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Shark Teeth-- Don't Panic!

June 25th 2024

There it is…two rows of teeth, often referred to as “shark teeth"

How did that happen?
What do we do?
Will everything be fine? 
Do we need to see the dentist? 
What does this mean?
Do not worry. Your child is not alone when this happens. In early mixed dentition, the permanent incisors may erupt or grow behind the primary or baby incisors. The sight of this can be alarming to any parent. 

First, it is important to understand that the eruption of teeth is a dynamic process. There are many factors that contribute to this process. When a permanent tooth erupts and the baby tooth is still

present, the is called ectopic eruption. Ectopic eruption means an altered eruption path of the tooth or the eruption of a tooth into a position that is not its normal position in the dental arch (3). Although it is not common, it is believed that prevalence of “shark teeth” is 4.3% in the general population (2). Statistics also show that siblings of patients have a prevalence rate of 19.9%, which is higher than the general population and this supports that there may be a genetic component to this presentation (3). The most common teeth to see ectopic eruption includes maxillary first molars, maxillary canines, mandibular lateral incisor, followed by the maxillary central incisor (3). Females often have a higher incidence of ectopic eruption when compared to males (3). 

Now that we know what this is, let’s understands why it happens. There are several etiological factors that can lead to the presentation of ectopic eruption. Some factors can include the rate of resorption of the primary (baby) tooth, tooth size, jaw width and length or the presence of supernumerary or extra tooth (3). Additionally, we also take into consideration if there has been any previous trauma that could have caused disruption in the development or rotation of the teeth (3). As stated earlier, genetics play some sort of role in this phenomenon, we often see smaller petite children in the office with the chief complaint of "shark teeth". When you think about it, of course it could be due to the child's stature, your looking at a child with a small and narrow jaw that is trying to figure out how to make all of these larger teeth fit. Sometimes the puzzle is not exact and we see patients with that second row of teeth (commonly the lower front teeth) where the permanent tooth missed the roots of the primary tooth by a small amount and in turn are erupting behind the primary tooth. What is important to understand is these factors are beyond our control, but with anticipatory guidance the crowding can help manage growth and development.

What does this mean and what are our next steps?

If there is significant concern, it is best to schedule an appointment for an evaluation. Treatment options vary from patient to patient. Treatment options can include allowing teeth to exfoliate naturally, possibly extraction, and possible early orthodontic intervention (2). Pediatric dentists and orthodontists can provide parents with anticipatory guidance and discuss treatment options and help establish a plan for long- 

Allowing the teeth to exfoliate naturally:

Often, with ectopic erupted front teeth, we can "watch and wait" instead of jumping right into extractions. In our clinic, we sometimes give the child and parent a goal to wiggle and loosen the tooth each day for a specified amount of time and then instruct them to give us a call if the tooth has not naturally exfoliated by that date. Most kids are goal driven so this can easily turn into a fun activity for a child who is not necessarily excited about the idea of the dentist removing the tooth for them. Also, on our side is the magnificent strength of the tongue. With normal talking, chewing, swallowing, tongue thrust motions the majority of the time these "shark teeth" will in fact work their own way out.


Sometimes we do not see the ideal results from "watching and waiting" and the dentist will need to intervene. We know this can also sound terrifying, but at Carolina Orthodontics & Children's Dentistry, you are in great hands. Surprisingly to many, our number one goal is not to treat decay, but to make sure ALL of our guests have a positive experience each time they step inside one of our locations. All of this to say, do not fret if you are advised that your child needs an extraction. Our office offers many tactics to help your child through procedures that may be a little "nerve-wrecking" for them (and sometimes the parent). At Carolina Orthodontics & Children's Dentistry, our team will recommend treatment in a way that will lead to a life-long happy dental patient; such options can include nitrous oxide (laughing gas), oral conscious sedation, and even IV sedation. We also pride ourselves on knowing what our guests need and sometimes that just means a friendly face to walk you through the whole procedure and have you leaving with a smile (and we do have A LOT of smiles to pass along- have you seen the size of our staff?).

Early Orthodontic Intervention:

Carolina ORTHODONTICS & Children's Dentistry, it's all in the name. We know the importance of catching things early and we pride ourselves on having open communication between our orthodontic team and our pediatric team. Our Orthodontists and Pediatric Specialists work hand-in-hand to deliver quality care; this can mean consulting with each other about specific patient needs, having the orthodontist or pediatric specialist take a second look, or tag team a procedure. Our team is trained to spot early signs that a young guest should start seeing the orthodontist and we can even facilitate those visits at the same time (in most locations*) as your cleaning visits to make things even easier on mom and dad.

Take a deep breath & leave the shark antics to the Discovery channel!

In conclusion, maintaining regular dental wellness visits (every 6 months) is your best option to combat "shark teeth". By having a pediatric specialist check your child's growth and development we can usually catch these minor issues early or in some cases give a good warning to mom & dad. If you are ready to schedule your child's next wellness visit please click here and while you are at it, give us a follow on social media to stay in the know for all things CAROLINA ORTHODONTICS & CHILDREN'S DENTISTRY.

"Creating Smiles For All Seasons"

| Cary | Fuquay | Apex | Brier Creek | Rolesville | Fayetteville | Pittsboro |

American Academy of Pediatric Dentistry. Management of the developing dentition and

occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago,

Ill.: American Academy of Pediatric Dentistry; 2023:466-83.

E. Jayni Bradley, DMD, Bell, R. Eruptive malpositioning of the mandibular permanent

lateral incisors: three case reports, Pediatric Dentistry 1990; 12(3):380-7.Rajashekhar R, Sharada J, Suhasini K, Hemachandrika I, Shaik H, Singh PT. Occurrence

of ectopic eruption of different classes of teeth in growing children – A prospective

Study, Indian J Orthod Dentofacial Res 2019;5(3):96-7.

Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting

Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233.

Graduation: Life After Braces

June 1st 2024

 Graduation:  Life After Braces 


Graduation day has finally arrived – not the kind where you walk across a stage in cap and gown, but the day your braces come off, marking the end of an era and the beginning of a new chapter. As you run your tongue along your teeth, feeling the smoothness that was once concealed beneath brackets and wires, you can't help but marvel at the transformation that has taken place. Life after braces is a journey of liberation and newfound confidence. 

While the removal of braces marks the end of one chapter, it also signifies the beginning of another: post-braces orthodontic care. Orthodontic visits in the months following braces removal are essential to ensure that your teeth stabilize properly in their new positions. These visits allow your orthodontist to monitor the progress of your smile, make any necessary adjustments to retainers or other appliances, and address any concerns or discomfort you may experience as you adjust to life without braces. 

Stabilization is crucial because, after the braces come off, your teeth may tend to shift back to their original positions. This is why wearing retainers as prescribed by your orthodontist is imperative. By staying proactive with post-braces orthodontic care, you can safeguard the investment you've made in your smile and enjoy long-lasting results. 

One common concern among individuals who have undergone orthodontic treatment is the development of white spot lesions on their teeth. These chalky white marks are the result of poor brushing and hygiene practices during the time braces were in place. The accumulation of plaque around the brackets and wires can lead to demineralization of the enamel, resulting in these unsightly spots. 

Fortunately, advancements in dental technology offer a solution for treating white spot lesions without invasive procedures. Icon, a minimally invasive treatment, is designed to penetrate the enamel and reverse the early stages of tooth decay. This innovative approach involves the infiltration of resin into the porous enamel, effectively masking the white spots and restoring the natural appearance of the teeth. 

Icon treatment is a game-changer for individuals who may feel self-conscious about the appearance of their teeth post-braces. Not only does it improve the aesthetic appearance of the smile, but it also promotes overall dental health by addressing early signs of decay. With just a single visit to the dentist, you can bid farewell to white spot lesions and enjoy a smile that exudes confidence and vitality. 

Graduation day may have marked the end of your orthodontic journey, but it's just the beginning of a lifetime of smiles. Life after braces is about embracing every aspect of your journey, from the initial excitement of getting braces to the moment you unveil your new smile to the world. So, as you step into this new chapter of your life, remember to celebrate your unique journey and embrace the confidence that comes with your beautiful smile. 

Do you want a whiter, brighter, show-stopping smile after orthodontic treatment? Do you want to amplify your new smile and make sure everyone see's your confidence shining through? At Carolina Orthodontics & Children's Dentistry, we now offer a variety of dental whitening treatment options to insure you have a smile for all seasons. If you'd like to discuss these affordable tooth whitening options and find a fit for your lifestyle just speak with a team member at your next visit or contact any of our convenient locations to learn more. 

If you're inspired by the transformative power of orthodontic treatment, why not take the first step towards your own smile transformation? Schedule your COMPLIMENTARY consultation with one of our orthodontists today to explore your options and learn more about how orthodontic treatment can enhance your smile and boost your confidence. Your journey to a radiant smile begins with a single appointment – don't hesitate to take that first step towards the smile of your dreams. 

Serving smiles for all ages, seasons, & reasons. Book your next visit with us and become a member of the Carolina Smile Squad.
Now scheduling guests at all locations: 
Cary, Fuquay Varina, Apex, Raleigh, Rolesville, Fayetteville, & Pittsboro!

Visit our website to learn more about the services we offer and meet our team! Want to stay connected? Give us a follow on Instagram, Facebook, & TikTok to stay in the know about all Carolina Orthodontic & Children's Dentistry happenings, giveaways, & promotions! Just search @mycarolinasmile

All Are Welcome!

April 30th 2024

All Are Welcome 

(Even If You Don't "Like" Visiting Us)

Bad flavors. Distinct smells. Cavities. Pain. Blood. Bad jokes. Dental bills. Personal space. Private information. The fear of the unknown. There are a lot of reasons to experience anxiety associated with going to the dentist. There are countless TV episodes that, while comical, render a visit to the dentist, at best, uncomfortable. There is even an entire song and scene dedicated to the “horrors” of dentistry brought to life by Steve Martin in Little Shop of Horrors. The fears and anxieties surrounding dental visits are so common to the human experience, that almost anyone can appreciate the way writers and comedians exaggerate what many feel when facing their oral healthcare.

The fear of the dentist is known as dentophobia or odontophobia, and is a very real form of anxiety. According to the Cleveland Clinic, dental anxiety affects more than a quarter of the American population. 12% of those are even reported to experience extreme fear. Dentophobia is documented to prevent people from seeking care, even if they are in pain! This is a problem!

Typically people who have dentophobia are most fearful of the anesthetic, blood, choking, the dentist him/herself, feeling pain, needles, noise from the instruments, and smells. Interestingly enough, studies show that people are not so much afraid of getting the anesthetic, as much as they are of it not working or the lingering numbness.

All of this being said, dentistry has come a long way in creating a more positive experience. Not only have materials and technology improved, but there have also been great advancements in education on behavioral management, conservative treatment philosophies, and an overall transition to a more patient-centered approach to care. Gone are the days where dentists dictate the treatment plan in a “my way or the highway” fashion. Dental students are taught that patient input is critical to the long-term success of treatment, and are trained to engage patients in a discussion about their goals and priorities for their oral health.

While the dental experience has become more comfortable for many, that is not to say that fears are not still present. The triggers for those that suffer from dentophobia or even mild anxiety in a dental setting are still a reality of providing dental care. The soft skills or bedside manner can make all of the difference in how those triggers are perceived. If adults are known to have such significant worries at the dentist, how must our little ones feel during these encounters? Especially with significantly less life experience and coping mechanisms. They are tiny humans, everything feels bigger and scarier!

One of the greatest privileges as a pediatric dentist is having the opportunity to create the first associations with the dentist for our little ones. The fears many people experience at the dentist

can often be traced back to a negative experience they had as a child. People underestimate the complexity of a child’s thoughts or their level of awareness. Because of this, it is easy to fall into the trap of speaking “at” children. Directive or command based language may be used without the explanation that children (or anyone) would benefit from. In my experience, showing children all of the materials and instruments that are used with a fun or relatable explanation, can be the difference between a “screaming and uncooperative child” to a child that may still be anxious, but trusting and ready to follow instructions step by step.

The American Academy of Pediatric Dentistry recommends that children see a dentist for their first exam at the eruption of their first tooth or by their first birthday. There are important developmental reasons for this. But it is also largely to encourage early exposure to the dentist. Early exposure builds confidence through easy and painless visits. While there may be tears for a toddler, they can leave knowing that nothing hurts. Building trust with their provider is critical to good oral health. Without regular and early visits, undetected cavities can form and pain or infection can ensue. Pain often results in emergency visits, which may require emergency treatment. Accidents happen too! Even if you have excellent oral hygiene and healthy dietary choices at home, kids still play contact sports, fall, and do unexpected (or unexplainable) things that can cause dental injuries. If an emergency visit/treatment is your first experience with the dentist, your foundation can be severely compromised.

At Carolina Orthodontics & Children’s Dentistry, we encourage early visits. We do everything we can to create a comfortable experience for the entire family. We are aware of the anxieties that exist and have even worked with other specialists to develop resources to help your child prepare for their visit. When you schedule your first visit, you will be asked if your child has any anxiety, fear, or sensory issues. If these items are flagged, the resources highlighted below can be sent directly to you. We want to make sure that all children, adolescents, and young adults are welcome and comfortable when they join our team.

Some of the resources available to patients include videos showing our dental instruments. These videos allow patients to see what these instruments look and sound like, and how they are used. This may be particularly helpful for those with sensory issues that may struggle with loud or high pitched noises. Preparatory videos help to gain some familiarity before their arrival. You can always expect us to “tell, show, do” each step of the experience with your child before we get started. Rest assured, your child will have the opportunity to see and feel most things we use in the office several times before getting started.

2Social stories can be a great resource for children on the Autism spectrum. The stories can help present the experience at the dental office from the pediatric patient’s perspective in a step by step fashion. We have social stories available for different types of dental visits.

We have weighted blankets and hand held items available for use at each visit. We also have fun incentives that can be helpful for patients to get through challenging steps.

All of the pediatric dentists you’ll see in our offices have completed specialty training in pediatric dental care after dental school and are board-certified. The pediatric dental curriculum includes extensive training in behavior management, child/adolescent psychology, and being able to safely and comfortably deliver dental care in all scenarios to meet all of our patients’ unique needs.

We pride ourselves in doing all that we can to make your child feel safe, seen, and comfortable when they are in our care. You may notice that we have crafted our own language for the materials and instruments that we use, so that our patients can understand what they are and how they are used. We communicate in a way that children can understand and relate to, without using trigger words like “shot” or “needle.” You can also find a list of other common trigger words on our website that are helpful to avoid when preparing your child for a visit with us.

Our hope is that everyone who walks through our door, no matter their age, gender, anxiety or with the dentist, or experience level can visit us knowing that it is a safe space.

We are proud to serve our community and create "Smiles For All Seasons" with locations across the Triangle and the Sandhills. 

Convenient Locations: 

Cary Park: 7535 Carpenter Fire Station Road Cary, NC 27519

Fuquay Varina: 1625 N. Main Street, Suite 201 Fuquay Varina, NC 27526

Apex: 1460 Kelly Road, Suite 201 Apex, NC 27502

Raleigh: 7860 Brier Creek PKWY Raleigh, NC 27617

Rolesville: 101 Redford Place Drive, Suite 100 Rolesville, NC 27571

Fayetteville: 2350 Bentridge Lane, Suite 301 Fayetteville, NC 28304

Pittsboro: OPENING IN JUNE- 50 Lifestyle Place, Suite 200 Pittsboro, NC 27312

Need to schedule your next visit?

Call or click to request a visit at the location that fits you best!

Do's and Don'ts of Braces

March 26th 2024

 Do's and Don'ts of Braces


1. Maintain Regular Oral Hygiene: Brush your teeth after every meal to prevent food particles from getting stuck in your braces. Flossing is equally important to reach areas that your toothbrush might miss.

2. Follow Orthodontist's Instructions: Adhere to the guidelines given by your orthodontist. Attend regular appointments for adjustments and follow-up visits.

3. Eat Braces-Friendly Foods: Choose soft and easy-to-chew foods to avoid discomfort and damage to your braces. Opt for items like yogurt, soft fruits, and pasta.

4. Use Orthodontic Wax: If wires or brackets cause irritation, use orthodontic wax to create a barrier between the braces and your cheeks or gums.


1. Avoid Hard and Sticky Foods: Hard foods like nuts, hard candies, and popcorn kernels can exert excessive pressure on braces, potentially causing brackets to break or wires to bend. Sticky foods such as caramel, taffy, and gum can easily get stuck in braces, making them difficult to clean and increasing the likelihood of plaque buildup and tooth decay. By making mindful dietary choices, you can help protect your braces.

2. Don’t Skip Appointments: These appointments are essential for your orthodontist to monitor the movement of your teeth, make any necessary adjustments to your braces, and ensure that your treatment plan is on track. Skipping orthodontic appointments can disrupt your treatment progress and may lead to setbacks in achieving  your desired results.

3. Limit Sugary Snacks: Sugary snacks, such as candies, sodas, and sweets, can increase the likelihood of tooth decay. When sugary snacks are consumed, bacteria in the mouth feed on the sugars and produce acids that will cause decay. Instead of sugary snacks, opt for healthier alternatives like fruits, vegetables, and dairy products, which are not only lower in sugar but also provide essential nutrients for maintaining overall health.

4. Skip Cleaning Your Braces: Neglecting oral hygiene can lead to tooth decay and discoloration. By maintaining diligent oral hygiene habits, you can ensure the success of your orthodontic treatment and maintain a healthy smile throughout the process.

Hygiene Care for Braces:

1. Brushing:

Choose a toothbrush with soft bristles to avoid damaging your braces or causing irritation to your gums. Angle the toothbrush towards the gum line and brackets to ensure that you clean around the brackets and wires thoroughly. Brush the front, back, and chewing surfaces of your teeth and use fluoride toothpaste to strengthen enamel and protect against decay.

2. Flossing:

Flossing with braces can seem challenging, but it is essential for maintaining optimal oral hygiene. While traditional flossing may be more difficult with braces, there are specialized tools like floss threaders, and interdental brushes that can make the process easier and more effective.

3. Mouthwash:

Your braces are crafted from top-quality stainless steel, ensuring they resist rust and corrosion. Incorporating daily mouthwash use with braces is crucial for maintaining oral hygiene, since it prevents gum disease and cavities, and leaves breath feeling fresh.

4. Regular Dental Check-ups:

In addition to your orthodontic appointments, it is highly advisable to include regular dental cleanings in your schedule. By doing that, you ensure that any potential issues are addressed promptly, helping to prevent complications such as gum disease, cavities, or enamel erosion. Additionally, your dentist can provide personalized advice on oral hygiene practices tailored to your specific needs, ensuring that your orthodontic journey is as smooth and successful as possible.

Things to Avoid:

1. Chewing on Hard Objects:

Chewing on hard objects with braces can damage your orthodontic appliances, leading to discomfort and requiring extra visits for repairs. Avoiding hard objects like ice or pens helps protect your braces and teeth, ensuring your treatment progresses smoothly.

2. Playing with Braces:

Resist the temptation to play with or manipulate your braces, as this can lead to breakages.

3. Ignoring Discomfort:

If you experience significant pain or discomfort, contact your orthodontist instead of trying to address it yourself.

Dealing with a Broken Bracket:

1. Temporary Solutions:

 If you notice a broken bracket, first assess whether it is causing any discomfort or irritation. If so, you can apply orthodontic wax to the area to help alleviate any discomfort and prevent further irritation/

2. Contact Your Orthodontist:

Contact your orthodontist as soon as possible to schedule a repair appointment. In the meantime, try to avoid eating hard, sticky, or crunchy foods that could further damage the bracket or wires. By addressing the issue promptly and seeking professional assistance, you can minimize any disruptions to your orthodontic journey and maintain the integrity of your braces.

Our practice offers 24-hour emergency care assistance, with 3 simple ways to get in touch with a trusted orthodontist. You can utilize the chat tool located on our website, open your DentalMonitoring app (if it is a part of your treatment plan), or call our office at (919) 846-7900 and follow the prompts to speak with the on-call doctor. We may even be able to talk you through a simple temporary fix to hold you over until you can visit us in the office. 

3. Avoid DIY Repairs:

Refrain from attempting to fix the broken bracket yourself, as this can lead to more significant issues.

Caring for braces involves a combination of good oral hygiene practices, adhering to your orthodontist's advice, and being mindful of what you eat. By following these do's and don'ts, practicing proper hygiene care, and knowing how to handle common issues like a broken bracket, you can ensure a smoother and more successful orthodontic experience.

We are proud to serve our community and create "Smiles For All Seasons" with locations across the Triangle and the Sandhills. 

Convenient Locations: 

Cary Park: 7535 Carpenter Fire Station Road Cary, NC 27519

Fuquay Varina: 1625 N. Main Street, Suite 201 Fuquay Varina, NC 27526

Apex: 1460 Kelly Road, Suite 201 Apex, NC 27502

Raleigh: 7860 Brier Creek PKWY Raleigh, NC 27617

Rolesville: 101 Redford Place Drive, Suite 100 Rolesville, NC 27571

Fayetteville: 2350 Bentridge Lane, Suite 301 Fayetteville, NC 28304

Pittsboro: OPENING IN MAY- 50 Lifestyle Place, Suite 200 Pittsboro, NC 27312

Need to schedule your next visit?

Call or click to request a visit at the location that fits you best!

Treatment Spotlight: Zirconia Crowns

February 22nd 2024

               Treatment Spotlight:

Zirconia Crowns

It can be overwhelming to be told that your child has extensive dental needs and tooth decay that requires more than a filling.  Many parents become concerned with the child’s experience with the procedure, the cost, the invasiveness and, of course, the appearance of the restoration.  Luckily, we live in an era of oral health care that provides us with options and alternatives that can be both affordable, manageable and beautiful for patients of all ages.

As parents, you may be wondering why we are even using crowns on baby teeth.  Baby teeth serve a very important function for children - for purposes of speech, growth and development and eating.  Research has shown that untreated cavities in baby teeth can lead to issues with sleep and even with problems performing in school.  And the scientific literature shows numerous benefits to saving teeth over removing the tooth when possible.  The best option to hold space for an adult tooth is a properly functioning baby tooth!

Parents often wonder what their options are when exploring various alternatives for their child’s oral health.  Many of us have seen or know a child with a silver crown on their back teeth.  And while those silver crowns, or stainless steel crowns, are considered the gold standard and have many years of successful clinical outcomes, parents and occasionally patients are bothered by the esthetic shortcomings.  Fortunately we are able to offer our families an alternative option for full-coverage restorations that are far superior esthetically.  Thanks to very advanced dental technology, we have the option of Pediatric Zirconia Crowns, which are both attractive and functional.  And for some families this can mean a world of difference in their perception of their child’s oral health.

Many years ago, in an effort to make stainless steel crowns more appealing in their appearance some companies began to offer white coated stainless steel crowns.  Frequently these crowns do not hold their initial improved appearances long-term as the white facing chips, breaks or comes off completely.  This leaves the original silver backing very present and obvious, creating more esthetic concerns for the family and patient.  Additionally, this rough surface is a larger area for plaque accumulation and cleanliness is more difficult for the patient and parent.

Alternatively, pediatric zirconia crowns are metal-free and research has shown that they are very biocompatible, which means less gingival irritation for your child and optimum conditions for maintaining ideal oral hygiene after placement of the crowns.  Because of their smooth surface and glazed exterior they are resistant to stains and their appearance makes it difficult to discern them from natural teeth.  Pediatric zirconia crowns can be used to address cavities or esthetic concerns on front and back teeth, helping to totally transform a young child’s smile.  Patients gain an increased sense of confidence when their smile is restored and parents can feel confident that they have chosen an option with a proven track record.

In our practice, our doctors use EZ Crowns by Sprig Oral Health Technologies (  Each provider has participated in advanced training to learn the most effective techniques in diagnosis and placement of EZ Crowns.  These days there are numerous pediatric zirconia crown options but our team of specialists chose EZ Crowns for several reasons.

EZ Crowns have a unique approach to removal of carious tooth structure, making them a more conservative option than some of the other brands on the market.  Additionally, they have internal ridges that increase their retention, making them designed to last until the permanent teeth are ready to erupt.  According to the Sprig website “Each crown is glazed with a hint of natural color, making them very smooth, shiny, and impermeable to staining.”  This makes a very big difference in the appearance of the zirconia crowns and most people have no idea that what they are seeing is not natural tooth structure.  They are durable because they are made from solid Zirconia, which gives your child the confidence to behave (and eat!) like a child!

EZ Crowns have been around for over a decade, with their initial conception dating back to 2006.  The founder, a dentist, worked with colleagues to create the first pediatric zirconia crown, when his own son experienced a fractured tooth from an accident.  From that time he worked tirelessly to create a product that would be easy to use for practitioners, comfortable for patients, and esthetically pleasing for families.

We have been using EZ Crowns in our office for well over 8 years.  We have personally seen the lives of patients and their families changed for the better because of the transformational power of providing a healthy and happy smile to children.  A healthy and confident smile are priceless and we can help your child to achieve that!  Allow our pediatric dental specialists to talk to you about our options and whether or not pediatric zirconia crowns are a good option for your child!

Don't just take our word for it, watch the video below to hear testimonies from parents just like you!

"Creating Smiles For All Seasons"

| Cary | Fuquay | Apex | Brier Creek | Rolesville | Fayetteville | Pittsboro- COMING SOON |


How Does Orthodontic Treatment Work?

January 24th 2024

 How Does Orthodontic Treatment Work?

What a question!  Here is our attempt to break down and summarize the 10-11 years of professional training that each of our Orthodontists here at Carolina Orthodontics & Children’s Dentistry have completed.


One of our favorite analogies is to think of every single person as a puzzle.  

The major puzzle pieces that we need to take into consideration and fit together include:

  • The number of teeth present.
  • The shape and size of those teeth.
  • The shape and size of the jaw bones.
  • The position of the jaw bones relative to the base of the skull.
  • The position of the jaw bones relative to each other.
  • The soft tissues that surround the bones of the face and skull.
  • The soft tissues that surround the teeth

… AND we also need to make sure that everyone is satisfied with the outcome!

At Carolina Orthodontics & Children’s Dentistry each of our Board Certified Orthodontists takes careful consideration to each of these puzzle pieces (and more) to ensure that we achieve the most healthy, functional, stable, and esthetic result possible.  The decision on which appliances to use will depend on which mechanical movements are most important in achieving those desired results.  For the most part, we feel we can achieve ideal results with either of the two main options we offer here at Carolina Orthodontics & Children’s Dentistry.  Of course there will be cases where one option will be more favorable than the other either in mechanics, cost-effectiveness, or efficiency.

The two main Orthodontic options we offer here at Carolina Orthodontics & Children’s Dentistry are: Traditional Braces & Clear Aligners (like Invisalign).  Let’s briefly discuss the similarities and differences of the two options:

Traditional Braces

Braces are attached to each tooth to help control the position of each individual tooth.  The wires that are tied into the brackets are what provide the forces necessary to achieve the desired position.  Each individual bracket has a specific prescription milled into what we call the bracket slot.  The prescription of the bracket will have a different value for rotation, tip, and torque. As we progress through treatment we move into larger and stiffer wires that will eventually “fill” the slot of the bracket and therefore provide more control over the exact position of the tooth.  When we reach our “working” wires which are also referred to as “final” wires we can then make adjustments to the shape of the wires to make finite, detailed changes in tooth position.

Traditional Braces are a fixed appliance.  This means that they are adhered to your teeth and stay there throughout the course of treatment.  Fixed appliances have an advantage in that you know they are always working for you as long as they are in tact.  They are a little more involved when it comes to brushing and flossing around them.  It’s also necessary to be careful and aware of diet with fixed appliances.  In general, the foods that you want to try to avoid are those that are hard, crunchy, and sticky.

Clear Aligners

Clear Aligners are a series of custom-fit plastic aligners that gradually move your teeth between each set.  Small amounts of prescriptive movement are present in each set of aligners and teeth move incrementally until the desired position is achieved. Tooth colored attachments (also called buttons or anchors) are placed on certain teeth to help provide specific pressure points and specific movements.  They also help in the retention of the aligner itself so it doesn’t pop out easily.  Clear Aligners are removable so there are no dietary restrictions and you can brush and floss normally which is a major benefit.  Because the aligners are removable, if they aren’t worn for as many hours as directed, their effectiveness can be significantly diminished.

Clear Aligners have become increasingly more popular over the last 10-15 years.  With increased popularity we have seen improvements in the product materials and improvements in clinical efficiency.  At Carolina Orthodontics & Children’s Dentistry we LOVE both options and for most cases feel we can get an ideal result with either method.

"May The Force Be With You"

Teeth do not know the difference between plastic and metal.  What they understand is the forces that are pushing and pulling against them.  When a force is applied to a tooth a signal is sent to the body to modify the shape and position of the bone that supports those teeth.  This is why moving teeth TAKES TIME.  Orthodontics is actually the process of modifying the bone and ligaments that holds teeth in their position.

After achieving the desired result it is absolutely essential to have a retention plan.  Retainers are designed to prevent teeth from moving back to where they came from.  As long as our hearts are beating, our teeth are trying to move and establish a stable home.  So our saying at Carolina Orthodontics & Children’s Dentistry is “Night Time for a Lifetime!”. Retainers should be worn at least while sleeping for as long as you want to keep your teeth straight.

In Summary, there is A LOT that goes into how Orthodontic treatment works.  Here at Carolina Orthodontics & Children’s Dentistry our Board Certified Orthodontists try to help each guest reach their smile goals individually.  We love what we do… and we’re super grateful for entrusting us with your treatment.

Have you been considering orthodontics to improve the look and function of your smile for yourself or your child? The time is now and getting started is easy. Connect with us today to reserve your FREE orthodontic consultation and our team will make a game-plan for piecing together your custom puzzle (smile). At Carolina Orthodontics and Children's Dentistry, we firmly believe in creating smiles for all seasons, meaning smiles for a lifetime and smiles for ALL AGES! 

See you soon.

"Creating Smiles For All Seasons"

| Cary | Fuquay | Apex | Brier Creek | Rolesville | Fayetteville | Pittsboro- COMING SOON |


🦃Thanksgiving 2023- What Are We Thankful For?

November 22nd 2023

What Are We Thankful For?

Thanksgiving 2023

Thanksgiving is not just for enjoying delicious food with family, having extra time off from work, shopping the big sales, or watching football with a full stomach. No, Thanksgiving is so much more than that. Thanksgiving is the perfect holiday to reflect on all that you have and to re-focus your heart and mind on being gracious. Whether you are thankful this year for the roof over your head, your awesome career, your caring family, or maybe you are thankful for the smaller things in life like fast internet, a morning of sleeping in past 7, or scoring the last box of little Debbie Christmas tree desserts (because lets face it, those things are a hot commodity), you should still take a few moments to reflect on it. As you read along and learn about what some of the Carolina Orthodontics & Children's Dentistry doctors are thankful for this year we challenge you to join in on the fun and post what you are thankful for (and while your there tag us-- @MyCarolinaSmile). Not only do our doctors have so much to be thankful for this year, but they also thought it would be fun to share a few Thanksgiving traditions. Our team is so diverse and we enjoy learning new traditions and encourage you to try adding a new tradition or holiday recipe to your rotation this season. 

Dr Nate-- Fayetteville Location

I'm thankful for an exciting past year with lots of good changes like moving to Fayetteville and starting a new practice. And I'm thankful for my wife who encouraged me and supported me with all these new changes!

Like a lot of families we get together for a big Thanksgiving meal with all the classics, and then eat Thanksgiving leftovers for days afterwards. I like to sneak in watching some football and napping, too.

Dr Felicia-- Apex Location

My favorite holiday is hands down Thanksgiving! I Kick off the day with an 8K race in Carboro every year with my running buddies and their family members! 

Dr Jed-- Fuquay & Cary Locations

I'm thankful the Cubs are finally making roster moves to compete for a World Series again. I'm thankful that Hubert Davis seems to be the leader Carolina Basketball needs to continue to lead the Tar Heels to be the greatest basketball program in the history of the universe. I'm grateful for leftover Halloween candy that always seems to satisfy the unexpected cravings that pop up throughout the whole year. I'm thankful for beef jerky, energy drinks, Titleist golf balls, college football, stand-up comedy, sappy country music, and NC beaches. I'm also thankful for the person that absolutely loves me more than any other person on this planet possibly could.... 
my dog. 

I'm actually most thankful for all the beautiful people that I get to rub shoulders with every day especially my wife, kids, family, friends, neighbors, and coworkers alike. I've been seriously blessed with some incredible people in my life and I'm grateful for all of them!
Happy Thanksgiving!

My wife makes a killer pumpkin pie. My signature move on Thanksgiving is smoked brussel sprouts w/ bacon

Dr Erin-- Rolesville & Brier Creek Locations

This year I am most thankful for the health of my family!

My favorite Thanksgiving tradition is Friendsgiving - We moved to NC and do not have extended family here. We are thankful for friends helping make it a memorable holiday every year!

Dr Jordan-- Cary & Brier Creek Locations

I am thankful for my amazing family both near and far, every day but especially when Thanksgiving gives us a chance to focus on it.

As far as favorite recipes go, can’t beat the stuffing (secret ingredients can’t be shared)

Dr Lauren-- Fuquay Varina Location

I'm so thankful for the time that we've been able to spend with family this year! We've had 5 family weddings this year, which is sometimes the only time we get to see extended family all together since we live so far apart. We have also gotten to travel to California and the NC mountains with family, and recently ran the Disney Half Marathon in Orlando with family! It has been so fun seeing everyone more than once this year!

Our traditions go a little like this: We always watch the Macy's Thanksgiving Day Parade, followed by the Thanksgiving Day National Dog Show -- the miniature schnauzer should ALWAYS win, in my opinion! Then it's turkey time!

Dr Brett-- Apex & Brier Creek Locations

I am thankful for my wonderful family!

One of my go-to's is Raspberry Cream Pie... You've got to try this recipe!

Follow this link to make your own!

Dr Jenna-- Apex & Cary Locations

I am thankful for so many things this year and always. I am so grateful for my family - even with the expansion!! 😊 I am thankful for my work family. They keep me on my toes and help make sure we all get through this adventure together.

 I am thankful for all of our amazing patient families and how trusting they are for us to take care of their most precious members. I am grateful for the awesome team of doctors that I work with every day. We really do have the best of the best on our team! I am grateful for friendships, learning and growth.

 And I am especially grateful for the UNC Tar Heels and the excitement that sports brings to my life! 👣👣

My favorite Thanksgiving dessert is the Pioneer Woman pecan pie-- It's the best version of pecan pie I've ever made, follow this link if you want to impress your family!

Dr Jenna was recently a guest on the My Carolina talk show to discuss healthy dental habits around the holidays.

You can watch her feature here ^ and let us know what you think!

In conclusion, we have SO MUCH to be thankful & grateful for. As a practice we are so thankful for YOU, our guest, for entrusting us each day with caring for your family and allowing us to create smiles for all seasons.
Happy Thanksgiving, to everyone near and far!

ps. Don't forget to brush & floss after you devour all of those delicious holiday desserts!

Need an appointment? Click here <---

| Cary | Fuquay Varina | Apex | Brier Creek | Rolesville | Fayetteville | COMING SOON- Pittsboro |

Debunking Myths: Orthodontic Treatment

September 20th 2023

 Debunking Myths: 
Orthodontic Treatment

Let’s set the scene: you are considering straightening your smile, but now you are thinking about all the options and all the pro’s and con’s and it is becoming slightly overwhelming. Or maybe your son/daughter has been BEGGING you for braces because his/her friends ALL have them, but you are not convinced there is a need or that your child can handle treatment. Let this be a guide to help ease your mind and make you feel more confident in your decision making when choosing an option to straighten your smile and take control of your smile journey. 

Traditional metal braces are not esthetically pleasing!

Braces are used by your orthodontist to help you improve the look and feel of your smile. While traditional metal braces are what most people think of first when considering straightening their smile, there are many popular options available. At Carolina we offer our guests traditional metal braces, metal Damon braces, ceramic or “clear” Damon braces, and Invisalign clear aligners. 

With the advances made by Align Technology, clear aligners or trays are becoming more and more popular amongst guests of all ages. Not only have clear aligners become the choice amongst teens and young adults, but also with adults and professionals because the aligners are discrete and the care aspect is easy to maintain. Clear aligners have their perks as the aligners are easily removed for routine oral hygiene care, eating, drinking, and are easily removed for big presentations or if needed for work tasks. 

Our ceramic or “clear” Damon option is a good fit for anyone who may feel overwhelmed with keeping up with your clear aligner trays. The ceramic Damon system is very similar to traditional metal braces, the science is the same but the upper brackets are “masked” as the ceramic brackets blend in with your smile unlike the metal option where you can see each bracket immediately. As a general rule, our office offers the clear ceramic Damon brackets for the upper teeth. We usually recommend metal on the lower teeth because when most people smile you cannot see their bottom teeth. At the end of the day, the decision is up to you, you know yourself best and know what option will fit best with your lifestyle.

Orthodontic treatment takes too long!

The amount of time spent in braces will vary depending on the individual patient, because every smile responds differently to treatment. Treatment times can take anywhere between 6 and 30 months, but most standard treatments take about 18 months. At Carolina, we offer complimentary orthodontic consultations to all of our guests so that we can take the time to sit down with you and review your X-rays, hear your concerns about your smile, review your customized treatment options, and importantly give you an estimate of how long it may take to give you the smile you’ve been dreaming of. 

Will I spend all of my free time at the ortho office?

Believe it or not, some orthodontic treatment options CAN free up your schedule and you CAN actually spend minimal time at the office (compared to traditional braces). At Carolina, we partner with DentalMonitoring to provide our ortho guests with optimal care while allowing you to be in the driver seat, orthodontic treatment your way! Did you know you can see your Orthodontist less, but stay more connected than ever? DentalMonitoring is an app based technology that is powered by the industry’s largest dental image database making their AI capabilities unique in assisting our board certified orthodontists to provide each guest with precision care. It is so easy to use, anyone can do it.. Promise. With the DentalMonitoring app and ScanBox pro, you can now send in photos of your teeth and communicate with your doctor securely from the comfort of your home — or anywhere in the world. Your doctor will receive your photos to review your treatment and ensure it’s on track without the need for unnecessary trips to the office. The doctor will send communication and guidance on your treatment via the app, such as “You are doing great, please advance to your next tray” or “Let’s allow these trays to work a little longer, please do not advance this week”. Over time, you can monitor the progress of your treatment with our photo time lapse technology that shows you how your teeth are moving towards your goal. You get to see your teeth “move” in real time! 

Is orthodontic treatment only for cosmetic purposes?

Braces are a cosmetic treatment procedure if you are self-conscious about your teeth and want to improve your smile. However, if you have a dental problem that needs to be corrected to improve your oral health, you should see care with an orthodontist. Here are some common reason orthodontic treatment may be recommended to you:

  • Keep teeth from erupting in the wrong position
  • Correct crowding
  • Protect teeth and gum tissue 
  • Correct an overbite, underbite, or cross bite 
  • Prevent jaw pain
  • To avoid or aid with breathing or swallowing problems
  • Correct over-spacing or “gaps” between teeth
  • Correct the effects of finger or thumb sucking
  • Prevent heart disease
  • Aid in preventing tooth decay

There are many reasons why orthodontics can improve your daily life along with your overall functionality and health.

Braces are too painful!

Braces do not hurt when they are placed. You will likely feel some discomfort for a couple days as your teeth, gums, cheeks, and mouth get used to your new braces. We always recommend a softer diet the first few days after starting treatment and keeping Tylenol or pain relieve on hand. If the “pain” factor is keeping you from choosing traditional braces vs Invisalign know that both options can come with soreness and discomfort. 

Will I be deprived of good food and drinks during treatment?

Though there are limitations on what you SHOULD and SHOULD NOT eat and drink during treatment, the goal is never to “deprive” your stomach of happiness. With caution and self-control you can still enjoy the “sweeter” things in life… as long as you avoid the sticky treats. Check out this list of foods that are on the ortho “No-No List” that can cause harm or damage to your braces and the overall health of your teeth.

Do you have to skip your dental cleanings when in treatment? How do you keep your teeth clean while in treatment?

Absolutely NOT, in fact, it's even more important that guests receiving orthodontic treatment visit their dentist regularly. With braces, food may be caught in places that your toothbrush can't reach. This causes bacteria to build up that can lead to cavities, gingivitis, and gum disease. Your dentist will work closely with your orthodontist to make sure that your teeth stay clean and healthy while wearing braces. Your dentist and your orthodontist should have close communication during your orthodontic treatment. 

With braces, you should brush your teeth at least three times a day to keep your teeth, gums, and mouth healthy and clean. Brushing regularly will help remove any food that may be caught between the braces or trapped inside your clear aligners. You should also floss daily to get in between your braces where your brush isn't able to reach. Your orthodontist can show you how to properly brush and floss once your braces are placed.

Orthodontic treatment is just for kids!

If you want to improve the look and feel of your smile, then any age can be a great age to see the orthodontist. The American Association of Orthodontists recommends that children first visit an orthodontist around the age of seven; however, orthodontic treatment is not exclusive to children and teens, with about one in every five orthodontic patients being over the age of 21. Whether you're considering treatment for yourself or for a child, any time is a good time to visit the orthodontist.


Orthodontic treatment is too expensive!

Orthodontic insurance is different from most regular dental policies. Most orthodontic policies cover 50% of the cost, up to a specified lifetime maximum set by each insurance company. Prior to your first appointment, we ask that you become familiar with your benefits so we can provide the most accurate information regarding your out of pocket expenses throughout your treatment.

At Carolina, we accept most major insurance plans as well as Health Savings Accounts (HSA). Since Carolina Orthodontics and Children's Dentistry is an in-network/preferred provider for many of the major insurance companies, you can maximize your insurance benefits more easily. As a service to our patients, we are happy to verify your orthodontic benefits and process your insurance forms for you.

Treatment fees vary according to the time estimated for your individualized treatment and a few other factors. Our fees are all-inclusive. This means we do not charge for pre- and post-treatment records, braces removal, or retainers. An estimate of these fees will be provided during your first appointment at the complimentary consultation. Don’t worry, all financial arrangements will be thoroughly discussed with you before beginning treatment.

We offer various payment plans and work closely with you to find one that fits into your budget. Our payment and financing options include:

No interest, in-office financing: This usually consists of a down payment and then the balance divided into interest-free, monthly installments over the course of the Orthodontic treatment.

Fee reductions are offered for pre-payment in full or for families with multiple patients.

So What Comes Next?

Connect with us and schedule your FREE orthodontic consultation at one of our many locations including: Cary, Fuquay Varina, Apex, Brier Creek, and Fayetteville.

Have your insurance card ready when you chat with a team member to schedule your visit, our team will do our best to have your benefits breakdown in time for your visit.

Maybe you’ve already had a consult and you needed some extra time to think over your options, your next step is to reach out to our team and schedule your bonding appointment (traditional braces) or Invisalign scan. Still have questions before you schedule? Don’t be shy, contact the office and we can have one of our outstanding treatment coordinators reach out to go over any questions that you may have. 

Before you go, check out this amazing offer available to all eligible Invisalign guests who schedule their scan or secure their deposit by 9/30. 

“Creating Smiles For All Seasons”

| Cary | Fuquay Varina | Apex | Brier Creek | Rolesville | Fayetteville | COMING SOON- Pittsboro |

Pediatric Oral Health (Including Breastfeeding & BOHP)

August 4th 2023

Pediatric Oral Health (Including Breastfeeding and BOHP) 

“Why does my child have cavities?” 
“What should I have done differently?” 

You may find yourself thinking about questions similar to these. Cavities are preventable and helping your child start out “on the right track” by establishing healthy habits is crucial to not only healthy oral health as an adult, but optimal systemic health, too. 

Early childhood caries (ECC) is a “significant chronic disease of childhood.” According to the American Academy of Pediatric Dentistry, ECC is defined as a decayed, missing, or filled tooth in someone under 6 (AAPD ECC). If a child under 3 years old has a cavity on a “smooth” surface (not in the grooves of the teeth), a cavity on a front top tooth under the age of 5, or more cavities than their age (ex 5 cavities in a 4 year old) then the AAPD describes the child as having severe early childhood caries. Did you know 23% of kids between 2 and 5 years old have cavities on baby teeth? 

Many consequences of early childhood caries exist: “a higher risk of new caries lesions in both the primary and permanent dentitions, hospitalizations and emergency room visits, high treatment costs, loss of school days, diminished ability to learn, and diminished oral health- related quality of life” (AAPD). 

A cavity is formed when a healthy tooth starts to break down (or demineralize) forming a hole or cavitation in tooth structure. Bacteria exists in the oral cavity and that bacteria metabolizes food creating an acid that breaks down the tooth structure creating a cavity. Thus, good oral hygiene practices (including brushing and flossing) and a healthy diet are essential. 

Cavities are preventable and it is important to instill healthy dental habits from a young age. Below are helpful tips for caries prevention: 

  • Baby's First Dental Visit
    • Establish a dental home by baby’s 1st tooth or 1 year of age (the rule of 1’s). 
  • Optimal Oral Hygiene. 
    • Prior to tooth eruption, wipe your baby's gums with a warm, soft, damp cloth. Once the teeth erupt, transition to a small, so^-bristled toothbrush. 
    • Adult supervision is key. Cleaning an infants gums or brushing a child’s teeth once tooth eruption has occurred, minimizes the oral bacterial load and sugars that can cause cavities.
  • Fluoride 
    • Community water fluoridation (It is key to preventing dental caries on a public health level. Lifetime exposure to community water fluoridation has been shown to reduce cavity prevalence, may reduce caries-related visits, and avoid dental surgeries under general anesthesia)
    • Professionally-applied fluoride varnish treatments. These treatments are commonly preformed at routine dental cleaning appointments twice per year, but can also be recommended on a more frequent schedule as prescribed by a dentist.
    • Fluoridated toothpaste
    • Fluoridated toothpaste: if your child cannot spit (typically 3 and under), use a smear/grain/rice sized amount. Once your child can spit, transition to a pea sized amount. Please always check the label of your child’s toothpaste, training toothpaste and flouoride-free toothpaste will not aid in preventing cavities (look for the words “Anti-cavity” and “Active Ingredient: Sodium Fluoride”).
Tip: allow your child to choose their own toothpaste, this gives them a 
sense of control in their daily hygiene routine.

  • Diet
    • Sugary snacks and drinks such as juice and flavored milk should be limited (and avoided in children under 2 years of age).
    • Limit juice to 4 ounces per day for children 1 to 3 years. The rule of thumb is to allow your child 1 special drink per day (at a mealtime) whether that be juice or flavored milk.
  • Encourage 4-6 oz of water per day for a infants age 6 months to 1 year old. 

What About Breastfeeding?
Breastfeeding and bottle feeding – Per the American Academy of Pediatric Dentistry, parents should eliminate the baby bottle and plan to stop breastfeeding beyond 12 months”.

The American Academy of Pediatrics (AAP) recommends breastfeeding due to its “short- and long-term medical and neurodevelopment advantages.” The AAP also recommends “exclusive breastfeeding” for approximately 6 months after birth. A baby’s first tooth typically erupts between 5 and 8 months. The American Academy of Pediatric Dentistry encourages the nourishment of children up until 12 months with breastmilk but acknowledges the increased caries risk for children fed beyond 12 months or breasted nocturnally (throughout the night). It is important to note that breastfeeding alone does not contribute to cavity formation, but in combination with carbohydrates and sugars breastmilk has been found to be cariogenic (causes cavities). It is important to make sure we are brushing a child’s teeth after having a bottle at night, too. 

We often forget our youngest kids when considering diet. Yes, we realize kids should have limited sugars and carbohydrates. Yes, we likely know the benefits of breastfeeding. Do we always remember that breastmilk or formula may play a part in cavity development? Early Childhood Caries (ECC) was previously called “baby bottle tooth decay” and “nursing bottle caries”. The broader name of ECC was adopted to make it clear that cavities in young children are not just due to dietary considerations (see the first three bullet points above). That being said, diet is an important part of the equation. Let’s dive a little deeper... 

The pediatric dentists at Carolina Orthodontics and Children’s Dentistry are trained in the Baby Oral Health Program (BOHP). BOHP is a program designed to educate and provide resources for dental healthcare providers regarding infant and toddler oral health. This is of utmost importance considering “oral health [is the] window to the entire body.” BOHP’s mission is “to improve the health trajectory of every child by engaging providers to deliver comprehensive and essential preventative oral health services in early childhood.” Through the BOHP program, the dental healthcare provider has access to resources such as a caregiver presentations to not only better educate themselves, but their patient’s parents. By using the resources provided, our pediatric dentists are better able to understand where their parents are in their oral healthcare journey and better help them achieve an optimal oral healthcare routine and health trajectory for their children. 

We have 5 convenient locations throughout the triangle:



“ Policy on Early Childhood Caries (ECC): Consequences and Preventive Strategies. “ American Academy of Pediatric Dentistry: America’s Pediatric Dentists. The Big Authority on Little Teeth. 

“Policy Statement: Breastfeeding and the Use of Human Milk.” The American Academy of Pediatrics: Policy Statement.hdps:// Statement-Breas4eeding-and-the-Use-of?autologincheck=redirected 

Quinonez, Rocio, et al. The Baby Oral Health Program. 


Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21(2):86-90. 

Autism Acceptance In The Dental Office

April 10th 2023


 Autism Acceptance In The Dental Office

April is Autism Acceptance month and it is important we recognize the amazing caregivers and patients who have been diagnosed.  Autism Spectrum Disorder (ASD) can be defined as a developmental disability with differences in social interaction and or repetitive behavioral patterns that can sometimes interfere with daily interactions or activities. Autism is a developmental disability that affects the way people experience the world. This may include differences in processing senses, thinking, physically moving, communicating, socializing and going about daily living.(1) In 2020, one in 35 children aged 8 were diagnosed as having ASD.(1)  For some patients with ASD, participating in day to day activities can be challenging, many families have a team of providers to assist with providing the best care for their child (1).   The team of providers may consist of the pediatrician, occupational therapist and your dentist.  Together we can provide anticipatory guidance to help parents and patients prepare for their dental visit. 


Establishing a dental home is the first step towards maintaining optimal dental health.  A dental home will allow the patient and parent to develop a relationship with a dental provider and will provide an opportunity for the patient to become familiar with the dental setting (2). 


When scheduling an appointment, please inform the office if you desire increased time for the visit and if there is a certain time of day that works best for you and your child.  During the initial exam, medical history will be thoroughly reviewed.  Information regarding previous treatment or medications used is important to share.  Sometimes it may be necessary to complete a consultation with other health care providers prior to the dental visit. 


During your visit it is important for the dental team to told what to avoid or understand what can trigger negative behavior (2).  Please expect providers to do a clinical examination (head, neck, inside the mouth) and cleaning if the patient allows us to.  We will also attempt to obtain radiographs at the visit.  If there are treatment needs, we will review behavior management options that is offered in our office.  Sometimes a discussion regarding completing or deferring dental care may be necessary prior to major procedures or treatment such as cardiac surgery or chemotherapy (2).   

Caregiver and patient education is key to prevention of dental decay.  Maintaining good daily oral hygiene is important.  We encourage brushing two times a day with fluoridated toothpaste and nightly flossing.  If brushing is difficult to implement, an occupational therapist may be able to offer guidance that can assist with brushing.  Electric toothbrushes and handheld flossers can make brushing easier for the caregiver and patient. A discussion with the caregiver regarding a noncariogenic diet will also help to prevent the development of cavities. (3) 


If you have questions about how to schedule a visit with us, please contact our office.

You may ask, what sets our practice apart from other pediatric dental providers? The answer is simple, our providers and team take your child’s care seriously and prepare for your child’s visit in many different ways to provide your child with optimal care.

1. Specialty Training For Doctor’s And Team

Our pediatric dentist’s have had extensive training to help children of ALL backgrounds, medical disorders, and behavioral disorders. Our dentists specialize in treating children and have learned over time that each child and family is different therefore having different needs. Whether your child is diagnosed as being "on the spectrum” or not, our doctors know the importance of tweaking our methods to match your child’s needs. For example, if your child is not a morning person and would have a better attitude towards their visit if it were in the afternoon we would suggest avoiding scheduling the earliest appointment of the morning. Our team prides themselves on taking continuing education courses to stay up to date with the guidelines and recommendations for treatment and they are always willing to try new things if it means helping your child have a successful dental visit. 

2. The Dental Toolkit 

Last summer we had the pleasure of working with Hannah Schultz, OTD, OTR/L as she wrapped up her capstone project to become an occupational therapist. With the help of Dr. Schultz, we were able to implement her idea of the Dental Toolkit to help children of ALL needs to have successful dental visits. 

The dental toolkit is for children and families that could use additional resources to be comfortable during a visit to the dentist. The toolkit includes access to video models, social stories, and items like weighted blankets and fidget toys to help ease any fear or anxiety during dental treatment. If you would like more information about how you can access the dental toolkit please give our office a call prior to your child’s visit and one of our caring team members can send you the information and links to the video models and social stories. 

Autism Acceptance Month was created by and for autistic people to respect the rights and humanity for all autistic people and center “the perspectives and needs of autistic people with intellectual disabilities, nonspeaking autistic people, and autistic people with the highest support needs.”

Ways To Support The Autistic Community During Autism Acceptance Month:

1- Don’t speak over autistic voices. 

Decisions about autism need to be made by or with autistic people.

2- Avoid harmful language & labels 

Descriptions such as “high functioning” or “low functioning” can come across as harmful and people with autism do not always fit inside the “high/low functioning” category. Everyone has things that they are good at and things they may need help with.

3- Support autistic-run organizations & businesses. 

Support organizations that center autistic voices and are run by autistic people.

4-Don’t perpetuate myths about autism.

Stay up to date on current research & take a second glance before sharing something that furthers stereotypes about autistic people

Acceptance means not only understanding Autism, but respecting Autistic people and not trying to change fundamental aspects of who they are.

Acceptance includes education and inclusion. We encourage you learn about autism and accept differences in the people around them.

Did you know that Carolina Orthodontics & Children’s Dentistry has 6 locations across the triangle?




Brier Creek 



Ready to schedule your family?


1.Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism  Spectrum Disorder Among Children Aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.  MMWR Surveill Summ 2023;72(No. SS-2):1-14. 


2. American Academy of Pediatric Dentistry. Management 

of dental patients with special health care needs. The Reference 

Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of 

Pediatric Dentistry; 2022:302-9. 


3. American Academy of Pediatric Dentistry. Policy on 

dietary recommendations for infants, children, and adol- 

escents. The Reference Manual of Pediatric Dentistry. 

Chicago, Ill.: American Academy of Pediatric Dentistry; 



No Insurance? No Problem!

January 27th 2023

 No Insurance? No Problem!

    Brushing and flossing twice daily is great, but good oral practices alone are not enough. Visiting the dentist at least twice a year is an important part of maintaining good oral health because your dentist can detect areas of decay or other dental issues (in most cases) before they become major problems.

    At Carolina Orthodontics & Children’s Dentistry, we understand that not every family has access to dental insurance whether that be due to the high cost of adding your family as dependents or maybe your employer does not offer family dental coverage or maybe you are self-employed and dental insurance just isn’t possible right now. So you might ask one of more of the following questions: What do we do? How can I ensure my family gets the dental care they deserve? Do I have to pay out of pocket for dental care? Does my budget allow for paying out of pocket? We have an affordable solution for you and your family, because making sure our community has access to dental care is one of our top goals. Did you know that Carolina Orthodontics & Children’s Dentistry offers an in-house dental membership plan to help our un-insured patients offset the cost of cash fees?

Dental Advantage Plan

    Carolina Orthodontics & Children’s Dentistry is now offering to our patients without dental insurance a way to save money while still receiving excellent dental care. For this reason, we have created a Care Advantage Plan. With this plan there are no deductibles, no yearly minimums, and no waiting periods to begin your dental care.

    Our annual membership benefits include preventative care, limited & emergency care, and discounts on restorative treatment. Preventative care benefits are covered at your first visit to include the dental exam and screening, cleaning (prophy), fluoride treatment, and radiographs (either bitewings or a panoramic X-ray). Preventative care benefits also include the services at your second visit of the year (recall appointment); the dental exam and screening, cleaning (prophy), fluoride treatment, and radiographs (only if not take at your first visit). Limited and emergency visits include a 10% discount on the exam and X-rays required for diagnosis. Active dental advantage members will receive 10% off of all treatment including sedation, hospital treatment and in-office IV sedation (discount only applies to the dental portion of the proposed treatment/ hospital fees and anesthesia fees are billed by the hospital or PDAA). Another bonus for active dental advantage members is a 15% orthodontic discount, so if your child is ready for braces you would have instant savings. 

Terms & Conditions: 

  • 10% Off treatment is to be completed within the year of contract
  • All appointments must be scheduled and completed before the plan year ends
  • Dental advantage membership may not be combined with other offers
  • Non-transferable 
  • No refunds. No Exceptions 
  • Not valid with any other form of dental insurance 
  • The dental advantage plan is NOT dental insurance, it is a loyalty membership discount plan
  • Cancellation prior to plan year end date will result in reversal of the discount applied to all services rendered

So what’s the cost to be a dental advantage member?

    At Carolina Orthodontics & Children’s Dentistry, the yearly cost for dental advantage membership is $347 per child and additional children receive a discounted rate of $299 for each additional child. We understand that each household has different budgets and financial situations so membership can be paid at activation for the entire year or it can be broken into mostly auto-payments of about $29 a month. See the chart below to compare the cost of dental advantage membership to the standard cash fees at our office. 


Standard Fee

Dental Advantage Plan

Initial Exam 


$ Included

Periodic Exam


$ Included

Cleanings (2 per year)


$ Included

X-Rays (with initial exam)


$ Included

Fluoride Treatment (2 per year)


$ Included

Total Cost



But what is the REAL cost?

    We totally and completely understand the struggle of daily life, running a household, having a career, and caring for your family and we also understand the financial hurdles and stress that all the previously listed topics bring about. We know that as parents and caregivers it is tough to make decisions like choosing between dental insurance and skipping out on dental care due to tight finances. We never want to see or hear of our patients having to make the tough decision to not go to the dentist and that is why having a membership program like this has been successful amongst our guests. The American Academy of Pediatric Dentistry recommends that every child has a check-up with their dentist every six months in order to prevent cavities and other dental problems. Primary or “baby” teeth are important for many reasons. Not only do they help children eat and speak clearly, but primary tooth also aid in normal growth of the jaws and forming a path that permanent or “adult” teeth can follow when they are ready to erupt. We hope to see you soon at your next visit. 

Did you know that Carolina Orthodontics & Children’s Dentistry has 5 locations across the triangle?

  • Cary 
  • Fuquay-Varina
  • Apex
  • Brier Creek 
  • Wake Forest/ Rolesville

And coming soon.....

  • Fayetteville, NC

We are so excited to serve the Fayetteville & Fort Bragg community this spring!

Ready to schedule your family?

Check out these excellent resources for parents from the American Academy of Pediatric Dentistry

Interventional Orthodontic Treatment

November 15th 2022

 Interventional Orthodontic Treatment

“Why am I seeing so many kids with braces while they’re still in Elementary School?”

“Aren’t people supposed to get braces when they’re in Middle School?”

“My neighbor’s child got braces when he was in 2nd grade, is that too early?”

As Orthodontic Specialists we are on the receiving end of questions and concerns similar to these every day. Timing in Orthodontics is very important, but also varies greatly from case to case. We wanted to shed some light on Interventional Orthodontic Treatment (also known as: Phase I treatment or Early Phase Orthodontics)

Interventional Treatment has existed for many years, but has recently (in the last 5-10 years) increased in prevalence significantly. The more traditional school of thought was to monitor growth and development until someone has all of their permanent teeth. Once that person had lost all of their primary (baby) teeth, a treatment plan was made on how to align the teeth and correct the bite. Orthodontic treatment has since evolved to include shorter phases of treatment while patients still have quite a few baby teeth and before the majority of their permanent teeth have erupted.

The main objectives and goals behind Interventional treatment is to:

Eliminate or minimize potential risks to permanent teeth as they are erupting into the mouth.

Make complicated orthodontic cases more straightforward to significantly reduce the amount of time in orthodontic treatment once all the permanent teeth are in.

Combat irregularities in growth and development and imbalances in jaw position.

Prevent teeth from getting stuck (impacted) due to severe amounts of crowding

Eliminate esthetic and social concerns when recognized early.

We would like to highlight a few of the most common reasons why Interventional Treatment is prescribed:

1. Severe Crowding:

Crowding occurs when there is a mismatch between the size of teeth and the size of the upper or lower arch. In cases with severe amounts of crowding, some of the permanent teeth that are the last to erupt into the mouth may not have any room to be able to erupt into a reasonable position. This can lead to impaction (teeth getting stuck), ectopic eruption (teeth erupting in a position or angle they aren’t designed to do), or potential root resorption (damage to the roots of neighboring permanent teeth). Any of these risks can significantly complicate orthodontic treatment in the future or may lead to an inability to save a particular tooth or teeth. To avoid those complications an Orthodontist may prescribe early phase treatment to create room for the erupting permanent teeth. This may include: removal of baby teeth before they come out on their own, orthopedic appliances like headgear or expanders, or braces.

2. Traumatic Occlusion:

Traumatic Occlusion refers to damage to teeth, gum tissue, or bone caused by the incorrect position or function of neighboring/surrounding teeth. Each type of tooth in the mouth is anatomically designed for certain functions. When teeth erupt out of position, we can see wear, gum recession, tooth fracture, and bone loss. When these risks are identified, timely treatment is usually recommended to prevent further progression of any potential issues.

3. Growth & Development Imbalances

One of the most important aspects of getting teeth to fit together properly is having balance in the position of our upper and lower jaws relative to the base of our skull. Genetics play a large factor in where the upper and lower jaws are going to grow, but it is extremely difficult to predict the magnitude and exact direction that growth will occur. If early imbalances are detected, an Orthodontic Specialist may prescribe early treatment to help re-establish balance in the position of the jaw bones. This is done most commonly with orthopedic appliances (headgear, expanders, etc.) in conjunction with braces.

4. Esthetic & Social Concerns:

The most common reason Interventional Orthodontics is sought after is to improve the esthetics of our smile. This varies widely from patient to patient. Some patients are aware of what their teeth and smile look like very early and others are not. Some patients may be getting a negative response to their smile from classmates, neighbors, or family members. We want to do everything we can to help these situations and provide patients with confidence in their smile. It’s impossible to quantify the value of having that confidence, but we know it is important for many reasons. We strive to ensure that each patient is pleased and happy with the result after having gone through orthodontic treatment.

When considering Interventional Orthodontic treatment it is essential to also evaluate the patient’s level of cooperation. High dental anxiety, lack of good oral hygiene habits, high risk for developing cavities, and poor compliance are some of the more common reasons that an Orthodontic Specialist might choose to NOT prescribe early orthodontic treatment. Careful consideration for each patient is taken to ensure that we don’t inherit more risks or cause more harm by doing early treatment. In these instances we may elect to allow a particular patient more time to mature.

Hopefully this information can help provide more clarity regarding Interventional Orthodontic Treatment. If you have any questions about how our Orthodontic Specialists use Interventional Orthodontics in our practice, feel free to email, call, text, or chat! We are here for you!

Ready to schedule your child? Great!

We offer complimentary orthodontic consultations to all guests, call schedule your child's visit today!

We have 5 convenient locations throughout the triangle:


& Coming soon to ROLESVILLE!

Dental Trauma-- What Should You Do?

September 27th 2022

 Is your kid wobbly? Does your kid roughhouse? Does your kid play contact sports? 

Emergencies happen. Being prepared is essential. Did you know that the second most common area injured in 0-6 year olds is the mouth? Did you know that if your child has had a traumatic dental injury he/she is likely to have another? Dental emergencies are most likely to occur between two and six years of age and most often affect the gingiva (gums). Ever wonder what to do or who to call if your child has a dental emergency? If your child has lost consciousness, has a compromised airway, has nausea or vomiting, or is bleeding from the ears, nose, or throat, go straight to your physician or the emergency room. If not, don't look any further - we are here. 

We understand accidents do not always happen from 830am-5pm during our normal business hours. Do not hesitate to contact our office. Please call the office and you will be directed to an answering service. Below are some common dental emergencies and what to do. 

“Shark Teeth” 

Does your child have two rows of teeth on the bottom in the front? Do not panic – this is not an emergency. Often, lower front permanent teeth erupt “behind” the existing baby teeth. Once the baby teeth fall out, the permanent teeth are “pushed forward” into the U-shaped arch due to the pressure of the tongue. 

Toothache or discomfort

Clean/ brush around the tooth. Rinse with warm salt water. Use dental floss if anything is lodged in between the teeth. Apply ice or a cold compress if the patient is swollen. Over the counter Tylenol or Motrin can be taken – please, avoid using aspirin. Make an appointment to see the dentist. 

Mouth/Cheek cut or lip bite

Apply pressure to the area to stop any bleeding. Use ice or a cold compress for swelling or the bruised area. Exercise caution when eating - generally a soft, bland diet is recommended until healed. 

Broken/Cracked tooth

Look for the tooth fragments. If found, place them in milk. Check your childs lips, tongue, cheeks for any tooth pieces. Make an appointment to see the dentist. 

Tooth “pushed up/in” (intruded tooth)

Check your surroundings to make sure the tooth did not break. Apply ice or a cold compress to ease any swelling or discomfort. If in pain, take over the counter Tylenol or motrin as prescribed on the bottle. Call the emergency/after-hours number to talk to a dentist and determine the next steps. Call (919) 846-7900 and follow the prompts to connect with one of our doctors.

My kids tooth was "knocked out" (avulsed tooth)

  • Permanent tooth knocked out? Find the tooth. Touch the tooth by the crown (portion of the tooth with white enamel that is exposed in the mouth). Rinse the tooth with a gentle stream of water (do not clean the tooth). Place the tooth back into the socket (inside your child’s mouth). If unable, place the tooth in milk. Time is of the essence - call our emergency/after-hours number to speak to a dentist and determine the next steps. 
  • Baby tooth knocked out? Take a clean piece of gauze/toilet paper/wash cloth/etc. and place it over the area with applied pressure or have your child bite on it (applying pressure). The bleeding should stop. If the bleeding is not controlled, call the dentist. 

Broken braces/orthodontics or appliances

If you can remove the appliance, remove it. If unable to remove it, cover any portion that is uncomfortably poking your child with dental wax. Call your orthodontist or pediatric dentist to assess the situation and make an appointment. 

Wondering about the impact of dental trauma to a baby tooth on the developing permanent dentition? The answer to this question largely depends on the age of the patient, but in general, the root of the baby tooth is located near the developing tooth bud. Some possible sequela to the developing permanent tooth may be change in permanent tooth shape, a “bruise” or mark on the developing permanent tooth, impacted teeth, and changes in tooth eruption patterns. These side effects most often happen when a baby tooth is intruded (pushed in) or avulsed (knocked out). 

Carolina Orthodontics and Children’s Dentistry has a team of orthodontists and pediatric dentists that are here to help you. Contact our office and we can help you decide if your child needs emergency dental care, how soon your child needs to be seen, and/or get your child scheduled. If you contact the office after hours, stay on the phone and a representative will pick up, take your message, and forward it to our on-call doctor. We always have a pediatric dentist and orthodontist on call – someone will be in touch with you shortly. Pictures are often very helpful and can allow the pediatric dentist to make an assessment without seeing the patient – Don’t be surprised if we ask you to send us a picture or two! 

Attend your child’s appointment. One of our pediatric dentists will get a history of the incident from both you and your child and examine the injury. We may obtain radiographs and will perform any necessary emergency dental care. 

Ready to schedule your child? Great!

We have 5 locations throughout the triangle:


& Coming soon to ROLESVILLE!

**CLICK the image above to request your next visit**



Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2020;36(4):343-359. 

“ Frequently Asked Questions. “ American Academy of Pediatric Dentistry: America’s Pediatric Dentists. The Big Authority on Little Teeth.


Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020;36(4):331-342. 

Levin L, Day PF, Hicks L, et al. International Association of Dental Traumatology guidelines for the management of trau- matic dental injuries: General introduction. Dent Traumatol 2020; 36(4):309-313. 

August 23rd 2022

 Should I stay or should I go?

Being present in the treatment room for your child’s dental treatment 

It has happened, your child has their first cavity and treatment is recommended. You are nervous for them and you want to be there to support them every step of the way. However, you ask yourself, “Should I be in the room?” 

Parents are always welcome to accompany their child in the treatment room in our office. There are some benefits to being present for your child’s dental treatment. For example, it allows the parent to see how hard the dental team worked to help make their child as comfortable as possible. It also allows the parent to see the necessary steps for providing dental care for different procedures. Parents can also be supportive and help their child relax if they notice their child is starting to become anxious or extremely nervous. 

If a parent wants to be present for treatment it is important for the parent to know their role in the room. Here are some things to consider: 

  • It is best for the parent to be a silent observer. During dental treatment if your child is doing well, but you ask, “Does it hurt?” or “Are you ok?” repeatedly, this can be distracting and confuse a well behaving patient. Additionally, it can cause them to think that perhaps something should be wrong. It can create anxiety for the patient when everything is actually going well.
  • If the parent has dental anxiety, it may best if that parent is not present for treatment. When a parent has anxiety that anxiety can be transferred to the child. Children will notice if their parent is anxious and this could cause them to be concerned as well. If you know your child does better with mom, dad or their grandfather, they may be the better person to accompany them to their visit.
  • Communicate to the dental team if you have questions. It is important for the parent to understand the treatment process and the treatment that is being provided. You are always welcome to call and speak with a team member about what to expect prior to dental treatment. In fact, asking questions prior to the appointment will help decrease dental anxiety on the day of treatment.
  • It is important for parents to know that body language is important. During and after anesthesia has been given, some patients may cry or become upset. This is normal and expected behavior in most cases, especially if it is their first time receiving anesthesia. Many children may have what we call a compensatory cry during treatment, which very different from a painful cry. A compensatory cry usually is the way a child copes in a stressful situation. When there is a compensatory cry there is no movement, arms and legs are still (sometimes the patient even has their legs crossed). A patient with that behavior is comfortable and doing well. A painful or fearful cry is usually accompanied with lots of movement and patients are unable sit still. If we notice lots of movement or unsafe behavior we will stop treatment. If we are unable to help your child become more comfortable, we should consider other behavior management options for your child. 

When a child is given the opportunity to complete care without the parent present, it can give them a sense of accomplishment and bravery. Having dental treatment is a very different experience. For example, the anesthesia feels strange, the noises can be loud and the vibration can be scary. However, despite all of those factors the pediatric team does their absolute best to calm all fears and provide the best support for a positive experience....because that is what we do for our patients! 

Full circle moment: Why do so many adults have dental anxiety?

Yes, pediatric dentists have a goal of children being cavity-free, but as a profession we are also realistic. We understand that children get cavities and that those cavities require treatment, but we also have the knowledge that some parents may be extremely uncomfortable with the thought of going to the dentist because of their own past experiences as children. It is simple. Pediatric dentists have a mind-set that positive dental experiences stick with us as children and in return those children have a better tolerance of going to the dentist and keeping up with their oral health as adults. There is a cycle at play here. Parents who have positive memories of going the dentist as a child will then willingly bring their child to the dentist (for routine care, not only when there is a specific reason or dental pain). We hear it all the time, “Wow, I wish when I was a kid the dentist made me feel comfortable, where were you when I was growing up”. This is the reason we focus so much on positive visits and strive to provide each child with a customized plan for treatment that works best for their situation. We work together, with parents, to set realistic goals and ways to accomplish said goals. 

If you would like to learn more about the different treatment options available at our practice please follow the link below to our website.

Ready to schedule your child? Great!

We have 5 locations throughout the triangle:


& Coming soon to ROLESVILLE!

Follow the link here or give us a call at (919) 846. 7900

July 7th 2022

Dental Work For Children- Sedation (and Non-Sedation) Options for Treatment 

So, your child has a cavity and needs dental treatment - your next question may be “How do you do dental work on kids?”  Today’s focus will be on sedation, but we’ll review our other treatment options to help you think about which method may be best for your child. 


A pediatric dentist considers many things to help determine which option(s) may help your child manage dental treatment. Some of the things we take into account are behavior during non-treatment visits (cleanings and exams), ability to tolerate dental x-rays, and the amount and type of dental work needed. While we strive to make every dental visit a positive and fun experience, dental treatment visits are typically longer appointments that some children have more difficulty sitting through. There may also be new sounds or feelings they have never experienced before which can be overwhelming for some kids. For children who need multiple appointments to complete treatment, sometimes subsequent treatment visits can be more challenging because they are more aware of what is involved in those kinds of visits, and we can see a decline in cooperative behavior. 


Our office offers several different ways to complete treatment:

(1) Conventional treatment without nitrous oxide

(2) Treatment with nitrous oxide (i.e., laughing gas)

(3) Moderate oral conscious sedation

(4) IV sedation or general anesthesia.  


Conventional Treatment (Without Nitrous Oxide) 

This is the most basic level of care - having dental work done while reclining in the dental chair, without the use of any auxiliary relaxing agents (like laughing gas). This option is great for children with little or no dental anxiety, who are able to tolerate laying in the dental chair for longer appointments (compared to routine cleaning visits). 


Treatment With Nitrous Oxide (aka: Laughing Gas) 

A step up from conventional treatment without nitrous oxide is using what is often referred to as “laughing gas”. Nitrous oxide is a colorless, non-toxic gas that is breathed in through a soft mask placed over your child’s nose. It is an anxiolytic - helps reduce feelings of anxiety - and can help take the edge off for children with mild levels of dental anxiety. This is not a form of sedation, so it will not put your child to sleep (although some children are so comfortable during treatment that they take a light nap!). Aside from reducing anxious feelings and helping children feel more relaxed, nitrous oxide can also help reduce strong gag reflexes and help children tolerate treatment more easily. Another benefit of nitrous oxide is that it is quick acting and wears off quickly. Your child will breathe regular oxygen for the last few minutes of the appointment, which flushes the nitrous oxide out of their system so there are no lingering effects following dental treatment. 


Oral Conscious Sedation (aka: Moderate Conscious Sedation) 

A step up from treatment with nitrous oxide is what we call conscious sedation. This is a type of sedation, but not to the extent that your child will be asleep for treatment. With conscious sedation, your child will drink a liquid oral medication before the appointment starts that makes them feel a little more wobbly and makes them care a little less about what is happening around them; an added benefit is that the medication(s) used can have an amnesic effect, limiting memories of the dental visit. There are a variety of oral sedation medications that can be administered to achieve this effect, and the dosage is based on the weight of the child. It can take some time for the medication to take effect, so the overall amount of time you’ll spend in the office may be a little longer. Typically, nitrous oxide is also used during these kinds of visits. The nitrous oxide will be flushed from the body by breathing a few minutes of oxygen at the end of the appointment, but it can take a little longer for the sedation medication to fully wear off; this means your child may still be a little wobbly once dental treatment is completed and may need to be held when leaving the dental office. While conscious sedation can be beneficial for some, not every child is a good candidate. If your child has high dental anxiety, is unable/unwilling to lay in the dental chair, or would require multiple visits to complete treatment, this kind of sedation may not be enough to get your child comfortably through treatment. If your child has certain medical conditions (i.e., respiratory or cardiac issues), large tonsils, recent or current cough/cold/congestion, or obstructive sleep apnea, your child may also not be a good candidate for conscious sedation. 


IV Sedation (in the dental office) or

General Anesthesia (in a hospital setting) 

This is a deeper level of sedation where your child is asleep to have treatment completed. Children that could benefit from this type of treatment may include those who have higher anxiety, are unable or unwilling to complete treatment while awake, and those with more involved dental treatment needs. Because this is a deeper level of sedation, the sedation will be performed by an anesthesiologist; the anesthesia team will keep your child happy, healthy, and sleepy while the dentist does any treatment that is necessary. An added benefit of this type of treatment is that all dental work that is needed can be done in a single visit. Sometimes these types of visits can be completed in the dental office, while other times they are completed in a hospital setting. One reasona child may be seen in a hospital setting is if they have a complex medical history. 



With any increase in the level of sedation, there can be increased risks. This is why it is important to share your child’s medical history with the dental team, so the dentist can identify and mitigate these risk factors. In addition, it is imperative to follow any instructions regarding food and drink prior to the administration of any kind of sedative medication to minimize the risk of an upset stomach and/or vomiting during dental treatment, as aspiration of stomach contents can become a medical emergency. 


Your child’s safety is always our top priority! With any type of treatment – but especially with any form of sedation your child’s vital signs are closely monitored by their care team. We use visual cues such as seeing their chest rise and fall during breathing, and color of their skin and lips to ensure adequate blood flow. During sedations, we also have tools to monitor their heart rate and oxygen saturation. While we do our best to avoid emergencies during dental treatment, the dental team and anesthesia team are trained in managing emergency situations and have the appropriate rescue gear and protocols in place should an emergency arise. 


The goals of any dental visit include safely completing the visit, minimizing physical discomfort or pain, managing anxiety, and promoting a positive attitude towards oral health. Sometimes, to achieve these goals, children need very little assistance and can tolerate dental treatment with or without nitrous oxide. Sometimes, achieving these goals involves some form of sedation. Your pediatric dentist will discuss what may work best for your child to give your family the best dental experience possible. 


Key Take-Aways: 

  • There are a number of ways dental treatment can be completed: (1) conventional treatment without nitrous oxide, (2) treatment with nitrous oxide, (3) oral conscious sedation, and (4) IV sedation or general anesthesia. Your dentist considers many factors in determining which option(s) may work best for each child, including behavior during cleanings and exams, how well they tolerate taking dental x-rays, medical history, the amount and type of dental treatment needed, anxiety levels, and more. 

  • Safety is our top priority! Share your child’s medical history with the dental team to help us mitigate any risks that could arise during dental treatment. 

  • We aim to make every dental visit a positive experience for you and your child and offer a variety of ways to make this possible! 

  • Ready to schedule your child? Great!

    We have 5 locations throughout the triangle:


    & Coming soon to ROLESVILLE!

    Follow the link here or give us a call at (919) 846. 7900

Maternal Health

May 27th 2022


Maternal Health

May is always a time that we reflect on the importance of mothers in our lives.  We all have a mother or mother-figure that had a strong impact in our lives.  So often mothers sacrifice their time, their energy, their sleep, and their overall well-being to make sure that those they love are cared for and that their needs are met.  During this month we would like to take a moment and talk about the importance of maternal health and how making a mom’s well-being can actually improve the lives of those they love and the community they live in.

From the moment a woman realizes that she is pregnant or has been introduced to the baby that she is now responsible for, her priorities and perspectives immediately change.  Things are no longer about just her and now include concerns for another human being.  There has been significant evidence to show that improving the health of mothers-to-be and mothers increases the health outcomes of their children as well.  In their publication Ensure Health For All, the organization Women Deliver said “Healthy girls and women are the cornerstone of healthy societies. Provide girls and women access to health throughout their lives, and they deliver a healthier and wealthier world.” Early evidence suggests that primary prevention focused on mothers can lead to an improvement of the child’s oral health and general health well into adolescence (Meyer et al., 2013).

Ensuring that a mother’s overall health - both mental and physical - has lasting impacts that reach well beyond their home.  Not only are families happier and healthier, but local and national economies improve when women are healthy.  And these benefits can extend into subsequent generations (Onarheim, et al).

Unfortunately, significant health disparities do exist both globally and in our own country, with minority and under-represented women experiencing increased rates in mortality associated with childbirth, increased complications during postpartum recovery, and continued disadvantages in accessing adequate medical care and nutrition.  As such, making leaders at all levels aware of the barriers these women and families face is extremely important. (Improve Maternal and Newborn Health and Nutrition, As noted above, making strides to close these gaps in access to nutrition and healthcare will benefit all of us.

While all of this may seem overwhelming and hard to think about on a grand scale, we can start by taking an introspective look at ourselves and where we are in our own health journey.  We can make sure that we are up-to-date with our health care needs, scheduling our annual physical and dental appointments.  And we can allow ourselves the opportunity to practice self-care and self-reflection.  Self-care for mothers is extremely important.  It should be pointed out that self-care is not being selfish.  And there are some very important points that need to be acknowledged before we move on:

*Being a mom is hard!

*Being a mom is tiring!

*Being a mom is a daily challenge that 

can test even the most patient person!

You are normal to feel overwhelmed, stressed, confused, or even scared from time to time.  These are all emotions that all mothers feel in their motherhood journey.  Acknowledging that you, as a mother, are entitled to feel this way can help you to step back and process situations as they arise.  Additionally, taking time to be focused on yourself for a period of time is not only helpful, but crucial!

Kaiser Permanente recommended these self-care tips for busy moms:

  1. Get physical - Get moving in whatever way feels comfortable for your fitness level.  This can range from taking a walk around the block, doing strength training, doing yoga, or going for a bike ride.  Just getting up and getting moving, even if for ten minutes, can make a big difference in your mood and well-being.
  2. Think of your Brain - Meditation, journal writing, and reading a good book are all excellent ways to divert your attention from the normal everyday stresses and focus on something you find enjoyable.  There are good resources for meditation, including free applications on your phone like the Calm App and the Insight Timer App.
  3. Pamper yourself - Kaiser Permanente mentions relaxing in a hot bath, planning a spa day, taking a nap, splurging on your favorite flowers or giving yourself a facial.  These are all great ways to unwind from a busy day of shuffling kids to and from practices or figuring out your busy work schedule.
  4. Make time for your friends - you can be creative about how you sneak in time to strengthening friendships.  You can invite them to join in on your yoga session, you can go for a walk, have lunch at a new restaurant, or volunteer with a friend.
  5. Take a leap - Kaiser Permanente recommends doing something that you have never done before - like indoor rock climbing or geocaching.
  6. Working on sharpening your skills in a particular area - like getting back into a sport you once loved, taking a class to improving your cooking skills or artistic abilities.
  7. Let loose - feel free to find laughter in whatever ways you can!  Sing along to a song you love and dance along in the mirror!  

Making time for yourself is not selfish.  It is self-protecting and benefits not only you but your family will also see how more engaged you are and how you are more yourself. 

Ready to schedule your child? Great!

We have 5 locations throughout the triangle:


& Coming soon to ROLESVILLE!

Follow the link here or give us a call at (919) 846. 7900

Meyer K, Khorshidi-Bohm M, Geurtssen W, Gunay H. An early oral health care program starting during pregnancy – a long-term study – phase V. (published online ahead of print June 28, 2013). Clinical Oral Investigations. 2013; DOI 10.1007/s00784-013-1059-3.
Onarheim K, Norheim O, Miljeteig I. Newborn health benefits or financial risk protection? An ethical analysis of a real-life dilemma in a setting without universal health coverage. Journal of Medical Ethics. 2018 Aug; 44(8): 524–530.
Kaiser Permanente (

March 30th 2022

 Virtual Care and Communication

Similar to other industries, the whirlwind of the past two years has brought to our attention the need to better utilize virtual care and communication. At Carolina Orthodontics & Children’s Dentistry we have incorporated two programs that we’d like to make sure you’re aware of that has helped us, our patients, and our patient’s families communicate and even minimize unnecessary trips to the office.

What Virtual Options Can We Offer You?

As a whole, our practice is constantly learning new ways to better the experiences of our patients and to customize each patients experience to meet their needs. As mentioned above, one of the positive outcomes from the pandemic was un-masking the many virtual possibilities in healthcare settings. It is impossible to have an orthodontist conveniently in your pocket, but with the help of SMILESNAP & DENTAL MONITORING we have gotten pretty close! 

1. SMILESNAP (virtual consults and communication)

SmileSnap is directly connected to our website. When visiting our website at it’s located on the lower left hand side of the page. Once you enter some quick general information the software will communicate through text messaging and walk you through how to take 5 photos of your teeth. These are sent directly to our orthodontists and pediatric dentists to review. In turn we’re able to respond with an asynchronous video to answer your questions and help direct you or your child what type of appointment we need to make and when. This has greatly helped provide quality and timely communication to parents, patients and families. In addition, it has helped minimize unnecessary visits for families. If you are accustomed to orthodontic treatment you are familiar with this scenario: 

Your having a late Friday evening snack, you decide to take a risk and indulge in some buttery popcorn and just as you are making a dent in the bowl….POP, SNAP, CRACKLE… your bracket has broken!!!! What do you do? Who do you call? Its Friday evening?

With SMILESNAP there is no need to stress or panic, you can simply send your orthodontist a message and they can assure you of your next steps that way you are not panicking all weekend and you can have re-assurance that everything will be okay and you will get scheduled to have your bracket repaired next week! 

SMILESNAP has also been extremely helpful to our pediatric patients, because everyone with small children knows its proven that dental emergencies almost always happen “after-hours”. Though we have our after-hours phone line for emergencies using smile snap is also very helpful because parents can quickly send photos to our pediatric dentists and receive guidance on how to handle each situation. 

Not a patient yet, but you have been toying with the idea of orthodontics? SMILESNAP allows you to “break the ice” and start the conversation with a board certified orthodontist. The SMILESNAP tool makes it easy and efficient to submit concerns and photos. Our orthodontists are quick to respond and let you know if you are a great candidate for braces and our team can then reach out and schedule you for a traditional consultation (which are ALWAYS complimentary) with the necessary x-rays. 

So why wait?

Click here to start your SMILESNAP consultation and chat with one of our skilled doctors today! 

2. DENTAL MONITORING (Invisalign treatment focus):

What is DentalMonitoring? 

The orthodontic industry’s most advanced remote monitoring solution. AI-powered platform and patented technology to detect and monitor 130+ oral observations, remotely.

  • Allows our orthodontists to check treatment progress and detect issues early through closer supervision of treatment between appointments
  • Giving patients the convenience of connecting with our practice through the app.
  • Patients can scan & send images from anywhere
  • Allows our orthodontists to closely track your aligner treatment and optimize your results
  • Decrease your in-office visits by half

With the DentalMonitoring app and ScanBox pro, you can now send in photos of your teeth and communicate with our offices securely from the comfort of your home — or anywhere in the world. Our team will receive your photos to review your treatment and ensure it’s on track without the need for unnecessary trips to the office. We will send communication and guidance on your treatment via the app. Over time, you can monitor the progress of your treatment with our photo time lapse technology that shows you how your teeth are moving towards your goal. With the convenience of DentalMonitoring technology, why wait to start your smile journey? Click here to start a conversation with one of our board certified orthodontists today!

Whats next for Carolina Orthodontics & Children’s Dentistry?

We are proud to announce that we had our first ever Invisalign virtual event. With the great success of the virtual event we plan on having many more in the future! We never stop learning and adapting to todays technology and will continue to improve the services we offer with each patient in mind.

Be sure to follow us on social media so that you don’t miss out on our next virtual event! 

We hope to see you there.

February 8th 2022


We strive to deliver outstanding specialty oral health care to our patients and to provide them with the care and guidance necessary to have a lifetime of healthy smiles. We genuinely care for the well-being of patients, their families and the community.

Our goal is to provide our community with the highest level of specialized care available.

We believe that your smile is a significant part of your overall health and we strive to provide

our patients with the smile they deserve.

At Carolina Orthodontics and Children's Dentistry in Raleigh, Apex, Cary, Wake Forest and Fuquay Varina, our top priority is to provide you and your family with the highest quality care in a friendly, fun, state-of-the-art environment with unmatched professional service. Our specialists and the entire team are proud to offer outstanding orthodontic and children's dental care in the greater area of RTP.

Please know that we are available to answer any questions that you may have concerning care for you, your family and your friends. Let Carolina Orthodontics and Children's Dentistry help you develop a smile for all seasons!

Watch the video below to hear a special story, read by Dr. Lauren


  • Proper chewing & eating
  • Stimulation of Jaw Muscles for Ideal Development
  • Saving Space for the Permanent Teeth
  • Speech Development
  • Sweet Smiling Faces

**Check out our previous blog post "Why Are Baby Teeth So Important?" to learn more**


There are some things that you can do at home to help keep those teeth healthy and bright. It starts with using fluoridated toothpaste and brushing the teeth every morning and night. We recommend brushing in the morning after breakfast and at night right before bed, avoiding anything to eat or drink after that nightly brushing. 

For children under the age of three, we recommend using toothpaste that amounts to a size of a grain of rice. For children above three, they can use the amount that is similar in size to a green pea. Most children need an adult to help when brushing. We recommend that the grown-up brushes first, allowing the children to “check behind” the adult to ensure that they did a good job of brushing all of the sugar bugs away! And flossing every night can clear away any food stuck between those chompers!

The sorts of things kids drink are just as important in keeping those teeth healthy. Our favorite drink is water! Water is sugar-free, doesn’t cause any changes to the mouth chemistry, and in some cases can have a beneficial amount of fluoride added to it to help protect against any cavities. White milk is our second favorite drink, but it also should be used with caution because it has natural sugars present in the milk. Any other drinks, like juice, soda, or sweet tea, should be saved for special occasions. Those drinks typically have ingredients added that can negatively affect teeth and lead to cavities.

Having a healthy diet is not only good for your body but it is also critical in having a great smile! Fresh fruits and veggies, cheese, and yogurt are good snacks not only for a growing body but also for a growing smile! Avoid sticky foods like gummy snacks, raisins, and sticky granola bars so they don’t get left behind in teeth. And foods like chips and crackers can make a paste when they are chewed and stick around for some time after the snack is all done!


Ready to schedule your child? Great!

We have 5 locations throughout the triangle:


& Coming soon to ROLESVILLE!

Follow the link here or give us a call at (919) 846. 7900

November 18th 2021

 Maximizing Your Dental Benefits:

What's The Benefit?

If you wish to get the most value out of your dental benefits you should schedule a dental visit prior to the beginning of a new year and have any outstanding treatment recommendations completed. The reason is simple, in most situations you can not roll over your remaining un-used dental benefits to a new year or plan and you want to get your money’s worth since you or your employer have paid your premiums all year long.

How Does Dental Insurance Work? 

Most dental plans are equip with an annual maximum of coverage. The amount is determined by the insurance company and each individual on the policy usually has their own individual maximum. With most dental policies this amount renews every year (usually the first of January). Most dental plans require patients to pay a specific amount of money out-of-pocket before any benefits kick-in, this is called the deductible. Once your deductible is met, your insurance company will pay the provider for services completed based on the negotiated fees set between your insurance company and your dental provider (this is only the case if your provider is in network with your insurance company). Unfortunately, If your dental provider is out-of-network with your insurance company there are no negotiated fees or discounts built into the cost of treatment. If you want to know which dental providers are in-network with your insurance company you can either call your insurance company or visit their website/portal or you can call your dental office and simply ask who they are in-network with. Once treatment is completed claims are sent to your insurance provider and are paid out accordingly, but the patient is responsible for their estimated portion on the date of service in most circumstances. IT IS IMPORTANT THAT THE SUBSCRIBER KNOWS AND UNDERSTANDS THEIR INSURANCE POLICY AND THAT THE SUBSCRIBER IS IN THE KNOW IF THAT POLICY CHANGES IN ANY WAY WHEN SIGING UP OR RENEWING EACH YEAR. 

Why You Shouldn't Post-Pone Dental Treatment? 

The most important reason not to post-pone dental treatment is to ensure your dental treatment needs do not worsen. Cavities generally become worse over time and waiting could make the difference between needing a small filling versus more complex treatment such as a crown or extraction. Always remember, dental caries are a form of INFECTION and the bacteria can travel through the bloodstream to your heart and brain so from an overall health stand point you should not neglect your dental health. When weighing the pro’s and con’s of your Childs dental treatment you also have to remember that a filling is a much simpler process than a crown or multiple crowns or extractions and our goal is to make sure kids have a pleasant experience now so that they are never too afraid to go to the dentist throughout their lives. Most dental insurance policies will cover 2 cleanings and exams per year, so although you may not need any dental treatment, it is still recommended that children and adults visit their dentist twice per year for wellness exams and cleanings. When you or your employer pay your premiums you are paying for these preventative services, so again you want to benefit from what you are paying for. 

What About Orthodontic Benefits?

It is rare to have your dental insurance company cover the entire cost of orthodontic treatment as most will pay a partial amount, but there can also be certain stipulations or clauses such as age of the patient or waiting periods that could hinder coverage. Although plans vary, there are a few points to understand about dental insurance that often carry across policies and providers. If braces are covered under your plan, there is likely a lifetime maximum to your insurance. In some cases, there are waiting periods that require enrollment prior to treatment. Finally, if you have recently switched insurance carriers, you should wait until the effective date of the policy. Otherwise, your braces will not be covered. Additionally, if you are currently in orthodontic treatment remember not to make changes to your policy as such changes could result in your insurance stopping payments to your orthodontist leaving the patient responsible for the balance unexpectedly. Unfortunately, these changes are sometimes made by your employer if they decide to switch insurance companies which is common. By scheduling a consultation with an orthodontist you can plan financially for orthodontic treatment and best decide if you are ready to start now based on your coverage. 

The Bottom Line:

If you have outstanding dental treatment needs or are considering starting orthodontic treatment, let us help you! Our staff is ready to talk through your child’s treatment plan and help you maximize your benefits to benefit you best. If you are on the fence about starting orthodontic treatment now versus later, again, let us help you. We partner with an amazing team of insurance coordinators who are skilled in picking apart your insurance plan and estimating your cost to the best of their abilities.

Ready to schedule your next visit? Click here!

September 26th 2021


Baby & Child Safety

September is Baby Safety Awareness Month – a campaign initiated by the Juvenile Products Manufacturer’s Association (JPMA) to educate caregivers on how to safely choose and use products for children.  We’ll be sharing tips to baby-proof your home and create a safe environment for your children!

Typical Developmental Milestones

The average age for babies to start crawling or scooting around is between 6 and 12 months. Children will start to pull themselves up on objects sometime between 9 and 12 months, and can take their first steps between 8 and 18 months of age! Here is your gentle reminder that while these age ranges are averages, there is a wide range of normal and every child is unique! The important take-away is that as children become more mobile, they are more at risk from injury, whether from pulling up on things that can topple over, or from falls when moving around on unsteady legs.

Baby-Proofing Your Home

Start by viewing your home from your child’s perspective – get down on your hands and knees to spot things that could be potentially dangerous that you may not see from above. Here are some helpful tips for common household hazards:

  • Baby-safe toys should be larger than the hole of a toilet paper roll – anything smaller can be a choking hazard

  • Secure loose or dangling cords from blinds or window shades, hanging tablecloths, and cords from lamps or other electric appliances so they are out of reach

  • Move plants out of reach, and ensure plants you have in your home are not toxic

  • Remove free-standing floor lamps, decorative items, or other pieces that can be tipped over

  • Mount or secure free-standing TVs to prevent toppling

  • Fasten furniture to the walls (i.e., bookshelves, dressers, display cabinets, etc.)

  • Install child-proof gates at stairs and doorways to limit access

  • Use cabinet and drawer locks throughout the house, especially to protect your child from household cleaning products, medications, sharp items, or glassware/dishes that could be broken

  • Cover the corners of tables and fireplaces with corner guards or corner protectors to cushion against injury if bumped or fallen into

  • Cap electrical outlets to prevent electrical burns, which can be severe

  • Cover bathtub nozzles/spouts with spout guards to protect children from cuts, bumps and bruises during bath time

  • Place non-slip strips or mats on the floor of the tub

  • Install toilet lid locks and keep the lids closed when not in use


Once child-level items have been removed or secured, look for these other potential hazards:

  • Make sure cribs are a safe distance from windows and cords/curtains, as well as other furniture that could be climbed on

  • Do not use cribs that are over 10 years old unless it meets safety standards set by the US Consumer Product Safety Commission

  • Make sure cribs are assembled according to the manufacturer’s instructions

  • Use a mattress that is firm and fits snugly against the sides of the crib

  • Clear the crib of any thick blankets, pillows, stuffed animals, or other toys as these are potential suffocation hazards

Other Helpful Safety Tips

  • Avoid force-feeding and be careful with forks and spoons to avoid trauma during meal times

  • Follow manufacturer’s recommended age, weight, and height when choosing toys for your child, and discontinue use when your baby outgrows these limits or if toys are in disrepair

    • Only us infant bouncers or activity centers on flat, level surfaces to avoid tipping over

  • Make sure car seats (whether rear-facing, forward-facing, or booster seats) are not expired, and that they are appropriately sized and correctly installed

    • For those who need help, most local police or fire stations can provide assistance

  • Register your car seats – if they are recalled for safety reasons, you will be alerted

  • Ensure that drivers and passengers of any age are wearing seatbelts and appropriately secured

    • The back seat is the safest place for children under age 13 to ride

  • NEVER leave a young child alone in the car to prevent them getting locked in and to prevent heat stroke

    • If you see a child alone in a car, call first responders at 911

  • Create reminders to check the back seat once you’ve arrived at your destination so a child isn’t accidentally left in the car

    • Placing items you need in the back seat, or putting a stuffed toy in the front seat can be good visual cues/reminders

  • Arrange for your childcare center to call if your child is unexpectedly absent once the day begins

  • Assemble any bath time supplies before bringing the baby into the bathroom; after filling the tub, use your wrist to check the water temperature before placing your child in the tub

  • NEVER leave a baby or young child alone in the bath tub for any reason to avoid risk of drowning

  • Encourage wearing a helmet any time riding bikes, scooters, skateboards, or other similar toys to prevent head injuries in case of a fall

  • Use a mouthguard during sports activities – you can find these at sporting goods stores, drug stores, Walmart, Target, and Amazon


Dental Trauma Plan

Dental injuries are fairly common. It is estimated that 25% of school-age children experience a dental injury. Following the suggestions above can help reduce the risk of injury and can reduce the severity of an injury should it occur.

It is also useful to develop a trauma plan in case of a dental emergency. This way, if an injury does occur, you already know what to do and who to call! 

The American Academy of Pediatric Dentistry (AAPD) recommends establishing a dental home for your child by age 1 year. Not only does this allow the dentist to provide you with tips and recommendations for preventing cavities and monitoring your child’s growth/development, but it allows your child to begin developing a relationship with the dental team and can be helpful to be in a familiar place should dental trauma occur. You should keep the phone number for your child’s dental office in your phone for quick access. Most dental offices also have an after-hours emergency number you can call outside of regular business hours.

Ready to schedule your child? Great!

We have 5 locations throughout the triangle:


& Coming soon to ROLESVILLE!

Follow the link here or give us a call at (919) 846. 7900


Baby Oral Health Program (

American Academy of Pediatrics Policy Statement: Maintaining and Improving the Oral Health of Young Children

Juvenile Products Manufacturer’s Association (JPMA):

Four Ways to Start the School Year off RIGHT!!

August 15th 2021

Four Ways to Start the School Year off RIGHT!!!

It is always an exciting time of the year!  New shoes and new crayons, new folders, and new teachers!  The time of the year when everyone heads back to school brings so many fun changes and it feels like everyone gets a fresh start on learning and growing!  New beginnings at school mean getting back into the swing of routines now that the lazy days of summer have come to an end.  Our team here at Carolina Orthodontics and Children’s Dentistry have come up with some ideas to help make this school year the absolute best!  Here are our suggestions:

1- Establish a morning AND nighttime routine!

We all know how hard it is to remember everything that needs to get done in the morning rush!  Remembering to grab the lunch box and tie those shoes can add to the normal stresses of not missing the bus.  One key way to make the mornings run a little more smoothly is to establish a routine and sticking as best you can to that routine.  Sometimes routine charts can help kiddos to know what their responsibilities are in maintaining that routine.  An example of a morning routine could include waking up, making the bed, getting dressed, eating breakfast, brushing teeth and hair, getting supplies ready for school.  Obviously, we ALWAYS want to remember to brush your teeth before rushing off to school!  

And nighttime routines are equally important!  There are things that you can do the night before to make sure that the morning routine is streamlined.  We always recommend having a nightly routine that includes brushing teeth followed by reading a book and then off to bed!  But maybe your nighttime routine could also include packing the lunch boxes for the night before.  Or laying out clothes for the next day.  Checking to make sure that everything is in the backpack before bed also helps to avoid those last-minute stresses about having all of the homework packed.

Check out our FREE Routine Chart to help!!

(Save & Print these images to help keep your morning and nighttime routine running efficiently)

2- Get up to date on all of those wellness visits!

Back to school means making sure all of those wellness visits are taken care of!  Stay up to date on all of the well-child visits with your pediatrician, getting all sports physicals completed, and of course making sure that your dental wellness visit is complete!  Studies have shown that children that have untreated cavities perform poorer in school and have more missed school days (Bessa Rebelo, et al).  Making sure that those smiles are school picture-ready is an important step to check off of your back-to-school list!

Click here to schedule your child’s next wellness visit with our team!

3- Healthy snacks help curb after-school hunger!

At the end of the day, kids come home starving from a long day of growing smarter!  Making sure they have healthy snacks at hand will help to tide them over until dinner.  Our recommendations for snacks include fresh fruits and vegetables, such as apples, carrots, tomatoes, grapes, and berries.  Cheese and yogurt are also really great snacks that do not have a high tendency to cause cavities.  These healthy snacks are not only good for your teeth but good for your body as a whole!  We recommend avoiding really sticky snacks like gummy snacks, raisins and dried fruits, and candy.  Those types of snacks, along with crackers and chips that stick together when eaten, find their way into those deep grooves of the back teeth and stay, leading to a higher risk for cavities.  And what you drink is equally important!  Water is our absolute favorite drink and is the healthiest for your entire body!  White milk without any additives is okay, too.  But we want to limit how much soda, juice, sweet tea, or energy drinks that kids consume because all of those are loaded with sugars and can also lead to cavities.  Be sure to keep these healthy foods in mind when packing those lunches as well!  We know that it isn’t just the amount of sugar that can be problematic, but also the frequency of sugar consumption.  And bacteria don’t care if the sugar is all-natural, organic, or man-made!  It might be helpful to keep a handy list of healthy, teeth-friendly foods nearby for when hunger strikes!

Follow this link for 50 low-sugar snack ideas!

4- Chat with your children!

With all of the excitement about a new school year, be sure to stay engaged and ask lots of questions!  Chat with them about their day, their likes and dislikes, their concerns and definitely their accomplishments (no matter how big or small!).  

We know that everyone is super excited about the year ahead and all of us here at Carolina Orthodontics and Children’s Dentistry wish all of the students, teachers, and families the best school year possible! 


Bessa Rebelo, Maria Augusta. Rebelo Vieira, Janete Maria. Pereira, Juliana Vianna. Quadros, Larissa Neves. Vettore, Mario Vianna, Does oral health influence school performance and school attendance? A systematic review and meta-analysis,  International Journal of Paediatric Dentistry, 10.1111/ipd.12441 (2018). 

July 15th 2021

What You Need to Know About Cavities

How common are cavities?

The medical term for cavities is “dental caries”, and it is considered the most common chronic disease of childhood. How common is it? 60% of people experience cavities by age 5, and nearly 80% of people in the US have had a cavity by age 17. 

Cavities are considered a disease process because they are a breakdown in the structure of teeth, which can cause symptoms (i.e. pain, sensitivity, infection) that can affect normal functions like eating/drinking and speech. If left untreated, tooth pain can lead to nutritional deficiencies and can negatively affect normal growth and development, learning, and communication. The good news is that cavities are preventable, and if they do occur they can be managed in a number of ways to avoid these negative effects. Keep reading to learn more!    

What are cavities?

Cavities are a breakdown of the hard outer tooth surface (called enamel). Sometimes cavities are visible holes in the teeth, sometimes they look like dark stains on the teeth, and sometimes they are only visible on dental x-rays. 

There are a number of things that cause cavities – we typically think of things like diet and inadequate oral hygiene practices, but other factors include the frequency we eat/drink throughout the day, if we breathe mainly by mouth, the type and activity level of bacteria in our mouths, and how much spit we make. Areas most prone to cavities are the chewing surfaces of the back teeth, between teeth that are touching, and areas where plaque or food are able to get stuck.

How do cavities form?

Our saliva (spit!) is naturally neutral, with a pH around 7. However, when we have something to eat or drink other than water, the pH of our mouths changes. Foods that are higher in sugars or carbohydrates – pasta, chips, crackers, cookies, pastries, candies, etc. – are broken down by bacteria in our mouths, making our mouths more acidic. Some things like soda, juice, tea are already very acidic, which makes the pH in our mouths drop more quickly. This acidic environment is the perfect environment for cavity development, as it allows the hard outer surfaces of teeth (i.e. the enamel) to demineralize or “soften”.

How low does the pH have to go for our teeth to lose minerals? Not as low as you might think! The critical level for cavity development is just a pH of 5.5, and it can take at least 20 minutes for the mouth to recover to the neutral zone. If your child grazes or snacks throughout the day, or if they sip on non-water drinks over long periods of time, their teeth spend more time in an acidic environment than in a healthy, neutral state. The longer teeth are in an acidic environment, the more prone they are to cavities.

Best Practices to Reduce the Risk of Cavities:

Brush teeth 2x/day with fluoride toothpaste
  • Use the size of a grain of rice for children under 3 years
  • Use the size of a small green pea for children 3 years and older

Floss teeth nightly

  • Do this for any teeth that are touching or are close to touching where food can get caught
  • Whether you use a floss stick or a string of floss – both will do the job!

Avoid rinsing with water after brushing or using a fluoride mouthwash

  • This allows more of the protective fluoride to remain in the mouth to restrengthen tooth enamel

Drink water throughout the day, keeping non-water drinks to mealtimes

  • The best water for protecting teeth has fluoride in it, so if your family drinks primarily bottled water or has well water that does not contain fluoride, look for bottled waters that contain fluoride

Limit the overall amount and frequency of foods and drinks that are high in carbohydrates or sugars – both natural and added sugars contribute to cavities!

  • Limit grazing or snacking at will – this gives the mouth time to neutralize its pH
  • Don’t put drinks other than water in a sippy cup or bottle that a child can sip on at will throughout the day

Brush teeth after having sticky foods (even gummy vitamins!) or snack foods like chips, crackers, and cookies 

  • This can help avoid food getting trapped between teeth or in the deep grooves on the chewing surfaces of the back teeth.

Healthy snacks for teeth include fresh fruits and vegetables, yogurt, hard cheeses, and nuts.

  • Want more information on tooth-friendly foods? Check out this blog post: Healthy Snacks & Drinks for Healthy Smiles!

Establish a dental home within 6 months of your child’s first tooth OR by your child’s first birthday – whichever comes first!

  • This will allow your dentist to identify any early warning signs of cavities developing to help you come up with strategies for reducing your child’s risk

Allow your dentist to apply professional fluoride varnish as recommended every 6 months

  • Multiple studies show this is an effective way to reduce cavities!

Click here to schedule your child’s next appointment with our team!


Policy on Early Childhood Caries: Classifications, Consequences, and Preventative Strategies (

Fluoride Therapy (

Policy on Use of Fluoride (

Policy on Medically-Necessary Care (

Use of Pit-and-Fissure Sealants (

Do They Still Use Expanders!?

July 1st 2021


Do They Still Use Expanders!?

    RPE's or Rapid Palatal Expanders still exist.  They are still used frequently in orthodontics to assist in treating a number of various issues including: crossbites, severe crowding, and other skeletal imbalances.  The upper jaw develops in two separate halves.  While children are growing and developing, those two halves can be separated slightly and orthodontists can take advantage of that by using an expander.  Once growth is complete, the two halves of the top jaw are fused together and the only way of separating the two is through a surgical procedure.

    Expanders come in many different forms and designs, but the concept and idea is the same for all.  Expanders usually anchor off a tooth or teeth on each side of the upper arch in the back and have a "screw" in the middle of the roof of the mouth.  The screw is turned with a "key" usually once per day.  The appliance slowly broadens the top jaw as the screw is turned. Each turn of the key separates the top jaw by about 1/4mm.  This is a very small amount of space and therefore doesn't cause pain or discomfort.

    After the amount of desired expansion is achieved by you and your orthodontist.  It is common to "hold" that expansion for a number of months to allow bone growth in the space that was just created with the expander.  Think of it like breaking an arm or a leg.  After the bone is re-set in place by your doctor, a cast is placed to encourage proper healing and bone growth around the area of the fracture.  An expander is creating a space between the two bones of the top jaw and the body needs time to fill in that space with newly formed bone.

 Expanders are most commonly prescribed for severe crowding and posterior crossbites.

Severe Crowding:

As you can imagine, by expanding the upper jaw you are creating more room in the upper arch to resolve any crowding that may exist. Orthodontists may recommend an expander before all the permanent teeth erupt to ensure that all permanent teeth have at least enough room to erupt into the mouth without getting stuck.  If permanent teeth are trying to work their way into the mouth and don't have an adequate amount of space they can actually resorb or damage the roots of other permanent teeth that are in the way.  Expanders help alleviate many risks in orthodontics.  Orthodontic treatment can get very complicated and lengthy when other permanent teeth are stuck or damaged.  This is why it is so important to use an expander when needed and that it is prescribed at the right time.

Posterior Crossbites: 

In an ideal occlusion (bite), the top teeth should overlap the bottom teeth all the way around the arch.  If a top tooth or a number of top teeth together fit on the inside of the bottom teeth this is called a crossbite.  If this happens in the back of the arch near the molars it is referred to as a posterior crossbite.  Posterior crossbites can be tricky to correct with braces and wires (or clear aligners) alone.  Expanders add a force from the inside out and are therefore an excellent way to correct posterior crossbites.

    There can be a little bit of a learning curve when getting an expander.  They usually occupy some space in the roof of the mouth and therefore can cause some minor effects in our speech.  This will resolve after several days (sometimes a little quicker depending on how much you sing in the shower).  The appliance should be brushed and should receive as much love and attention as our teeth.  Crunchy and sticky foods should be eaten with caution as they can dislodge or get stuck on or underneath the expander.

    Expanders can seem a bit medieval depending on how you look at them.  However, they will be around into the future and beyond because of how predictably they are able to address crossbites, crowding, and skeletal imbalances.  Hopefully understanding how and why orthodontists use them regularly will make them seem a bit less foreign or frightening to those patients who may benefit from their use.

    Orthodontics is like a puzzle for each individual patient.  The shape and size of teeth and the shape and size of jaw bones are different for everyone.  The job of the orthodontist is to determine the best way to establish balance and harmony for all the pieces of the puzzle to fit together as best as possible.  An expander is an appliance that when properly used can restore balance where balance didn’t exist before... especially when it comes to the widths of the top and bottom jaws!

Please let us know if you have any questions regarding expanders.  We would be happy to discuss this in further detail!

June 15th 2021

My child is SUPER nervous about the dentist!  What should I do?

It is very normal for children to be nervous and unsure about new and different experiences, including going to the dentist.  Many of us adults have fears of the dentist too!  Our faces and our mouths are very vulnerable areas of our body so it can feel overwhelming to have someone else enter that personal space.  Luckily there are some things that we can do to help to alleviate that anxiety and make the transition into the dental office an easier one for patients and parents.  Try some of these steps to help your little one be more at ease before their next visit to our office:

1. Talk to them about what to expect.

You can talk to them about what the experience is like at the dental office in positive terms.  Explain that dentists help to make their teeth strong and help to keep them healthy.  Explain that the dentist will talk with them about what to expect.  If you have dental anxiety yourself, try to be objective and leave your personal experiences out of your child’s expectations.  Don’t use any of our four-letter words, including shot, pain, numb, pull, hurt, and ouch.  Make sure your chats with them are uplifting and encouraging.

2. Read books and watch kid-friendly videos about going to the dentist.

There are many great resources that can be found that discuss going to the dentist.  Reading books and watching videos can be useful in helping a child understand what they can expect at the dentist.  Many children are visual learners so having a resource that gives visual cues can help them to better process the experience beforehand.  Some of our favorite books are My Tooth is Loose Dr. Moose!Peppa Pig: Dentist Tripand The Berenstain Bears Visit the Dentist.  PBS has great videos that families can reference, including Daniel Tiger’s Neighborhood.

3. Visit a Pediatric Dentist.

Pediatric Dentists are specialists that receive additional training that focuses on childhood development and their understanding of specific milestones in a child’s life can help make kiddos feel more comfortable.  At Carolina Orthodontics and Children’s Dentistry, we have a team of experts skilled in talking to kids and our office is specifically designed to help make children feel more comfortable.  We have more tools available to us to help us customize your child’s experience so that they receive the level of care they need and deserve.  We have private rooms and weighted blankets, music and videos, and an engaged team that can help your child feel more at ease. 

4. Schedule wisely!

Younger children tend to be less tired and more willing to try new experiences earlier in the day.  Avoid scheduling during nap times or other times when children may be more overwhelmed by the events of the day.  As parents we try to be efficient, frequently scheduling more than one doctor visit on the same day.  For the first few visits for apprehensive children, consider avoiding more than one doctor visit on the day they have their dentist appointment. 

5. Use role models!

Older siblings, friends, and parents can be excellent role models for patients that are nervous.  Have younger siblings accompany older kids to their visits so they can see that everything will be just fine!  Have a positive attitude about your own dental visits because kids are very receptive.  Encourage positive discussions about the dentist around those that enjoy going!

6. Use positive reinforcement.

At Carolina Orthodontics and Children’s Dentistry, we love to use positive reinforcement to help encourage children to feel good about their accomplishments at the dentist.  We always give praise for taking even the smallest step in the right direction.  If the visit doesn’t go as planned or if they struggle, avoid scolding them for this experience.  Remind them that next time they have the chance to do a little better!  Positive reinforcement has shown to be significantly more effective in changing behaviors than negative reinforcement.

7. Schedule a Meet and Greet!

Sometimes it is helpful for patients to visit the office and see what they will be experiencing before going through the motions themselves.  Feel free to reach out to our team to schedule a time for your little one to meet the team, see the office, touch the chairs, and hear the noises before their first official visit.  

8. Reach out with any questions!

Many times families have a specific question or concern about their child’s dental care.  Our team is always willing to answer any questions that you may have and review our practices with you over the phone.  We understand that choosing a provider for your child is an important decision and we do not take that lightly.  We pride ourselves on providing the highest level of specialized care, recognizing that each patient is different. Please let us help by providing customized care for your little one!

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Can I Still Wear My Retainer?

June 3rd 2021



    As long as your retainer doesn’t hurt and still fits over your teeth, you can wear it - even if it feels tight.  Your teeth may have shifted slightly, and you may need to wear your retainer longer each day to prevent your teeth from moving.


    Try wearing your retainer full-time for a few days to encourage your teeth to move back into their correct positions.  If the retainer continues to feel uncomfortable, contact our office to determine the next steps.


    Don’t force it.  Contact our office, and we will evaluate your situation and determine what actions, if any, are needed.  It could be as simple as making a new retainer or, if necessary, making some clear aligners (such as Invisalign) to realign the teeth back into their proper positions.