Services Offered

We look forward to taking care of your loved ones at Little Bird Pediatric Dentistry.

Please see the listings of our services below. Click on each drop down for more information.

1. Infant First Visit at Little Bird Philosophy/Policy
  1. When: All children are encouraged to be seen within the first two weeks of life
  2. Why:  Our philosophy of care at Little Bird is for maximal optimization and prevention, to therefore avoid or minimize treatment and correction at a later, older age. This is why we work collaboratively with pre/post natal health care providers, to see babies within the first two weeks of life– ensuring optimized tongue and lip rest posture, nose breathing, sleeping and feeding that will optimize their growth, development and function.
    Note: The dental profession’s guidelines which are aimed towards cavity prevention are for all children to be seen for their first dental appointment when their first tooth erupts (around 6 months of age), or by their first birthday. However, at Little Bird, it is our goal to optimize the growth, development and function of our children, and that begins at birth.
  3. What to expect:
    A comprehensive & caring assessment including:
  • Education and discussion regarding the essential keys to optimize your loved ones growth, development and function
  • Pre-and post-natal history
  • Infant breathing
  • Breastfeeding experience/challenges (as applicable)
  • Infant feeding (diet, chewing, swallowing, etc.)
  • Infant sleeping including sleep hygiene (and review of current pediatric guidelines)
  • Infant habits including products we encourage that optimize their growth, development and function
  • Clinical examination: extra-oral and intra-oral (including teeth)
  • Functional assessment of the tongue and lip movements, rest posture, suckle and swallow
  • Evaluation and diagnosis (overall)
  • Comprehensive instruction in oral health prevention & hygiene
  • Determination if immediate treatment is required if the airway / tongue/lip posture/ swallowing / breastfeeding are compromised
  • If immediate treatment is recommended: Post-operative care instructions (stretches and suck training exercises), education re: products in line with optimized growth & development, and follow-up care
  • Referral to affiliated partners that may include: lactation consultants, bodywork (i.e. osteopathy), dietitian/nutritionist, speech language pathologists, etc.
  • Arrangements for continued preventive pediatric care
2. New Patients Coming to Little Bird: All Children under 13 Years of Age
  1. WHEN: All children will be seen as soon as possible upon receiving a request for an initial appointment at Little Bird from the parent, caregiver, or upon receipt of a referral from a health care provider. Little bird staff will assess the urgency of the request in order to determine the most appropriate scheduling. For example, children who are in pain or have an acute injury will be given top priority.
    Note: Patients with government sponsored dental coverage (i.e. Ontario Disability Support Program (ODSP)), a referral from your physician or dentist is required for booking your first appointment.
  2. WHY: Our philosophy of care at Little Bird is for maximal optimization and prevention, ensuring optimized tongue and lip rest posture, nose breathing, sleeping and feeding that optimize their growth, development and function. Oral health is considered an important component of overall, total health and as such all children should have an oral/dental assessment and care as needed on a regular basis to:
    • Prevent pain, suffering and infection from dental disease such as cavities and gum disease
    • Assess breathing, feeding-diet, swallowing, chewing, bite (occlusion), sleeping, demeanor, oral (mouth) habits
    • Promote nasal breathing, optimized tongue posture and swallowing pattern, in order to promote optimized growth, development and function
    • Identify and treat any dental/oral conditions that may be present
    • Establish a caring, accessible and compassionate dental home for the child
  3. WHAT TO EXPECT:
    A comprehensive & caring assessment including:

    • Education and discussion regarding the essential keys to optimize your loved ones growth, development and function
    • Infant history (pre-and post-natal)
    • History of breastfeeding (experiences/challenges) – As Applicable
    • Breathing (day and night) with incorporation of Buteyko breathing assessments and methods
    • Feeding (diet, chewing, swallowing, etc.)
    • Oral (mouth) habits including products we encourage that optimize their growth, development and function
    • Sleeping including sleep hygiene (and review of current pediatric guidelines)
    • Clinical exam: extra-oral and intra-oral (including teeth)
    • Functional assessment of the tongue and lip movements, rest posture, nasal breathing, chewing/swallowing
    • May include X-rays, clinical photos and video
    • Evaluation and diagnosis (overall)
    • Comprehensive instruction in oral health prevention & hygiene
    • Treatment recommendations
    • Arrangements for treatment as needed based on severity and impact on future growth and development and for continued preventive care
    • As required, referral to affiliated partners that may include: physician, nutritionist, bodywork (i.e. osteopathy), dietitian/nutritionist, orthodontist, speech language pathologists, etc.
3. New Patients Coming to Little Bird: 13 years of age & Older (Teens and Adults)
  1. WHEN: All those over 13 years of age (teens and adults) will be seen as soon as possible upon receiving a request for an initial appointment at Little Bird from the parent, caregiver, patient, or upon receipt of a referral from a health care provider. Little bird staff will assess the urgency of the request in order to determine the most appropriate scheduling. Individuals whom are in pain or have an acute injury will be given top priority.
    Note: Patients with government sponsored dental coverage (i.e. Ontario Disability Support Program (ODSP)), a referral from your physician or dentist is required for booking your first appointment.
  2. WHY: Our philosophy of care at Little Bird is to provide comprehensive airway centric care in order to optimize every individual’s tongue and lip rest posture, nose breathing, sleeping and overall function. Demonstrating how each element is connected. Oral health is considered an important component of overall, total health and as such all children should have an oral/dental assessment and care as needed on a regular basis to:
    • Prevent pain, suffering and infection from dental disease such as cavities and gum disease
    • Assess breathing, feeding-diet, swallowing, chewing, bite (occlusion), sleeping, demeanor, oral (mouth) habits
    • Promote nasal breathing, optimized tongue posture and swallowing pattern, in order to promote optimized growth, development and function
    • Identify and treat any dental/oral conditions that may be present
    • Establish a caring, accessible and compassionate dental home for the individual
  3. WHAT TO EXPECT:
    A comprehensive & caring assessment including:

    • Education and discussion regarding the essential keys to optimize you (or your loved ones) function
    • Infant history (pre-and post-natal)
    • Breathing (day and night) with incorporation of Buteyko breathing assessments and methods
    • Feeding (diet, chewing, swallowing, etc.)
    • Oral (mouth) habits including products we encourage to optimize growth and function
    • Sleeping including sleep hygiene (and review of current guidelines)
    • Clinical exam: extra-oral and intra-oral (including teeth)
    • Functional assessment of the tongue and lip movements, rest posture, nasal breathing, chewing/swallowing
    • May include X-rays, clinical photos and video
    • Evaluation and diagnosis (overall)
    • Comprehensive instruction in oral health prevention & hygiene
    • Treatment recommendations
    • Arrangements for treatment as needed based on severity and impact on future growth and development and for continued preventive care
    • As required, referral to affiliated partners that may include: physician, nutritionist, bodywork (i.e. osteopathy), dietitian/nutritionist, orthodontist, speech language pathologists, etc.
4. Oral (Oro-facial) Myofunctional Therapy (OMT)
  1. What is it? Oral myofunctional therapy (OMT) can be defined as physical therapy for the oral / facial musculature which is used to optimize the function of the tongue and facial muscles both at rest and during function (i.e. chewing and swallowing).  The majority of what is above our necks is related to muscle (face, tongue, soft palate, airway). You can improve your breathing, swallowing and posture by exercising and retraining these muscles at ANY age.
  2. What do we address? With additional training in OMT, we can identify and address myofunctional disorders that may include, but are not limited to: mouth breathing, snoring, atypical (tongue-thrust) swallowing patterns, atypical chewing patterns, restricted/tethered oral tissues (tongue/lip ties), lip incompetence (lips apart at rest), and oral habits. A low tongue rest posture and/or tongue thrust swallow may be associated with a tongue and/or lip tie, oral habit (i.e. thumb sucking), or frequent utilization of oral products that train the tongue to be held down into the floor of the mouth. We pride ourselves in preforming a comprehensive assessment taking into account multiple contributing factors in order to provide the best care to our patients.
  3. Who would benefit? Individuals of any age that may benefit from OMT for oral myofunctional disorders may include those with: parafunctional oral habits like teeth grinding and clenching, lips apart at rest – lack of a lip seal, mouth breathing, drooling, low tongue posture, tongue thrust swallow, gagging, picky eating, bloating after eating, temporomandibular disorder (TMD), neck pain- postural problems (forward head posture),”long face syndrome”, sleep disordered breathing, ADHD, speech problems, dental malocclusion; crowding/crooked teeth, anterior open bite and posterior crossbites.
  4. Goals of OMT: The main goals of OMT are to:
    • Establish optimized nasal breathing and lip seal
    • Correct tongue posture at rest (on the “Spot” – up on the palate (roof of mouth) behind the front teeth)
    • Correct swallow (“Rocker” with tongue maintaining contact on the “Spot”)
    • Elimination of oral habits
    • Maximize the potential for optimized dental occlusal and facial development
  5. How? If after your comprehensive history and examination, a myofunctional disorder is identified the therapy may include all or some of the following:
    • Establish nasal breathing – Buteyko breathing re-education methods (exercises, steps, porous paper tape), nasal hygiene program (may include use of natural decongestant exercises, nasal strips, Xlear nasal spray)
      * Note: A referral to an Ear-Nose-Throat (ENT) doctor may be required if nasal breathing is not possible (irreversible obstruction) as determined at the initial assessment
    • A detailed personalized OMT instruction plan with specific oral myofunctional exercises to be completed daily. (The duration of therapy is age dependent, as older individuals will have more muscle memory needing more time to re-train/educate them)
    • Possible frenotomy procedure to release tongue and/or lip ties (treatment approach varies between age groups)
    • Use of appliances (aids) to exercise / strengthen the lips
    • Use of appliances/aids to promote normal tongue posture, swallow, and normal occlusal development with a wide broad palate
    • Patient compliance is key to success and each patient must keep a daily record / log of their myofunctional exercises
    • Fixed orthodontic treatment (i.e. braces) may be required for final tooth alignment (with an appropriate referral to an orthodontist)
5. Tongue and Lip Tie Release (Frenotomy) (Tethered Oral Tissues)
  1. What are tethered oral tissues (TOTS)?
    • Lesson #1: Everyone has frenums and as long as the range of motion of the tissues are not restricted, they are considered normal
      • Lingual frenum: a normal embryonic piece of fibromucous membrane tissue (connective tissue without any nerve innervation) in the midline of the under-surface of the tongue that joins the tongue to the floor of the mouth

        Lingual Frenum

        Adult patient raising their tongue to the “Spot” with arrow pointing to their lingual frenum

      • Labial frenum: a normal embryonic piece of fibromucous membrane tissue (connective tissue without any nerve innervation) in the midline of the under-surface of the upper lip that joins the lip to the gums (See Picture)

        Labial Frenum

        Arrow pointing to a normal labial frenum on a newborn (not restricted or tied)

    • Lesson #2: What is a Tongue Tie – Ankyloglossia?
      When the lingual frenum is short or inappropriately attached, it may restrict the movement, rest position, and function of the tongue. 
    • Anterior tongue tie is when the lingual frenum is restricted and attached more towards the tip of the tongue (See Pictures).
    • A posterior tongue tie is less visible, and is when the lingual frenum is restricted between the floor of mouth body of tongue; restricting the movement of the tongue body and preventing an optimized rest position, movement and swallow (See Pictures). Best diagnosed with a thorough history (signs/symptoms) and clinical interactive assessment and examination (feel).
    • Very commonly when there is a posterior tie there are submucosal connective tissue fibers further restricting the movement and function of the posterior tongue. This restriction can sometimes be felt during the exam, but more frequently are discovered during the frenotomy release procedure. It is of utmost importance that ALL restrictive fibers are identified and released in order to achieve optimal results and tongue function. Dr. Sigal ensures to provide this care, and advises families following the release if there were any submucosal fibers that were released (as the diamond oral scab/healing wound will appear slightly wider secondary to the muscular contraction of the surrounding tongue).
      Anterior tongue tie graphic - ali pres

      Anterior tie is when the lingual frenum (from the floor of mouth) is restricted and attached at any point along the red arrow of the blade of the tongue. The closer to the apex (tip) of the tongue, the more severe.

      Posterior tongue tie

      Posterior tie is when the lingual frenum (from the floor of mouth to the body of the tongue) is restricted (red arrow). This limits the movement and function of the body and base of the tongue.

      Posterior tongue tie

    • Lesson #3: What is a Lip Tie?
      When the upper labial frenum is short or inappropriately attached, which may restrict normal mobility and function of the upper lip. At LB, in conjunction with our comprehensive assessment, for lip ties we utilize the Kotlow classification system (See picture), but most importantly determine if a release is recommended based on a functional analysis.
    • A lip tie release may be discussed if presenting with any of the three findings: Notable breastfeeding challenges (preventing deep latch, upper lip regularly folding inward despite positioning assistance, etc.); Tautness puckering the upper lip towards the nose leading to an open mouth posture and increased tendency for mouth breathing; Cosmetic concern, creating a space >3mm between the top front teeth *Mostly in regards to the permanent (adult) dentition.

      Lip Tie Classifications

      The soft tissue covering the upper jawbone (maxilla) is divided into 3 zones.
      Zone 1 (Red Arrow): tissue under the nasal area (called non-keratinized or free gingival area (tissue is moveable) “colour changing line – referred to as mucogingival junction”
      Zone 2 (Yellow Arrow): Tissue under mucogingival junction (colour changing line) – Keratinized or attached gingiva (not moveable)
      Zone 3 (Orange Arrow): Extends into the area between the future erupting teeth – interdental papilla (towards the PALATE)
      Class 1: Within normal limits – undetectable or is present within zone 1 and/or extends to the mucogingival junction
      Class 2: Extends beyond mucogingival junction within Zone 2
      Class 3: Extends further into Zone 2 (but Not into zone 3)
      Class 4: Most severe – Extends to Zone 3 towards the palate (roof of mouth)
  2. How do TOTS relate to growth and development, airway and function
    If a baby is born with a restricted frenum it will always be there – frenums do not stretch or grow since they do not contain any muscle tissue

    • Ankyloglossia (Tongue Tie): May give rise to many problems such as (See Airway Centric Checklists to assess your own loved ones)
      • Tongue positioned/held down in the floor of mouth unable to reach and naturally be suctioned to its optimized normal rest “Spot” on the palate (roof of mouth)
      • Collapse of upper jaw/palate/roof of mouth to be narrow, V-shaped and highly arched, instead of being wide, U-shaped and flat
      • Compromised/reduced nasal airway (secondary to upper jaw/palate being narrow and high arched) (Remember the nose/nasal airway is just above the mouth)
      • Breastfeeding difficulties for both infant and mother
      • Minimal weight gain or failure to thrive
      • Swallowing of excess air (Aerophagia)– presenting as colic, gassiness, and reflux
      • Frequent ear infections (secondary to uncoordinated swallow)
      • Tongue thrust swallow
      • Tongue thrust will result in an anterior open bite malocclusion (Space between front upper and lower teeth, when back teeth are touching) with a long narrow face and crooked/crowded teeth
      • Open mouth rest posture (lips apart at rest)
      • Development of mouth breathing (compromised breathing)
      • Mouth breathing will result in inflamed/enlarged tonsils and adenoids which may further compromise nasal breathing
      • Snoring / restless sleep/ Sleep disordered Breathing (SDB)/ gasp or stop breathing
      • May affect speech (development and articulation)
      • Increased tendency towards forward head posture, with associated neck pain/stiffness, headaches and/or migraines
      • Obstructive sleep apnea (OSA)*if tongue tie is left un-treated, and the patient presents with a high arched, narrow palate, research shows that this individual is very likely to develop OSA in their lifetime
    • Upper Lip Tie: 
      • Difficulties with breastfeeding including poor latch or latch maintenance, as upper lip curls inward instead of flanging outwards (like a fish)
      • Maternal- Painful breastfeeding and/or increased risk for plugged ducts, and mastitis
      • Open mouth posture (lips apart at rest)– loss of milk, drooling, tendency towards mouth breathing (as with taut/restricted upper lip, poses greater difficulty for lips to naturally rest in sealed position)
      • Mouth breathing may result in large inflamed tonsils and adenoids which can further exacerbate (worsen) mouth breathing tendencies and associated consequences including development of a long, narrow face
      • Diastema (or space) greater than 3mm between teeth (both primary and/or adult teeth)
  3. What can be done and when?
    • Ankyloglossia (Tongue-Tie) – Newborn to 1 year of age:
      • At Little Bird, you will first meet with our new patient educator to learn about your baby’s breathing, sleeping, tongue and lip function prior to the interactive assessment/examination of your baby. During the assessment, Dr. Sigal ensures that you are involved. Following the assessment, treatment recommendations, procedures and post-operative care will be discussed. Our goal at LB is to ensure that our families feel comfortable every step of the way.
      • If diagnosed and impeding your baby’s function, recommended treatment is to release the frenum / tie. The earlier the better (as less re-training/learning involved), which is why at LB we advocate to assess babies within the first 2 weeks of life.
      • A simple surgical procedure is performed in the office (same day as the assessment) with the infant awake
      • As the connective tissue frenum (tie) that is released has no feeling (lacks innervation), NO sedation or freezing is necessary
      • Sucrose (pure sugar) is provided prior to the release for your babe’s increased comfort (Best analgesic for infants under the age of 12 months)
      • We encourage immediately resuming breastfeeding after the procedure (best post-op care!)
      • Our LB staff provide instruction in regards to comfort and care for your babe following release
      • For best results – Must perform post-operative stretching and fun oral myofunctional exercises (“Play-Time) as discussed/outlined in our post-operative instructions to prevent superficial wound attachment and optimize healing
      • We will see you and your babe at your follow up appointments at LB (included with the cost of the release procedure). We will assess your baby’s tongue elevation, tongue rest position, healing, stretches/exercises and breathing to ensure that their anatomy remains optimized throughout the critical healing window (first 2 weeks)
      • We strongly recommend for you to see a lactation consultant preferably pre-operatively and post operatively  (within 48-72 hours of release)*this is essential for the improvement of breastfeeding (positioning, breast milk supply discussions, and to assist baby, as they require re-learning/training of their tongues!)
      • We also encourage baby to be seen for bodywork with an osteopath / therapist (pre and/or post-operatively within 1-2 weeks of release)
    • Ankyloglossia (Tongue-Tie) – Children to Adults of All Ages:
      • At Little Bird, you will first meet with our new patient educator to learn about the connection between breathing, sleeping, tongue and lip function prior to the interactive assessment/examination. Following the assessment, treatment recommendations, procedures and post-operative care will be discussed. Our goal at LB is to ensure that our families feel comfortable every step of the way.
      • For many children – if the tongue restriction (tie) is not severe but demonstrating sub-optimal function, we first focus on tongue/mouth myofunctional exercises that will strengthen the tongue and ensure that they are nasal breathing (for optimal health). As we re-train and strengthen the tongue, we will re-evaluate the tongue restriction to determine if a release is necessary.
      • If the tongue restriction (tie) is significantly impeding function and/or the child is unable to master the tongue/mouth myofunctional exercises, at this point we would recommend a surgical release of the frenum (tie).
        *Note: For Adults – we conduct a comprehensive assessment, and if a tongue tie is noted and would benefit from a release. Following discussion and consent to proceed. Our adult patients will have 2-3 weeks of pre-release myofunctional tongue/mouth exercises (that must be mastered prior to release). Following release, myofunctional tongue/mouth exercises are required and discussed for optimal results.
      • Young children may require deep conscious sedation (still awake) or a light general anesthetic (asleep) performed by an anesthesiologist in the office due to need for excellent cooperation during the procedure for optimal safe care
      • For older children and adults, a functional release is performed that integrates myofunctional therapy (exercise program) before (1-2 weeks), during, and after surgery (2-3 weeks).
      • Our functional release is performed in office with the patient awake, under local anesthesia (topical numbing jelly and a few drops of freezing) with assessment of function during the procedure (exercises, tongue movements, with subjective (how they feel) and objective (how it looks) feedback)
      • Post-operative oral myofunctional therapy exercises must be practiced to encourage optimal healing and to prevent superficial wound attachment

     

    •  Lip Tie – Newborn to 1 year of age:
      • At Little Bird, you will first meet with our new patient educator to learn about your baby’s breathing, sleeping, tongue and lip function prior to the interactive assessment/examination of your baby. During the assessment, Dr. Sigal ensures that you are involved. Following the assessment, treatment recommendations, procedures and post-operative care will be discussed. Our goal at LB is to ensure that our families feel comfortable every step of the way.
      • Once diagnosed the simple surgical release should be performed as soon as possible in the office  (same day as assessment) with the infant awake *Note: If both tongue and lip ties are present, it is recommended that both be released at the same appointment for optimal results
      • As the connective tissue frenum that is released has no feeling (lacks innervation), NO sedation or freezing is necessary
      • Sucrose (pure sugar) is provided prior to the release for your babe’s increased comfort (*Best analgesic for infants under the age of 12 months)
      • The frenotomy technique performed by Dr. Sigal does not remove the frenum (as it is a normal part of our anatomy), but removes the restriction, allowing for it to function optimally with negligible inflammation or swelling (improving post-operative patient care and comfort). For example, the lip frenum may still appear as a Kotlow Class II, but it would function as a normal, non-restrictive, optimized frenum.
      • We encourage immediately resuming breastfeeding after the procedure (best post-op care!)
      • Our LB staff provide instruction in regards to comfort and care for your babe following release
      • For best results – Must perform post-operative stretching and fun oral myofunctional exercises (“Play-Time) as discussed/outlined in our post-operative instructions to prevent superficial wound attachment and optimize healing
      • We will see you and your babe at your follow up appointments at LB (included with the cost of the release procedure). We will assess your baby’s lip movement, rest position, healing, stretches/exercises and breathing to ensure that their anatomy remains optimized throughout the critical healing window (first 2 weeks)
      • We strongly recommend for you to see a lactation consultant preferably pre-operatively and post operatively  (within 48-72 hours of release)*this is essential for the improvement of breastfeeding (positioning, breast milk supply discussions, and to assist baby, as they require re-learning/training of their tongues!)
      • We also encourage baby to be seen for bodywork with an osteopath / therapist (pre and/or post-operatively within 1-2 weeks of release)
    •  Lip Tie – Children to Adults of All Ages:
      • At Little Bird, you will first meet with our new patient educator to learn about the connection between breathing, sleeping, tongue and lip function prior to the interactive assessment/examination. Following the assessment, treatment recommendations, procedures and post-operative care will be discussed. Our goal at LB is to ensure that our families feel comfortable every step of the way.
      • Once assessed and diagnosed if your lip tie is still having an impact on growth, or oral function, then the simple surgical release is performed in office with patient awake, under local anesthesia (topical numbing jelly and few drops of freezing in the frenum) with a pre-and post-operative course of oral myofunctional therapy (exercises/stretching)
      • Rarely, young children may require deep conscious sedation (still awake) or a light general anesthetic (asleep) performed by an anesthesiologist in the office due to the need for excellent cooperation during the procedure for optimal safe care
      • The frenotomy technique performed by Dr. Sigal does not remove the frenum (as it is a normal part of our anatomy), but removes the restriction, allowing for it to function optimally with negligible inflammation or swelling (improving post-operative patient care and comfort). For example, it therefore may still appear as a Kotlow Class II, but it would function as a normal, non-restrictive, optimized frenum
      • Post-operative oral-myofunctional therapy exercises must be practiced to encourage optimal healing and to prevent superficial wound attachment
6. Interceptive Orthodontics
  1. What is interceptive orthodontics? If we can ensure optimized nasal breathing and tongue function during the critical years of rapid growth (birth – childhood), we will be laying the best possible foundation for our children to reach their full genetic growth potential. The earlier the identification of any issues or concerns the better!
    Optimal early interceptive orthodontic treatment may include:

    • Establishment of nasal breathing
    • Elimination of oral (mouth) habits (i.e. thumb/digit sucking, lip chewing, etc.)
    • Optimization of the airway and development of the bite by ensuring ideal growth of the palate (roof of mouth, to be flat and wide)
    • Providing necessary space for all permanent teeth to erupt (with minimal to no crowding)
  2. How is this done?
    • After a comprehensive history and examination (with x-rays, pictures, etc. included as required), a diagnosis with associated cause(s) will be identified and explained alongside a recommended treatment plan that may include the following:
      • The establishment of nasal breathing with breathing exercises and the possible use of nose cones and natural nasal decongestants.  If the child has an irreversible nasal obstruction they will be referred to an Ear Nose and Throat (ENT) doctor for assessment and/or surgical management
      • Oral myofunctional therapy (OMT) to correct any oral (mouth) habits with exercises, such as thumb sucking or to promote optimized chewing, swallowing and tongue positioning
      • Occlusal adjustments performed on the existing primary (baby) teeth – selective grinding (shaving outer tooth structure without any need for freezing/local anesthetic) to remove interferences (premature tooth contacts) or adding bonded material to teeth to allow for normal movement of the bite and growth of the jaws
      • Use of oral appliances to strengthen the lips, promote optimized tongue posture, and to facilitate optimized growth of the maxilla (upper jaw) and mandible (lower jaw)
      • If baby teeth were prematurely lost because of dental cavities/infection or trauma the maintenance of the space(s) will be assessed in terms of the overall development of the bite (occlusion). This can be done with simple cemented appliances.
      • Possible referral to an orthodontist
  3.  When is this done?
    • As soon as the diagnosis and etiology of the developing condition is identified, treatment will be recommended dependent on the cooperation of the child. Early treatment is recommended to optimize the development of an optimized airway and overall growth and development of the child. Our programs will incorporate Buteyko breathing methods and myofunctional therapy in a classroom (group) setting and/or private one-on-one sessions.
    • For older children, teenagers and adults, following the establishment of nasal breathing with oral myofunctional therapy, traditional orthodontic care (i.e. braces) may also be recommended. This orthodontic care would be provided by an orthodontist recommended by Little Bird.
7. Buteyko Breathing (Breathing re-education/re-training methods)
  1. What? Airway trumps all. If we can optimize or improve any individual’s ability to breathe softly, quietly, through their nose – we can improve their life. Buteyko breathing is for everyone. Even more however, for those with asthma or allergies, mouth breathing tendencies, or athletes looking to improve their endurance, reduce their heart rate, and improve oxygenation. Named after Dr. Konstantin Buteyko, the Buteyko breathing method consists of a series of breathing exercises and guidelines specifically designed to reduce over-breathing clinically known as chronic hyperventilation syndrome.
    The simple fact is that many people breathe too much, it has been reported that at least 50% of children are mouth breathers, resulting in over breathing (i.e. taking too many breathes per minute). Over-breathing alters the natural levels of gases in the blood, reduces oxygen delivery to tissues and organs, and causes constriction of the smooth muscles surrounding blood vessels and airways. This may lead to numerous health problems such as hyperactivity, headaches, and high blood pressure to name a few.  Bringing breathing volumes towards normal and making the switch from mouth to nose breathing helps to alleviate such health problems. By re-educating breathing we hope to support lifelong health and well-being for our patients.
    Features of Optimized Healthy Breathing Include:

      • Breathing in and out through your nose (inhalation/exhalation)
      • Lips sealed (together at rest – when not speaking)
      • Teeth slightly apart (3-4mm) at rest (when not chewing/swallowing)
      • Light and quiet
      • Regular rhythm (10 – 12 per minute) *age dependent
      • Diaphragm (Belly) moving in/out, not the upper chest
      • No sighs or yawns
      • No need to take a big breath
    • What causes over-breathing?
      • Mouth breathing (causes may include a blocked nasal airway, tongue tie, learned suboptimal (low) tongue rest posture, and/or tongue-thrust swallow)
      • Diet: Processed foods that don’t need a lot of chewing, and overeating
      • Lack of exercise
      • Stress
      • Misbelief that it is “good” to take in a deep breath in/out through your mouth
      • Asthma
      • Genetic predisposition
  2. What to expect
    • All patients seen at Little Bird will have their breathing and swallowing evaluated as part of our initial comprehensive consultation and examination
    • If the patient is identified as having a breathing problem characterized by hyperventilation and/or mouth breathing, they will be offered the Buteyko breathing re-education program (may be in combination with OMT, age/patient dependent)
    • The Buteyko program will usually consist of 4 group sessions – parent/guardian(s) must attend with their child and will be encouraged to participate in the training
      • Each child will be assessed, followed by  a demonstration of specific re-breathing exercises, for them to practice with their parent/guardian
      • The child is required to practice their breathing exercises daily and keep a record in a log book which will be provided. The parent/guardian is encouraged to supervise the exercises to ensure correct completion
      • Course will usually be completed in 4 – 8 weeks at which time optimized nasal breathing should be established

Note: At Little Bird we will be offering separate Buteyko breathing workshops for adults, groups and sports teams. Please visit LB Workshops or contact us at Little Bird for further information.

8. Nasal Hygiene Programs
  1. What is this? It is important that nasal breathing be established to promote optimized growth and development of the airway. If the nasal passages are blocked, this must be cleared in order to allow for the establishment of nasal breathing.
  2. What may be involved?
    • Natural nasal decongestion exercises (Buteyko exercise)
    • Breathe right nasal strips
    • Xlear (Natural) nasal decongestant spray
    • Paper (micro-porous) taping
    • Possible referral for assessment/care of: allergies, tonsils and adenoids and/or nasal irreversible blockage/obstruction
9. Risk Management and Preventive Programs
  1. What is this? Cavities represent the most common chronic infectious disease in the world caused by bacteria in the mouth. Did you know that babies are not born with this cavity causing bacteria? They only receive it through the saliva shared by their caregivers with untreated active cavities (i.e. through kisses, sharing of food and utensils, etc.). As such, cavities (and gum disease) can be prevented through education and an individualized risk management programs based on their risk level.
    Goals of the Program are:

    • Promotion of healthy teeth and gums for life
    • Prevention of dental cavities and the pain, suffering and cost associated with the management of the cavities (Goal at LB: Patients with cavity free futures!)
    • Prevention of gum disease
    • Identification of other oral conditions that may require early care
  2. Who would benefit? All patients seen at Little Bird would benefit from an individualized preventive risk management program. 
  3. What may be included?
    • Regular Check-ups and Recare office visits on a frequency based on the patient’s individual risk to promote ultimate health
    • X-rays as needed to look for cavities or other problems in the teeth and supporting bone that cannot be seen clinically
    • Diet analysis and counseling
    • Customized oral hygiene instruction for the patient and caregivers that may include:
      • Toothbrush selection
      • Toothpaste selection
      • Tooth brushing technique and frequency
      • Use of oral hygiene aids including floss
      • Mouthwash with fluoride and/or other antibacterial agents (Xylitol, etc.)
    • Fluoride discussion and promotion to prevent cavities and remineralize/strengthen teeth (As applicable)
      • In water, toothpaste, & mouth rinses
      • Professionally applied at LB as a gel or varnish
    • Xylitol (Natural /sugar free sweetener) for cavity prevention
    • Fluoride free remineralizing agents to restore normal enamel such as MI paste
    • Pit and fissure sealants to seal deep grooves in teeth that may be prone to developing cavities despite good oral hygiene (brushing)
    • Specific care for other lesions or conditions identified
10. Snoezelen® (Controlled Multi-Sensory) Treatment at Little Bird
  1. What is this?  Snoezelen® (pronounced snooze–e–lin) Multi-Sensory Controlled Environments (www.snoezelen.info) are spaces that help reduce agitation and anxiety, but can also engage and delight the user, stimulate reactions and encourage communication. Snoezelen® can be described as an emotional and intellectual vacation. Snoezelen® involves the stimulation of the senses and provides an alternative way to interact with an individual.There is no restriction in terms of age or ability, Snoezelen® is for everyone, and provides the opportunity to bond and connect in a new way. They feature the use of imagery, light, auditory and tactile stimulation presented in a variety of formats. Little Bird Pediatric Dentistry is the first clinic to introduce the use of Snoezelen® with the delivery of clinical care.
  2. What to expect: Multi-sensory features are present throughout Little Bird for all patients to interact with, especially in the common waiting areas and in our Snoezelen® treatment/care room. Upon scheduling your initial appointment at Little Bird, our staff will ask a few key questions in order to determine the most appropriate space for each patient.
    Note: At Little Bird we also offer familiarization/desensitization programs and/or social story tours (See service item 11 below), in addition to rebounding therapy (before/after care) (See service item 12 below)
    For patients desiring care in the Snoezelen® treatment room, we will gather personalized information to customize the room to their unique needs. In addition, they will receive 5 minutes before and after their appointments to enjoy the space with their caregiver and/or family member. Over time, a customized Snoezelen® profile will be established for our patients at Little Bird.
  3. Snoezelen® Multi-Sensory Community Time: We will be offering community time for individuals, families and groups to come and interact in the Snoezelen® space for a small fee. Please click here to learn more!
11. Familiarization/Desensitization Programs and Social Stories
  1. What are the Familiarization/Desensitization Programs at LB?  Familiarization / Desensitization Programs vary depending on the unique needs of each individual. At LB we can offer a variety of staged appointments designed to allow each patient to become comfortable with our practice and care. For example, a 4-appointment program could look like this (with customized timing):
    • First appointment may be a set time spent in the Snoezelen open classroom space with their families/caregivers
    • Second appointment may include a conversation with a LB staff member within the Snoezelen open classroom space
    • Third appointment may include entry into our individualized Snoezelen® treatment room, for their new patient consultation/assessment
    • Fourth appointment may include an introduction to oral hygiene, provision of tooth cleaning, etc.As family members and caregivers know their loved ones best, our LB staff will rely on your suggestions as to the number of stages and what care may be best provided at each appointment.Furthermore, group homes (or larger groups) may come to Little Bird at the same time, spending time in the open Snoezelen ® classroom space. On the same day (or at set times), welcome each individual separately with their caregiver into the Snoezelen® treatment room for their consultation/assessment and/or on-going care.It is our hope that through creating these familiarization programs at Little Bird that our patients will feel comfortable, and receive more routine, preventive care thereby reducing their risks of future cavities, oral disease and associated discomfort.
  2. Social Stories at Little Bird
    Social stories provide a guided path towards an experience or the completion of a new task such as going to see the dentist. Social stories can be written as in a book, visual as in a video/pictures, or combination. At Little Bird, we encourage family members and caregivers to visit the practice (during specific times offered) to tour, experience the space, and take their own pictures, in order to create personalized social stories for your loved ones. Please contact us to learn more about this service.
12. Rebounding Therapy with the Health Bounce BPod™

Click here to learn more about the B-Pod™

  1. What? Physical activity obtained by bouncing on a trampoline has been shown to improve behavior, induce a calming effect and may improve one’s well-being in addition to providing physical activity.  The rhythmic motion and release of energy is responsible for the “calming” effect.
  2. What to expect: Little Bird will have a Health Bounce B-Pod™ which is a rebounding device (trampoline) that uses a padded C-frame handle for upper body support providing additional stability and safety. Patients may use this before or after their appointments at Little Bird to enhance their overall experience. This may be discussed with the parent, caregiver and/or patient at the initial consultation appointment or incorporated in an individualized familiarization/desensitization program.
13. American Sign Language (ASL) Translation Services

**Coming Soon**

  1. What? ASL translation services for patients who are hearing impaired
  2. What to expect: Little Bird Pediatric Dentistry will partner with community service providers for the hearing impaired to provide American Sign Language interpretation services during appointments and visits on an as needed basis.  In order to best accommodate each patient’s needs, the need for these services should be identified when the patient is referred to Little Bird, or when the first appointment is scheduled with our LB staff.

 

14. Cavity Management
  1. Little Bird Philosophy: Despite all of our best efforts some children and patients may still develop cavities, which unfortunately can be seen as early as the first year of life.
    Cavities in both baby and permanent teeth must be managed once they have been diagnosed to prevent progression because of the following potential consequences if left untreated:

    • Cavities can cause significant pain and suffering
    • Reduced eating due to the pain which will affect all aspects of growth and development
    • Altered behaviour (i.e. increase in behaviors that may include rubbing, hitting, chewing themselves or biting others, etc.)
    • Reduced or altered sleep due to the pain which may affect many aspects of growth, development and function
    • Cavities can spread beyond the tooth to cause a local, and then widespread (systemic) infection which can be life threatening
    • Account for missed days from daycare, school, program or work
  2. Little Bird Recommendations: Various materials and options exist for the management/treatment of dental cavities that our staff will explain to you (pros/cons/costs), to help you make an informed decision. Our recommendations are based on maintaining the natural baby tooth in its functional state until exfoliation (natural loss of tooth), and for permanent (adult teeth), for as long as possible. Longevity and durability are the key factors relating to our evidence based material recommendations, followed by function and esthetics. Only if a tooth is not restorable (due to large size of cavity, severely broken tooth, etc.) then extraction (removal) is recommended with appropriate management of the space (as needed) as it pertains to the occlusion (bite), function and esthetics.
  3. Cavity Treatment Offered at Little Bird:
    • Fillings/Restorations placed in the tooth
    • Crowns / Caps placed on/over the tooth (covering 360 degrees of the tooth – maximal coverage)
    • Pulp or nerve treatment (for teeth where cavities have chronically inflamed the nerve or caused nerve/pulpal death)) for both baby and permanent teeth that are considered important for function, growth and development or esthetics (Note: Procedure for baby teeth versus adult/permanent teeth is very different – our LB staff will be happy to explain further)
    • Extraction of non-restorable teeth
15. Sedation / Pharmacological Behavior Management
  1. Little Bird Philosophy: Everybody is unique and each child / patient seen at Little Bird will be assessed at each appointment to determine their ability to cooperate for the care that they require. An individualized behavior management plan will be developed to ensure that treatment can be provided efficiently in a manner that is both safe and effective for the patient, caregiver(s) and staff. Your approval is required before any such plan is provided. Some individuals may still require the use of pharmacological (drug) behavior management in order to provide their required care in a manner that is safe for them, caregivers and our staff.
  2. Pharmacological Behavior Management Options Offered:
    • Treatment without local anesthesia (no freezing) for minor and non-painful procedures
    • Treatment with local anesthesia (freezing) using topical (numbing jelly) and/or injected anesthetic
    • Conscious (light – awake) sedation with Nitrous Oxide gas (“laughing gas”) (with or without local anesthesia depending on the treatment needed)
    • Deep Conscious Sedation or General Anesthesia (asleep) provided by a certified dental/medical anesthetist at Little Bird. The facility and staff at Little Bird meet all the requirements of the Royal College of Dental Surgeons of Ontario to provide this care in the community. **Coming Soon**
    • Referral to a hospital for required care under general anesthesia (operating room setting – asleep) based on the individual’s medical history and required treatment.
    • Note: We do Not provide oral conscious sedation (“juice”) at Little Bird Pediatric Dentistry
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