Operative Procedures

Stainless Steel Crowns

These crowns are silver in color and made of chrome steel and nickel. After the decay is removed, a crown of appropriate size is selected and cemented onto the healthy remaining tooth structure. Stainless steel crowns are excellent restorations for large cavities because they provide strengthening and support that wraps around the entire tooth structure.

Post-Operative Instructions

Please refrain from giving your child solid food for about 2 hours following the appointment. This will give the cement under the crown time to properly harden. With correct care, this crown can last the life of the tooth. Chewy or sticky foods, such as caramels and gum, should be avoided completely.

The tissue around the crown just placed may be tender once the anesthetic wears off. Children’s Tylenol or similar medications are usually sufficient to relieve this discomfort. Thick saliva and heavy “drooling ” is often normal, and the tissue around the crown may have a grayish appearance for a few days.

Root Canal Therapy


When a tooth shows signs of irreversible changes due to infection, a pulpectomy, or the total removal of the arteries and nerve (pulp tissue) within the tooth space, is indicated. The inner space inside the root of the tooth is smoothed and filled with a suitable material. Typically, teeth that have been treated by means of root canal therapy will require a crown as a final restoration.

A pulpotomy is a partial removal of the pulp tissue within a primary tooth. The purpose of this procedure is also to remove the decay and prevent bacteria from further infecting the inside of the tooth. Once the treatment is complete, a medicated filling will be placed along with a stainless steel crown to protect the completed treatment.

Amalgams & Composites


Amalgam fillings (A) and tooth colored composites (C) are two types of restorative dental materials.

Amalgam (silver material) fillings are a traditional restorative material that is composed of varying percentages of liquid mercury and silver-tin-copper-zinc alloy powder. Shortly after it is placed in your child’s tooth, the mixture self hardens and often lasts for many years. In general, the advantages of amalgam restorations over composites are that they are less expensive, typically longer lasting, and have a lower chance of secondary decay.

Composite resins (white, tooth-colored filling material) are a mixture of powdered glass and plastic resin. The general advantages of composite resin fillings over amalgams are that they are better looking (more closely match the color of your child’s tooth) and save more natural tooth structure during placement because of their unique bonding properties. In addition, composites have less chance of fracturing your child’s tooth when exposed to strong forces, in contrast to amalgam fillings.

Dental Extractions

A dental extraction is the removal of a tooth from the mouth. Some common causes of dental extraction include: tooth decay that has brought the tooth beyond the point of repair, impacted or problematic wisdom teeth, and space maintenance in the course of orthodontic treatment.liltoothyextangel

Post-Extraction Care

Following extractions, prevent your child from:

Scratching, sucking, chewing, or rubbing the lips,tongue, or cheek while they are still numb following procedure
Spitting excessively
Drinking carbonated beverages for 24 hrs following extraction
Engaging in strenuous exercise for 24 hrs following extraction
Drinking through a straw (for 7 days)
Disturbing the extraction socket with fingers or tongue
Some bleeding can be expected. If unusual bleeding occurs, place cotton gauze, wet paper towel, or wash cloth firmly over the extraction area and bite down or hold in place for fifteen minutes. A tea bag can also aid in clotting. Repeat if necessary.

Maintain a soft diet for a day or two, or until your child feels comfortable eating normally again.

For mild to moderate discomfort following extractions, we recommend using Children’s Tylenol, Advil, or Motrin as directed for the age of the child. If a medicine was prescribed by Dr. Ruelf, follow the directions on the bottle.enamelplasty


Teeth often have variable thicknesses in their outermost enamel layer. Enameloplasty is a procedural term which means “to reshape or modify enamel”. It may be performed for a variety of reasons which include: preventing fractures from worsening, normalizing irregular anatomy, or making space for adjacent teeth. The goal is to leave plenty of enamel such that the tooth is not compromised.

Pulp Capping

Pulp capping is a technique designed to preserve the life of a potentially infected pulp. There are two broad types of pulp caps: direct and indirect. These techniques are only successful if the pulp is mildly inflamed. One may consider both of these procedures as a potential alternative to root canal therapy.

Direct Pulp Capping

This procedure is performed when a very small mechanical exposure to the pulp chamber has occurred. The small area exposed to the pulp is then covered with a biocompatible restorative material, such as calcium hydroxide or mineral trioxide aggregate (MTA), which seals the tooth from microscopic leakages. Once the final restoration (crown, amalgam, or composite filling) is placed, the pulp and dentin layers of the tooth should repair themselves over time.

Indirect Pulp Capping

In this figure, take notice to the gap between the pulp cap and pulp chamber.

Indirect pulp treatment is a procedure performed when a tooth exhibits a deep carious lesion that is close to the pulp but shows no signs or symptoms of entering the pulp. The caries surrounding the pulp is left in place in order to avoid a pulp exposure and covered with a biocompatible restorative material. So long as the tooth remains well sealed from bacterial contamination, the decay process will likely halt and reparative dentin will form to protect the pulp.

Preventative Dentistry

Sealant Therapy

Sealant is a dental material which is placed into the pits and fissures of teeth in order to help further block out plaque and bacteria. Teeth selected for this procedure are normally molar teeth because they have natural crevices (pits and fissures) which trap food, plaque, and bacteria. Once sealed, up to 80% of the decay that affects molar teeth can be avoided.

Sealants are actually clear in color, but appear white in this figure for demonstration purposes only.

Sealants are actually clear in color, but appear white in this figure for demonstration purposes only.

Teeth selected for sealant therapy are first cleaned with a special solution, washed and dried. Next, flowable sealant material is expressed onto the tooth to then be light cured (this is how the material is bonded and hardened to the tooth). Those teeth which have had their surfaces sealed are then checked by Dr. Ruelf during your child’s regular dental visits. If there has been wear or loss of the sealant material over time, they can be touched up or replaced to ensure they continue to act as an effective barrier against decay.


A prophylaxis is a professional dental cleaning recommended for the removal of plaque, stains and calculus.  Although it is possible to remove most plaque using a toothbrush and dental floss, many patients do not have the motivation and/or skill to maintain a completely plaque-free state for too long. The frequency that your child requires professional cleanings completely depends on their level of risk. If their risk of developing cavities or gum disease is high, they will naturally need more frequent observations, progress assessments, and professional cleanings than if their risk was low (for information on how such determinations are made, please visit the ‘caries risk assessment’ section below).  In general, however, most patients will receive a prophylaxis once every 6 months.


The benefits of a professional dental cleaning include:

The removal of plaque, staining, and calculus

The elimination of factors influencing the plaque build-up and retention

The demonstration of proper oral hygiene to your child

Receiving a thorough clinical exam and evaluation

supragingival cleaning refers to the removal of plaque and calculus above the gum line.  This is the most common area for plaque to form in children.  Some younger patients, however, require the additional removal of subgingival calculus, which exists below the gum line. This kind of calculus buildup is a major factor leading to periodontitis, or gum disease.  Calculus of both types is generally removed best by your dentist with the use of mechanical hand instruments known as scaling instruments.

Rubber cup prophylaxis, which uses a fine paste, is used to remove extrinsic staining and smooth roughened enamel surfaces following scaling. If significant staining of the teeth is still apparent, a professional whitening procedure may be desired (read more about tooth whitening here).

Caries Risk Assessment

Different methods of assessing the potential for developing caries exist.  All methods use a combination of evaluating diet, fluoride uptake level, dental history, and the amount of plaque and/or bacteria present in order to better guide patients towards making the changes necessary to avoid further decay.  Other important determinants of caries risk include genetics, socio-demographics, oral hygiene, and salivary flow.  The quality and accuracy of information provided by you and your child is therefore a critical factor pertaining to this assessment.  Examples of caries risk assessments can be found here.

Following each assessment, patient’s will receive a classification of either “high risk”, “moderate risk”, or “low risk” status.  These classifications ultimately determine the level of professional intervention required, such as the frequency with which your child will be recalled for cleanings and exams.  To better understand how interventional strategy and caries risk determinations work hand-in-hand, you may observe the following resources:

Diagnostic radiographs

X-Rays are used to visualize an area of the tooth or jaw that is not readily visible to the naked eye.  These images are valuable in helping dentists detect, diagnose, and treat oral health problems at an early stage. Many oral diseases can’t be detected on the basis of a visual and physical exam alone, which is why dental radiographs are valuable in providing information about a patient’s oral health. These images can detect such things as early-stage cavities, gum diseases, infections or some types of tumors.

We understand your concern of over exposure to radiation.  By providing our patients digital radiographs, we have reduced radiation exposure by one fourth that of standard film. Even with digital radiographs, it is important to only take x-rays when the benefit of potential diagnosis outweighs the consequences of not taking them. The frequency regarding when dental X-rays should be taken depends on those factors discussed in the caries risk assessment such as the patient’s oral health condition, age, risk for disease, and any signs and symptoms of oral disease that the patient might be experiencing.   To learn more about the current guidelines issued by the AAPD (American Academy of Pediatric Dentistry) when administering dental radiographs, click here.