Dr. Tina Merhoff and Dr. Melissa Blake Discuss Pediatric Restorative Dentistry

Podcasts
Pediatric Dentistry Oral Health Hygiene Winston-Salem, NC
Tina Merhoff, Child Dentistry, Pediatric Oral Health Winston-Salem
Winston-Salem Pediatric Dentists Merhoff DDS Board Certified Oral Hygienist
Pediatric Dental Emergencies, Winston-Salem, NC, Merhoff Dentist
Winston-Salem Child Dentist - Tina Merhoff and Associates Pediatric Dentistry Teen, Kid, Infant Dental

High-Tech and Child-Centered Care at Merhoff Pediatric Dentistry

Two of the top pediatric dentists in the Triad of North Carolina discuss how they apply the highest cosmetic dental technology for young patients. Pediatrics dentists Dr. Tina Merhoff and Dr. Melissa Blake discuss how they approach restoring children’s smiles at Merhoff Pediatric Dentistry in Winston-Salem, NC. They detail how they focus on making children feel at ease while receiving the highest-quality care. The pediatric dentists and the entire team at their practice understand that restoring a child’s smile is more than just a dental procedure—it’s about building confidence and supporting overall well-being. Using advanced materials like zirconia and Bioflex crowns, they can offer children beautiful, functional smiles that can last until their permanent teeth come in. This, combined with their emphasis on preventive care and education, ensures families can count on long-term dental health. Tune in to find out more about restorative care, tooth restoration, why a child would need cosmetic dentistry, and some of the types of pediatric dental crowns, including:

The practice offers several types of crowns, each suited to different needs and preferences.

  • Stainless Steel Crowns: These have been a durable and widely used option in pediatric dentistry for decades. While they don’t blend with other natural teeth, they are highly effective for molars and non-visible teeth.
  • Zirconia Crowns: A more aesthetic option, zirconia crowns blend seamlessly with a child’s natural teeth. These white crowns are a great choice for front teeth, offering strength and durability without compromising appearance.
  • Bioflex Crowns: A newer, hybrid option that balances the aesthetic benefits of zirconia crowns and the durability of stainless steel. These crowns require less preparation and are faster to place, making them an efficient choice for patients and practitioners.

The MedSoup Podcast joined Dr. Tina Merhoff and Dr. Melissa Blake, two of the pediatric dentists at Merhoff and Associates Pediatric Dentistry in Winston-Salem. Restoring a child’s smile is a significant part of pediatric dentistry, and it can be a sensitive process. The team here is uniquely qualified to treat children, obviously, but they also have the tools and the office to help make that happen.

Host: Dr. Tina, can you talk a little bit about crowns and why a child would need one? 

Merhoff Pediatric Dentistry: That’s a great question, Laura. We see children very early and early childhood caries in children as young as 18 months.

Host: So what is caries for someone who doesn’t understand? 

Merhoff Pediatric Dentistry: Caries is a cavity. It’s dental decay, as some will refer to it, but the proper term is early childhood caries, caries being the dental disease or dental decay, and when you ask the question about why a child would need a crown, there was a time when the teeth were broken down let’s talk about the four top teeth which are the first teeth you see when a child smiles and those teeth were badly decayed or have just very extensive dental disease that our best option was to extract that tooth and remove it. Now, we can offer these zirconium crowns as a beautiful aesthetic option that allows us to save those teeth. There was a time when those teeth were not restorable, and our best option was to remove them.

Host: And Dr. Melissa, Can you talk a bit about the different types of crowns you offer? 

Merhoff Pediatric Dentistry: Yes, I’d love to. We have a great variety of crowns. The first is a stainless crown, which is great. It’s a surgical-grade stainless steel. It’s been used in pediatric dentistry for decades now has great durability, but it’s not the best aesthetic option. So we also have more aesthetic alternatives, such as the zirconia crown, which is highly aesthetic. It’s got a beautiful natural color and shine.It blends right in. It’s almost not noticeable at all. And then, we have an intermediate option called the Bioflex crown, a newer material that has just been propelled to the forefront of pediatric dentistry. Now it’s making waves and that is kind of a hybrid material that’s got the best of both worlds so it has the aesthetics of a zirconia crown but some of the restorative benefits of the stainless steel crown so less prepping time a little bit more efficient to place on which is always our concern when placing a zirconia crown we have to remove a little bit more tooth structures to be able to accommodate that fit and it has a little bit more reflection so we find that it has better durability over time. So the Bioflex is a new interesting option that we have.

Host: What teeth are most often affected and which tend to need more restorative work?

Merhoff Pediatric Dentistry: That’s a great question when we start seeing children at a young age one of the most common areas that we see dental disease, especially if a child is still using a bottle or what they’re carrying in the bottle Or if they are drinking very sugary drinks beverages in their sippy cup and drinking that all throughout the day. That’s exposing those teeth to a sugary substance. So the teeth that are most commonly affected are the upper four incisors that you see when a child smiles and usually the first baby molars, the first molar that the child received that erupted. Those teeth are the most common teeth that are affected. The tongue protects the lower incisors so we can we can diagnose pretty quickly if that child is drinking something sugary or frequently maybe using the bottle and that gives us an opportunity to talk about how do we help with ceasing or stopping some of those habits how do we help with the nutrition and then we decide what’s the best treatment but the lower incisors are often protected by the tongue So the lower front teeth may not have a cavity at all and the upper incisors are very affected that’s a very common thing we see in our office.

Host: So what you were talking about in terms of options There are two that are a tooth color Those are going to be better for the front teeth Obviously because just like you said Dr. Melissa, you don’t want to put the metal in in the front teeth.

Merhoff Pediatric Dentistry: Oh, absolutely, absolutely. We want to give that child. We call it changing lives. We want to give them a happy, healthy, beautiful smile and the Zirconia crowns give us an option to do that now. And to save teeth that we might not otherwise have been able to restore.

Host: Yes, and like you were talking nutrition is important, you know, for any child, but then a child that maybe has teeth that are decaying or something like that. 

Merhoff Pediatric Dentistry: Nutrition is very important and we want to educate families on that first visit. We go through a range of different things showing pictures, but we like to talk to parents about how the gummy vitamins can stick into into those deep grooves of the molars and If it says they’re long it can cause a cavity even goldfish or crackers Graham crackers if a child is just eating that frequently then that’s keeping that tooth bathed in a Substance that can turn into a carbohydrate their carbohydrates and bacteria in our mouth combines with that and creates an acid that then forms a cavity. So it’s really important for families to know those gummy vitamins, you have to brush those out if you’re using those. We don’t love them because we are seeing cavities developed from that as well as the little fruit snacks.

– Oh yeah. – Parents often think this is– – Anything sticky or whatever. – Exactly, anything sticky. 

Host: So Dr. Melissa, talk a little bit about the going from maybe a child has developed a cavity and now it’s turned into something more so what what is the difference between you know putting a filling and going to a crown?

Merhoff Pediatric Dentistry: Well when we determine the best restorative treatment for to address a cavity we’re always looking at the size of the cavity and how much longer that child is going to need that specific tooth for So, there’s a time that we would expect a natural baby tooth to fall out. We call that exfoliation, but if we’ve determined that that tooth needs restorative work and it’s appropriate to do so based on the length of time the child needs that tooth for to avoid the development of an abscess or infection on the tooth, we’ll recommend a white composite filling if the cavity is shallow enough and hasn’t reached into the center of the tooth where the nerve is. The nerve, or the pulp, has a blood supply that’s very essential to keeping the tooth vital. And cavity really doesn’t hurt until it gets deep enough where it gets close to the nerve, and we can start to see sensitivity and pain develop. 

That’s when we know that that tooth may need more involved treatment, such as what we call a pulpotomy and crown. A pulpotomy is basically a baby tooth, root canal. So if you were I were to have a cavity on our adult teeth and it got into the nerve and was causing discomfort, then a root canal specialist or an endodontist would need to treat that tooth with a root canal procedure where they remove that portion of the nerve so that there’s no tissue that can relay the pain sensation to your body. and then they would fill the tooth with a medicated filling and place a crown over top of it. We’ve modified that procedure to fit the specific needs of the child. We just remove the upper portion of the nerve and we don’t go down to the root system typically.

We place that same medicated filling and then we place the same day crown so that that tooth is restored completely to health. And our goal is to really maintain the vitality of the tooth. We want that baby tooth to stay alive and give it a chance to heal.

But it’s it’s it’s important to us that we get to diagnose and treat that cavity, hopefully before it gets into the nerve altogether. Ideally, we would, you know, we would be preventing that if possible. 

Host: Talking about prevention, you talked about nutrition, and, of course, brushing techniques and things like that, but Dr. Tina, what about sealants? What can you do in terms of that to help prevent?

Merhoff Pediatric Dentistry: That’s a great question, Laura. Sealants are a preventative treatment. It’s almost like putting a water seal over a wooden porch, you know, how the rain will not penetrate through because you’ve put the sealer over it and it protects it. It’s the same philosophy with a sealant on a tooth. We always are recommending sealants on permanent molars, which start about the age of six.

But if a child has a weak enamel on their baby molars, we may recommend a sealant on that. We’d much rather place a sealant, which is preventative and less invasive, than allow that child to that tooth to decay and end up needing a filling. So those are things we’re looking at. I think sealants should always be on the permanent six year molars, the permanent 12 year molars. I wish that more dental insurance companies recognize the importance of having sealants placed on those two year molars, at least of the young child or and one year molars, because as I mentioned earlier, the one year molars are the ones that are usually first affected. They’ve been there longer in the child’s mouth at about the age the child is still using a bottle or still using a sippy cup.

So I think sealants are great preventative and we highly recommend them in our office. – Yeah. – There’s a neat statistic that for, and when we look at the research with the effectiveness of sealants Um, for children on their first permanent molar, their first adult tooth, 90 % of the time when the cavity starts, it starts in the chewing surface of the molar and those deeper grooves where food and plaque can accumulate. So the sealant is a very effective preventive tool we have. It’s not foolproof. You know, we still have to brush those teeth. We still have to floss. Unfortunately, if we could seal the entire tooth surface, it would probably just be a crown. But, um, but we love those sealants ’cause we know how much of a benefit our patients are getting when we can see them early enough to seal that tooth before it starts with the can.

Host: And it may prevent more restorative dentistry having to happen later, if you have that?

Merhoff Pediatric Dentistry: Absolutely, that’s our goal. If you’ve noticed, we continue to go back to starting early, the earlier we see a child, the greater our potential to have those preventative measures because once we have to do a filling now we’re talking about possibly needing to use local anesthesia where we put that little tooth to sleep we try to avoid using words like shot or needle there are bad words in our office we don’t use that those are no no words we want children to leave our office and to say dr. Tina Dr. Melissa, Dr. Victoria, they use sleepy juice to make my tooth go to sleep. So that they don’t feel when we are using the handpiece or what people refer to as a drill to clean their cavity out. And we have in our office a new device. It’s called the SOAN, S -O -A -N. It’s a new, beautiful device. It’s small. It doesn’t look like a syringe with a needle, one of those no -no words in our office, but it allows us to do some very local infiltration around the tooth to numb the tooth and the tooth alone.That’s going to help prevent that tongue biting and lip biting, which is the most common post -op complication we see in our office. So we’re really thrilled about using this with our little patients.

And one thing I’d like to go back to with what Dr. Tina was saying about sealing primary teeth, we love doing that so that we can avoid having to go forward in doing restorative procedures on a young child. Insurance typically doesn’t cover those procedures as well, but the insurance company, we like to dissociate ourselves as providers from what insurance covers because it’s not always in the best interests of a child. If a young child has really deep grooves that we can seal now, even though they’re baby teeth, I’d much rather seal that tooth than that child get decay, and that has to go through a restorative procedure, has to have local anesthetic. You know, just to that level of prevention to me, that has such a huge benefit that what the insurance company may not cover it because they don’t see that they’re saving money.

You know, they will seal an adult, they will cover sealants on an adult molar tooth because they feel that they’re going to save save save money doing that. But we just see things so differently. We look at what is this child going to benefit from? They’re going to have a much better experience not having to have a more invasive treatment by placing sealant on those teeth. – Because they’re gonna need something possibly much more invasive later where you could have helped prevent that.

Host: And the crown that you were talking about, there’s one that’s very aesthetic, especially it has to be used in the front of the mouth. Can you talk a little bit more about that as an option?

Merhoff Pediatric Dentistry: The Zirconia crowns, they are the most aesthetic option on the market now for pediatric dentists, and we have a couple of different companies that we are using their product.

We find that they continue to improve upon these products. Zirconia is very hard, it’s very durable and it is the best option in the upper front teeth for young children and we feel like we truly are changing lives by saving these teeth and Laura I mentioned before our goal is when a child starts pre -k or kindergarten those are such critical times in a child’s life we want them to go to school to start that fresh start with a healthy smile with beautiful teeth that is so important to us here in our practice so that zirconia crowns are beautiful and they give us that option in the past we used bonded composite resin crowns which were a little difficult to to make work in the anterior teeth because you couldn’t have any any bleeding around the gums, any moisture. It was very difficult to place these, especially in the office without a child sedated. So it gives us another option for kids. The white crowns, I’m very excited about our office using the BioFlex because it is more of like an interim. It’s not, it doesn’t take as long. It’s not as invasive as a zirconia crown, it’s much like the stainless steel crowns as Dr. Melissa mentioned. So at least parents have options for that. And the zirconia crown that you were talking about, one of the things is that it helps, I mean, it helps restore their smile, but then they can also bite or chew or what about heat, cold sensitivity, things like that. That’s a great question. We often are applying a medicated liner to these teeth. If the nerve is not involved that requires that tooth to have a baby root canal or a little pulpotomy, then we apply a liner to help prevent sensitivity. The zirconia crowns are very strong, especially in the anterior being the front teeth. They hold up very well and our goal is for that to last until that tooth would normally exfoliate.

Host: The children that needed very extensive work, how do they feel when, when it’s done, when they see how their teeth look?

Merhoff Pediatric Dentistry: They love it. Maybe not as much as the parents do, but they do glow and they are so excited to have a healthy, bright smile. I have a young patient that comes here from a far distance, and I was very encouraged by these crowns. We’ve been following this little boy since he was about two years old. He’s seven now. He still has two of his zirconia crowns in his mouth and the front, his front teeth. But His father really challenged me and encouraged me to try as hard as I could to save those teeth. They, families want their child to have a healthy smile. And often they feel a sense of, they feel guilty as if they had something to contribute to this. And our goal is to turn that around. If they bring that child into our office, we never want them to leave feeling guilty.They’ve brought them to us to restore those teeth. And I was happy that he encouraged me to remove the decay, build that tooth up so that I could get a nice preparation and a beautiful crown. And they lasted until they fell out and the Tooth Fairy came to take their little zirconia crown. 

Host: Yes, and that would make a difference. I mean, a child wants to be smiling. Absolutely. – Trying not to smile for some reason. It’s just, it’s like you said, when they go to kindergarten, you want them to be able to show their personality.

Merhoff Pediatric Dentistry: Oh, absolutely. I think it just goes back to our mission to at our practice, which is to treat every child like our own and and what parent wouldn’t want their child to have their all of their front teeth.

You know, I know we get we try to move away from that saying of they’re just baby teeth they’re gonna fall out well when that child goes you know and gets their Christmas photos taken or their yearbook photos taken or they start kindergarten no no parent wants to know that their child is treated any different than anyone else so being able to give that child their confidence their smile and know that they’re not being looked at any different it’s a huge gift that we get to give and it just goes back to getting away from that idea that we don’t nothing needs to be done and these are just gonna fall out we want we don’t want our children our children the children of our practice they’re like our family so we always say our children we want them to thrive we don’t want them to just survive I say could survive without those two front teeth or four front teeth but would they be thriving you know yeah yeah and and it may be a while like if something’s going on with their teeth that could be that way for a very long time like you mentioned absolutely that’s that is such a true point if a child comes in at the age of one they’re going to keep those upper incisors until they’re seven or eight and if they were delayed in getting their baby teeth their primary teeth they may keep those upper incisors until they’re nine and 10. Those x -rays and radiographs are important to show us the development of the permanent teeth.

That allows us to make the best decision for this child. Because like Dr. Melissa was saying, we do want to create a home here for every child to feel like this is their home. We see these children as if they were our kids. We want that child to have a beautiful, healthy smile. And we’re finding new ways every day to make that possible for every child in our community. Even if it’s through Give a Kid a Smile, our Give a Kid a Smile campaign allows us to care for those children who might have difficult for access to care. We’re hoping to expand upon that with other unique ways in our office so that all kids in our community have the opportunity for a beautiful smile.

Host: Yes, and I know you have some of those things detailed on your website so that people can read more about some of the community outreach programs that you have the things you do for kids the Activities you participate in in the community. You’re not just active in the practice your Your whole team is active outside in the community. 

Merhoff Pediatric Dentistry: Absolutely. We’ve been doing things for years in our office to give a kid a smile campaign and Halloween is just around the corner today’s October 10th but Halloween’s a big holiday for these kids.They love to get their bags full of candy so we’re going to do our candy buyback where we will buy back a pound of candy that child can walk away with a five dollar bill or with some money to apply towards something other than that sticky candy that truly might cause a little cavity. So I do encourage parents, pull out just a few things, throw out the sticky candy, give or tell something extra. We really like to give away some sugar -free lollipops. Talk about healthy options at this time of the year because it is fun for kids, but we also want to be brushing away those sugar bugs as we call it. 

Host: Yes, well, and it’s basically three months of between Halloween and Christmas and all of that, there’s lots of sweets in the house. 

Merhoff Pediatric Dentistry: Absolutely. 

Host: That’s some great information for parents to know. Again, you don’t have to be a patient of the practice to come here. You can come and just have a consult, see what your options are, and talk about that with one of the pediatric dentists here.

And if you have any questions just give the office a call. I know they’ll be happy to help you.