suggested treatments. We will gladly answer any questions that might come up.


Parents in the treatment room

During exams and cleanings we welcome parents to accompany their child in the treatment room. By doing this we can discuss all findings and recommendations with everyone as we build a relationship of trust and the child feels comfortable with the dental visit. 

During treatment visits our goal is to have your child comfortable enough to walk in with the dental staff independent of parents.  This will help us to focus on your child during the treatment, it will promote efficient communication between patient and dentist, making the dental visit more smooth and efficient. 

If the parent prefers to be in the room, we recommend:

  • Only one parent in the treatment room
  • Other family members should remain in the waiting area - During the COVID pandemic our waiting room is closed.
  • Please try not to interfere with the patient-dentist communication by touching or talking to the patient.  Allow the staff to take the lead in explaining the steps and procedures to your child.  It is also effective to let your child feel independent to answer questions on their own.

Oral Health Recommendations

Cleaning your child’s mouth

Before your baby’s teeth come in, the gums should be cleaned with a clean damp gauze or cloth at least twice per day, especially before bedtime.  


Once the teeth erupt it is very important to brush your baby’s teeth twice per day, after breakfast and before bedtime. Use an extra soft brush that has a small head.

Make sure you brush your child’s teeth until he or she has the motor skills and  coordination to achieve this task around 8 years of age. After this children should still be supervised to make sure they are not missing any difficult areas. 


Toothpaste

Children under 3 years old: Apply a small smear of fluoride toothpaste.

Children from 3 to 6 years old:  Apply a pea-size amount of fluoride toothpaste.

Make sure to supervise your child to make sure that they spit out and not swallow the excess toothpaste.


Floss

Baby teeth should be flossed! Floss between teeth that touch.  You can start by using a flosser with a handle and transition to regular floss as the child gains motor skills. 


Diet Recommendations

A healthy balanced diet is important for the development of healthy teeth and gingiva.

Watch your diet for

Sugar : foods with added sugar, acidic sugars, sticky sugary snacks will feed the bacteria that produce cavities.

Starch: foods such as  bread, crackers, pretzels, potato chips break down into sugar and stay stuck on teeth for a long time.

Sticky foods: even natural sugars when turned into sticky snacks like fruit rolls or dried fruit stay on teeth longer and are more difficult to wash away with saliva or water.

Sugary drinks: Soda, sports drinks, and juice are high in sugar. According to the American Academy of Pediatrics children ages 1-6 should have no more than 4-6 oz. of juice one time per day and children ages 7 to 18 should drink no more than 8-12 oz.


Plan your meals

Limit the amount of snacks per day and choose healthy snacks like cheese, vegetables, nuts and yogurt. 

Eat sugary or starchy foods as part of a main meal not as a snack.   

Do not put your baby to sleep with a bottle or sippy cup with milk, formula, or juice.



Resources:

https://www.mouthhealthy.org

https://mouthmonsters.mychildrensteeth.org

https://www.colgate.com/en-us/oral-health/life-stages/infant-kids

https://oralb.com/en-us/oral-health/tag/life-stages



Procedures

Fluoride applications

It is a mineral that is found naturally in many foods and water sources. It works by hardening the surface of teeth (enamel) making teeth more resistant to the acid attack caused by bacteria, when cavities begin to form it promotes enamel repair and it helps fight bad bacteria that causes dental decay. 

Ingesting too much fluoride can lead to dental fluorosis that changes the color of teeth permanently.

Trained dental professionals can assess your child’s caries risk and identify the best way to use adequate amounts of fluoride to protect your teeth from cavities. We can recommend different types of toothpaste that contain fluoride, we can apply it in the office in the form of varnish or gel and some patients might need fluoride supplements.

Sealants

Sealants are a white resin material that is placed on the grooves of the chewing surface of the permanent molars. These  grooves are difficult to clean, by placing the sealants, we are decreasing the chances of getting decay by approximately 60 %. It is a simple and painless procedure, once these sealants are placed, they usually last around 3 years. We check the sealants at every check-up and when they begin to wear we will replace them.

Fillings

Once the decayed portions of a tooth are removed, we use tooth-colored resin to fill the space, providing structural support and restoring a normal appearance. Tooth-colored fillings are durable, stable, and provide better aesthetics.  **Remember it is important to keep teeth clean and limit sugar in your child’s diet to keep filled teeth from getting recurrent decay. 

Pulpotomy (Baby Root Canal)

A pulpotomy is a procedure that requires partial removal of the damaged nerve tissue due to excessive amount of decay. The remaining vital tissue is then treated to preserve the function of the tooth. Then a stainless steel crown is placed over the tooth. 

Stainless Steel Crowns

Stainless steel crowns are prefabricated and are adapted to the child's individual teeth. They are used when gross decay, decalcification, or developmental defects are present. They are also used if your child has to have a pulpotomy which can weaken the tooth and make them prone to fracture. These crowns will usually last until the permanent tooth erupts.

Zirconia Crowns (White)

Zirconia white dental crowns are a highly esthetic and durable stainless steel crown alternative now available in pediatric dentistry. This option is very technique sensitive and works best with a child that is cooperative in the chair.  Our pediatric dentists can assess if this is a good option for your child.

Space Maintainers

The best space maintenance is the preservation of the primary molars until they are lost naturally. Sometimes, when a tooth is unrestorable or infected, the tooth may have to be extracted. The purpose of the space maintainers is to hold space for the developing permanent teeth.

Nitrous Oxide

Also known as “laughing gas”, it helps the patient feel less anxious, comfortable and helps manage pain. The patient will remain conscious and will be able to communicate well during treatment. 

A small comfortable mask is placed over the nose and the patient will breathe in the gas.  The amount of gas used is easily controlled.  The effect ends very soon after the gas is turned off allowing the patient to resume normal activities after the visit. 

Hospital Dentistry Under General Anesthesia

General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful or anxious, or for the very young who do not understand how to cope in a cooperative fashion. General anesthesia can also be helpful for children requiring significant surgical procedures or patients having special health care needs. All work is done by Dr. Kanoe Baird and Patricia Sanchez at Wilcox Hospital. At the time of your visit, we can help you determine if your child is a good candidate for hospital dentistry. 

Silver Diamine Fluoride (SDF)

‍SDF is a topical agent that temporarily stops dental caries. The application of SDF requires no use of local anesthesia, and no drilling or removal of tooth structure.  SDF leaves the arrested lesion with a black stain, or scar.   The other downside to treatment with SDF is that, although it arrests the caries, it does not fill the lesion and, therefore, cannot restore the form of the tooth.

Dental emergencies

If you face a dental emergency, give us a call immediately. If you need urgent treatment after hours, please go to the emergency room. We are always here to assist when your child's dental health is at risk. Below are tips on dealing with urgent dental situations. You may want to display this list on your refrigerator or store it near your emergency phone numbers for easy reference.

Bitten Lip or Tongue

If your child has bitten his lip or tongue severely enough to cause bleeding, clean the area gently with water and use a cold compress (a cold, wet towel or washcloth pressed firmly against the area) to reduce or avoid swelling. Give us a call to help determine how serious the bite is.

Object Caught In Teeth

If your child has something caught between his teeth, use dental floss to gently remove it. Never use a metal, plastic, or sharp tool to remove a stuck object. If you are unable to remove the item with dental floss, give us a call.

Broken, Chipped, or Fractured Tooth

If your child has chipped or broken a piece off of his tooth, have him rinse his mouth with warm water, then use a cold compress to reduce swelling. Try to locate and save the tooth fragment that broke off. Call us immediately.

Knocked Out Tooth

If your child's tooth has been knocked out of his mouth, find the tooth and rinse it with water (no soap), taking care to only touch the crown of the tooth (the part you can see when it's in place). Place the tooth in a clean container with cold milk, and if unavailable, the child's saliva could be substituted. Call us immediately and/or head to the hospital. If you act quickly it's possible to save the tooth.

Loose Tooth

If your child has a very loose tooth, it should be removed to avoid being swallowed or inhaled.

Toothache

If your child complains of a toothache, use a cold compress to ease the pain. Do not apply heat, any kind of aspirin, or topical pain reliever (ex: anbesol) directly to the affected area, as this can cause damage to the gums. Pain relievers dosed for your child may be taken orally (ex: children’s Tylenol). Schedule an appointment immediately.

Avoiding Injury

You can help your child avoid dental emergencies. Child-proof your house to avoid falls. Don't let your child chew on ice, popcorn kernels, or other hard foods. Always use car seats for young children and require seatbelts for older children. And if your child plays contact sports, have him wear a mouthguard. Ask us about creating a custom-fitted mouthguard for your child. Finally, prevent toothaches with regular brushing, flossing, low sugar diet, and visits to our office.

General DENTISTRY

*Root Canal Therapy

Root canal therapy becomes necessary when the inner nerve of a tooth becomes affected by decay or infection. When this happens the tooth may become extremely sensitive to both pressure and temperature and intense pain can be expected. In the initial stages of decay and infection, it is possible that no symptoms would be present. However, in the advanced stages of decay and infection an abscess (pimple-like inflammation on the gums) will form.

Getting a root Canal Can Alleviate Pain

When confronting this type of decay or infection, the patient has two options: pull the affected tooth or save it. When extracting a decayed or infected tooth, significant and costly dental problems will arise for adjacent teeth. In the end, tooth extraction may cause more problems than it will solve.

One problem that can occur is when a tooth is pulled toward the back of the mouth (premolars or molars), the tooth next to the extracted tooth will slowly lean forward over time. Imagine a picture of the leaning tower of Pisa and what can happen to a tooth next to an extracted tooth. The tooth can slowly lean over into the space left behind by the missing tooth. Root canal therapy is a much more desirable alternative for full functionality to the tooth and mouth, and it will prevent future problems with the adjacent teeth.

The reasons a dentist will recommend root canal therapy include the following:

  • Decay has reached the tooth pulp (the living tissue inside the tooth)
  • Development of infection or abscess inside the tooth or at the root tip
  • Trauma or injury to the tooth

Therapy and Treatment for a Root Canal

The restoration that root canal therapy provides will usually last a lifetime. It will provide full functionality back to your tooth and mouth. There may be a need in the future to retreat the tooth, but this would only be necessary if a new, separate infection arose.

Our team of doctors is highly skilled in these types of procedures. We can also save you money and time since you will not need to be referred out to a specialist in most cases, which is more costly and inconvenient.

Our office is in a convenient location on Kauai. Please feel free to give us a call for more details on how we can help improve your dental health. You may also book an appointment online with us now.

PReventative

Cleanings

No matter how often you brush and floss, plaque and tartar deposits can still build up on your teeth. A professional teeth cleaning with our hygienist is the single most effective way to remove these deposits and prevent them from causing more serious problems in the future. While a traditional tooth cleaning involves manually scraping away these deposits with special dental tools, advances in dental technologies now give you more options for teeth cleaning.

An “Ultrasonic” tooth cleaning is an excellent addition to traditional techniques and had gained popularity for good reasons. An ultrasonic scaler uses high- frequency sound waves to effectively remove deposits, kill harmful microbes and eliminate bacteria around the teeth and gums. Used in conjunction with hand instruments, it’s the most complete cleaning method available. Many patients find the cleaning combination more comfortable and comment that their teeth have never felt cleaner. We recommend having your teeth cleaned at least once a year but preferably every six months.

If you have been diagnosed with “periodontal disease”; where excessive hardened plaque and tartar deposits have developed below the gum line, a more aggressive deep cleaning will be prescribed. Deep cleaning, also know as “Scaling & Root Planing” involves a two-part process. First the stubborn deposits are carefully removed down to the bottom of each periodontal pocket along the tooth. The tooth’s root surfaces are then smoothed or “planed” to allow the gum tissue to heal and reattach to the tooth. A deep cleaning helps to stop the progression of the disease. Treatment may require one or more visits.


Periodontal Maintenance

Red, swollen gums that bleed easily are a “red flag” for gum disease.  If you have these symptoms along with persistent bad breath, gums that are pulled away from the tooth or loose teeth- then you’re not alone.  More than 80% of adults have some form of gum disease.  Fortunately, there are many effective and pain-free gum disease treatments available.  For gingivitis, the mildest form of gum disease, treatment typically involves a thorough dental cleaning followed by the patients commitment to perform daily brushing and flossing. Advanced gum disease, also known as periodontal disease, requires scaling and root planing under local anesthetic to remove stubborn deposits below the gum line.  To monitor the disease and to prevent further damage to the surrounding tooth structure, an individualized periodontal maintenance program and schedule is created to address the needs of each patient.

Treating gum disease is important because, the gum ligaments and bone form the foundation for healthy teeth. When any area of the foundation is negatively affected, it jeopardizes the teeth just as a bad foundation would threaten the stability of a house. It’s important to have gum problems checked promptly, as gum disease left alone may eventually need treatment through surgery or extraction. Severe gum disease has also been shown to affect the health of the heart, liver, pancreas and artificial joints in the body.

If you’re having a problem, come in and see us so it can be treated right away!

Comprehensive Exam

The secret to a bright, healthy smile is actually no secret at all: brush, floss and get a professional dental exam at least once every six months. Professional dental exams are all about prevention – preventing existing problems from getting worse and preventing dental problems from developing in the future. Regular dental exams make it possible to identify and treat a problem in its earliest stage – which is not only good for your oral health but also good for your budget!

There's nothing to fear with a dental exam. Your teeth will be visually examined for signs of plaque, tartar and tooth decay. Your gums will also be examined for puffiness or discoloration, which are signs of gum disease. A full set of dental X-rays may also be taken during your dental exam, to enable Dr. Rosser to see below the surfaces of your teeth. Dental exams typically end with a dental cleaning to remove surface stains and tartar.


Digital X-Rays (Radiographs)

Dental X-rays have come a long way. Today's dental X-rays are safer, faster, more comfortable and more informative than the X-rays of years past. Digital X-rays, one of the latest and most advanced dental technologies, produce high-quality images of your teeth that can be viewed instantly by you and your dentist on a LCD monitor. Digital X-rays reduce radiation by up to 90% and provide exceptional diagnostic information to ensure that potential problems are caught in their earliest stages. Our office also utilizes intraoral photography. With intraoral photography, problems such as cavities, fractures and discolorations in the teeth are captured through clear and sharp photographic images that are taken with a specially designed intraoral digital camera.

Extraction

The tooth extraction process can be the result of a number of things, including:

  • Gum disease
  • Tooth damage/trauma
  • Tooth decay
  • Tooth impaction

Tooth extractions are generally simple dental procedures that include the use of a local anesthetic prior to the extraction procedure. In more difficult extraction cases, a general anesthetic may be used to perform the dental procedure.

Restorative

Tooth Colored Fillings

If you’ve been told that you need a dental filling, you’re not alone. Ninety-two percent (92%) of Americans have had at least one cavity. Dental fillings are a tried-and-true treatment for treating cavities and they come in a variety of options to suit every need.

A filling is a way to restore a tooth damaged by decay back to its normal function and shape. If you have a tooth that requires a filling, the dentist will first remove the decayed tooth structure, clean the affected area and then fill the cleaned-out cavity preparation with a filling material. A filling helps to prevent further decay by sealing off any cracks or spaces where bacteria can enter.

There are a variety of filling materials available including gold, amalgam and composite. Your dentist will work with you to determine which material is best depending upon the extent of the repair, where the filling is needed and the cost of each.

  • Composite resins are recommended for restoration in the front teeth because they can be matched to the color of your natural teeth. Unfortunately, the durability of today's composites is limited and they must be replaced more frequently. Composites can easily become stained from coffee, tea or tobacco and tend to develop cracks and micro leakage when placed in large cavity preparations in the posterior (back) teeth. 
  • Gold fillings are custom made in a laboratory and then cemented into place. While gold fillings are often the most expensive choice, many dentists consider gold to be the best filling material. Gold inlays are well tolerated by gum tissue and may last more than 20 years. 
  • If decay or a fracture has damaged a large portion of a tooth, a crown or “cap” may be recommended. Decay that has reached the nerve may be treated through root canal therapy which is essential to save the natural tooth.


Crown & Bridges

Today’s restorative techniques allow us to not only reconstruct your smile but to improve it. Crowns and bridges are used to restore and enhance teeth that are damaged or to take the place of missing teeth. 

A crown (also referred to as a cap) is used to entirely cover a damaged tooth. A crown not only strengthens a tooth but it can dramatically improve a tooth’s appearance, shape and alignment.

Crowns may be used to:

  • Replace a large filling when there is little tooth structure remaining
  • Protect a weak tooth from fracturing
  • Restore a fractured tooth
  • Attach a bridge
  • Cover a dental implant
  • Cover a discolored or poorly shaped tooth
  • Cover a tooth that has had root canal treatment

A bridge is an ideal method to fill the space created by missing teeth. Comprised of two anchoring teeth and a replacement tooth, dental bridges help to prevent surrounding teeth from drifting out of position, improve chewing, speaking and help keep the natural shape of your face intact. The materials used may be gold alloys, porcelain bonded to metal alloy or a ceramic material made to match your natural tooth color. The choice of material depends on requirements for strength, wear and esthetics.

If you lose a tooth it’s important that the tooth be replaced as soon as possible. If not treated, the teeth surrounding the gap will begin to shift inward. Shifting teeth can affect your bite because of the changes in pressure and can eventually result in problems with the jaw joint or TMJ.

Bridges and crowns are made by first preparing the teeth and taking an impression of them. The impression is sent to a dental lab where your crown or bridge will be custom made to fit your mouth and match the natural tooth color. A temporary crown or bridge will be placed into your mouth until your permanent crown or bridge is ready or the finished crown cemented into place.

Bridges and crowns are very durable and can last a lifetime with extra care, good oral hygiene and regular dental visits.

Advancements in Dentistry also make “Dental Implants” an excellent alternative to bridges.

Dentures

A denture is a removable replacement for missing teeth and surrounding tissues.  There are two types of dentures available, a partial denture and complete dentures.  Partial dentures are used when some natural teeth remain, while complete dentures are used to completely replace all of the teeth.  Dentures are made to resemble your natural teeth so there should be no noticeable change in your appearance.  In fact, dentures may even improve your smile!  Dentures are custom designed to fit your mouth and esthetically made to create the most natural smile possible.  The process of getting dentures usually takes 5 dental visits during a 2-3 week period.

New dentures may feel awkward for the first few weeks but keep in mind that you will quickly adjust and enjoy the benefits a full mouth of teeth can provide.

In some cases an “immediate denture” can be fabricated and delivered on the same day that a patient has their extractions.  This particular procedure works best when replacing all the natural teeth on the upper arch.

A removable partial denture is a prosthesis used to replace missing teeth and surrounding tissues when some natural teeth remain.in the upper or lower jaw.  They usually consist of replacement teeth attached to a gum-colored plastic base which is clipped or hooked onto a grouping of the remaining natural teeth.  The partial denture will restore your smile and mouth function as if all of your natural teeth were present.

With advancements in dental technology, todays full or partial dentures can also be supported with the aid of “Dental Implants”.  A dental implant can help to secure the dentures by greatly increasing retention and stability.

Implants

WHAT ARE DENTAL IMPLANTS?

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.

WHAT ARE THE ADVANTAGES OF DENTAL IMPLANTS?

There are many advantages to dental implants, including:

  • Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
  • Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip.
  • Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
  • Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
  • Improved self-esteem. Dental implants can give you back your smile and help you feel better about yourself.
  • Improved oral health. Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
  • Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.
  • Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.

HOW SUCCESSFUL ARE DENTAL IMPLANTS?

Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.