The pediatric dentist has an extra two to three years of specialized
training after dental school, and is dedicated to the oral health of
children from infancy through the teenage years. The very young,
pre-teens, and teenagers all need different approaches in dealing with
their behavior, guiding their dental growth and development, and helping
them avoid future dental problems. The pediatric dentist is best
qualified to meet these needs.
Why Are The Primary Teeth Important?
It is very important to maintain the health of the primary teeth.
Neglected cavities can and frequently do lead to problems which affect
developing permanent teeth. Primary teeth, or baby teeth are important
for (1) proper chewing and eating, (2) providing space for the permanent
teeth and guiding them into the correct position, and (3) permitting
normal development of the jaw bones and muscles. Primary teeth also
affect the development of speech and add to an attractive appearance.
While the front 4 teeth last until 6-7 years of age, the back teeth
(cuspids and molars) aren't replaced until age 10-13.
Eruption Of Your Child's Teeth
Children's teeth begin forming before birth. As early as 4 months,
the first primary (or baby) teeth to erupt through the gums are the
lower central incisors, followed closely by the upper central incisors.
Although all 20 primary teeth usually appear by age 3, the pace and
order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first
molars and lower central incisors. This process continues until
approximately age 21.
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
Clean the area of the affected tooth. Rinse the mouth thoroughly with
warm water or use dental floss to dislodge any food that may be
impacted. If the pain still exists, contact your child's dentist. Do not
place aspirin or heat on the gum or on the aching tooth. If the face is
swollen, apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to
help control swelling. If there is bleeding, apply firm but gentle
pressure with a gauze or cloth. If bleeding cannot be controlled by
simple pressure, call a doctor or visit the hospital emergency room.
Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect
the tooth for fractures. If it is sound, try to reinsert it in the
socket. Have the patient hold the tooth in place by biting on a gauze.
If you cannot reinsert the tooth, transport the tooth in a cup
containing the patient's saliva or milk. If the patient is old enough,
the tooth may also be carried in the patient's mouth (beside the cheek).
The patient must see a dentist IMMEDIATELY! Time is a critical factor in
saving the tooth.
Knocked Out Baby Tooth: Contact your pediatric dentist during
business hours. This is not usually an emergency, and in most cases, no
treatment is necessary.
Chipped or Fractured Permanent Tooth: Contact your pediatric dentist
immediately. Quick action can save the tooth, prevent infection and
reduce the need for extensive dental treatment. Rinse the mouth with
water and apply cold compresses to reduce swelling. If possible, locate
and save any broken tooth fragments and bring them with you to the
Chipped or Fractured Baby Tooth: Contact your pediatric dentist.
Severe Blow to the Head: Take your child to the nearest hospital
emergency room immediately.
Possible Broken or Fractured Jaw: Keep the jaw from moving and take
your child to the nearest hospital emergency room.
Radiographs (X-Rays) are a vital and necessary part of your child's
dental diagnostic process. Without them, certain dental conditions can
and will be missed.
Radiographs detect much more than cavities. For example, radiographs
may be needed to survey erupting teeth, diagnose bone diseases, evaluate
the results of an injury, or plan orthodontic treatment. Radiographs
allow dentists to diagnose and treat health conditions that cannot be
detected during a clinical examination. If dental problems are found and
treated early, dental care is more comfortable for your child and more
affordable for you.
The American Academy of Pediatric Dentistry recommends radiographs
and examinations every six months for children with a high risk of tooth
decay. On average, most pediatric dentists request radiographs
approximately once a year. Approximately every 3 years, it is a good
idea to obtain a complete set of radiographs, either a panoramic and
bitewings or periapicals and bitewings.
Pediatric dentists are particularly careful to minimize the exposure
of their patients to radiation. With contemporary safeguards, the amount
of radiation received in a dental X-ray examination is extremely small.
The risk is negligible. In fact, the dental radiographs represent a far
smaller risk than an undetected and untreated dental problem. Lead body
aprons and shields will protect your child. Today's equipment filters
out unnecessary x-rays and restricts the x-ray beam to the area of
interest. High-speed film and proper shielding assure that your child
receives a minimal amount of radiation exposure.
What's The Best Toothpaste For My Child?
brushing is one of the most important tasks for good oral health. Many
toothpastes, and/or tooth polishes, however, can damage young smiles.
They contain harsh abrasives, which can wear away young tooth enamel.
When looking for a toothpaste for your child, make sure to pick one that
is recommended by the American Dental Association as shown on the box
and tube. These toothpastes have undergone testing to insure they are
safe to use.
Remember, children should spit out toothpaste after brushing to avoid
getting too much fluoride. If too much fluoride is ingested, a condition
known as fluorosis can occur. If your child is too young or unable to
spit out toothpaste, consider providing them with a fluoride free
toothpaste, using no toothpaste, or using only a "pea size" amount of
Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of teeth
(bruxism). Often, the first indication is the noise created by the child
grinding on their teeth during sleep. Or, the parent may notice wear
(teeth getting shorter) to the dentition. One theory as to the cause
involves a psychological component. Stress due to a new environment,
divorce, changes at school; etc. can influence a child to grind their
teeth. Another theory relates to pressure in the inner ear at night. If
there are pressure changes (like in an airplane during take-off and
landing, when people are chewing gum, etc. to equalize pressure) the
child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not require any
treatment. If excessive wear of the teeth (attrition) is present, then a
mouth guard (night guard) may be indicated. The negatives to a mouth
guard are the possibility of choking if the appliance becomes dislodged
during sleep and it may interfere with growth of the jaws. The positive
is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The grinding
decreases between the ages 6-9 and children tend to stop grinding
between ages 9-12. If you suspect bruxism, discuss this with your
pediatrician or pediatric dentist.
is a natural reflex and infants and young children may use thumbs,
fingers, pacifiers and other objects on which to suck. It may make them
feel secure and happy, or provide a sense of security at difficult
periods. Since thumb sucking is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of the permanent
teeth can cause problems with the proper growth of the mouth and tooth
alignment. How intensely a child sucks on fingers or thumbs will
determine whether or not dental problems may result. Children who rest
their thumbs passively in their mouths are less likely to have
difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their permanent front
teeth are ready to erupt. Usually, children stop between the ages of two
and four. Peer pressure causes many school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They can affect the
teeth essentially the same way as sucking fingers and thumbs. However,
use of the pacifier can be controlled and modified more easily than the
thumb or finger habit. If you have concerns about thumb sucking or use
of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through thumb sucking:
Children often suck their thumbs when feeling insecure. Focus on
correcting the cause of anxiety, instead of the thumb sucking.
Children who are sucking for comfort will feel less of a need
when their parents provide comfort.
Reward children when they refrain from sucking during difficult
periods, such as when being separated from their parents.
Your pediatric dentist can encourage children to stop sucking
and explain what could happen if they continue.
If these approaches don't work, remind the children of their
habit by bandaging the thumb or putting a sock on the hand at night.
Your pediatric dentist may recommend the use of a mouth appliance.
What Is Pulp Therapy?
The pulp of a tooth is the inner, central core of the tooth. The pulp
contains nerves, blood vessels, connective tissue and reparative cells.
The purpose of pulp therapy in Pediatric Dentistry is to maintain the
vitality of the affected tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic injury are the main reasons
for a tooth to require pulp therapy. Pulp therapy is often referred to
as a "nerve treatment", "children's root canal", "pulpectomy" or
"pulpotomy". The two common forms of pulp therapy in children's teeth
are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion
of the tooth. Next, an agent is placed to prevent bacterial growth and
to calm the remaining nerve tissue. This is followed by a final
restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved (into the
root canal(s) of the tooth). During this treatment, the diseased pulp
tissue is completely removed from both the crown and root. The canals
are cleansed, disinfected and, in the case of primary teeth, filled with
a resorbable material. Then, a final restoration is placed. A permanent
tooth would be filled with a non-resorbing material.
Is The Best Time For Orthodontic Treatment?
malocclusions, or bad bites, can be recognized as early as 2-3 years of
age. Often, early steps can be taken to reduce the need for major
orthodontic treatment at a later age.
Stage I - Early Treatment: This period of treatment encompasses ages
2 to 6 years. At this young age, we are concerned with underdeveloped
dental arches, the premature loss of primary teeth, and harmful habits
such as finger or thumb sucking. Treatment initiated in this stage of
development is often very successful and many times, though not always,
can eliminate the need for future orthodontic/orthopedic treatment.
Stage II - Mixed Dentition: This period covers the ages of 6 to 12
years, with the eruption of the permanent incisor (front) teeth and 6
year molars. Treatment concerns deal with jaw malrelationships and
dental realignment problems. This is an excellent stage to start
treatment, when indicated, as your child's hard and soft tissues are
usually very responsive to orthodontic or orthopedic forces.
Stage III - Adolescent Dentition: This stage deals with the permanent
teeth and the development of the final bite relationship.
Adult Teeth Coming in Behind Baby
is a very common occurrence with children, usually the result of a
lower, primary (baby) tooth not falling out when the permanent tooth is
coming in. In most cases if the child starts wiggling the baby
tooth, it will usually fall out on its own within two months. If it
doesn't, then contact your pediatric dentist, where they can easily
remove the tooth. The permanent tooth should then slide into the
Infant Oral Care
Perinatal & Infant Oral Health
American Academy of Pediatric Dentistry (AAPD) recommends that all
pregnant women receive oral healthcare and counseling during pregnancy.
Research has shown evidence that periodontal disease can increase the
risk of preterm birth and low birth weight. Talk to your doctor or
dentist about ways you can prevent periodontal disease during pregnancy.
Additionally, mothers with poor oral health may be at a greater risk
of passing the bacteria which causes cavities to their young children.
Mother's should follow these simple steps to decrease the risk of
spreading cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis to reduce bacterial plaque.
Proper diet, with the reduction of beverages and foods high in
sugar & starch.
Use a fluoridated toothpaste recommended by the ADA and rinse
every night with an alocohol-free, over-the-counter mouth rinse with
.05 % sodium fluoride in order to reduce plaque levels.
Don't share utensils, cups or food which can cause the
transmission of cavity-causing bacteria to your children.
Use of xylitol chewing gum (4 pieces per day by the mother) can
decrease a child's caries rate.
Child's First Dental Visit-Establishing A "Dental Home"
The American Academy of Pediatrics (AAP), the American Dental
Association (ADA), and the American Academy of Pediatric Dentistry
(AAPD) all recommend establishing a "Dental Home" for your child by one
year of age. Children who have a dental home are more likely to receive
appropriate preventive and routine oral health care.
The Dental Home is intended to provide a place other than the
Emergency Room for parents.
You can make the first visit to the dentist enjoyable and positive.
If old enough, your child should be informed of the visit and told that
the dentist and their staff will explain all procedures and answer any
questions. The less to-do concerning the visit, the better.
It is best if you refrain from using words around your child that
might cause unnecessary fear, such as needle, pull, drill or hurt.
Pediatric dental offices make a practice of using words that convey the
same message, but are pleasant and non-frightening to the child.
Will My Baby Start Getting Teeth?
Teething, the process of baby (primary) teeth coming through the gums
into the mouth, is variable among individual babies. Some babies get
their teeth early and some get them late. In general, the first baby
teeth to appear are usually the lower front (anterior) teeth and they
usually begin erupting between the age of 6-8 months. See
"Eruption of Your Child's Teeth" for more details.
Bottle Tooth Decay (Early Childhood Caries)
serious form of decay among young children is baby bottle tooth decay.
This condition is caused by frequent and long exposures of an infant's
teeth to liquids that contain sugar. Among these liquids are milk
(including breast milk), formula, fruit juice and other sweetened
Putting a baby to bed for a nap or at night with a bottle other than
water can cause serious and rapid tooth decay. Sweet liquid pools around
the child's teeth giving plaque bacteria an opportunity to produce acids
that attack tooth enamel. If you must give the baby a bottle as a
comforter at bedtime, it should contain only water. If your child won't
fall asleep without the bottle and its usual beverage, gradually dilute
the bottle's contents with water over a period of two to three weeks.
After each feeding, wipe the baby's gums and teeth with a damp
washcloth or gauze pad to remove plaque. The easiest way to do this is
to sit down, place the child's head in your lap or lay the child on a
dressing table or the floor. Whatever position you use, be sure you can
see into the child's mouth easily.
Sippy cups should be used as a training tool from the bottle to a cup
and should be discontinued by the first birthday. If your child uses a
sippy cup throughout the day, fill the sippy cup with water only (except
at mealtimes). By filling the sippy cup with liquids that contain sugar
(including milk, fruit juice, sports drinks, etc.) and allowing a child
to drink from it throughout the day, it soaks the child's teeth in
cavity causing bacteria.
The American Association for Orthodontists recommends that every child
have an orthodontic evaluation by the age of 7. Early detection and
treatment gives your child the edge: a much better chance for natural
and normal development. By working with the natural growth instead of
against it, we can prevent problems from becoming worse, and give your
child a lifetime of healthy smiles!
Early treatment should be initiated for:
Habits such as tongue thrusting and thumb sucking
A constricted airway due to swollen adenoids or tonsils
Mouth breathing or snoring problems
A bad bite
Bone problems (i.e. narrow or underdeveloped jaws)
In the first phase, the doctor is interested in the position and
symmetry of the jaws, future growth, spacing of the teeth, breathing and
other oral habits which may, over a period of time, result in abnormal
Treatment initiated in this phase of development is often very
successful and some times, though not always, can eliminate the need for
future orthodontic treatment.
Braces - Ages 12 to 14
In the second phase, the doctor will be looking at how your child’s
teeth and jaws fit, and more specifically work, together. Your child’s
teeth will be straightened and their occlusion (bite) is properly
aligned. Attention will be given to the jaw joint, (TMJ), the facial
profile and periodontal (gum) tissues. By undergoing the first phase, we
can usually reduce the amount of time needed for braces.
Facts: Early Treatment Is Important to Consider!
Seventy-five percent of 12-year-olds need orthodontic treatment. Yet 90%
of a child's face has already developed! By guiding facial development
earlier, through the use of functional appliances, 80% of the treatment
can be corrected before the adult teeth are present!
children between the ages of 8 and 11 are often much more cooperative
than children of ages 12 to 14.
Shorter Treatment Time-
Another advantage of early Phase One treatment is that children will
need to wear fixed braces on their adult teeth for less time.
To Correct Underdeveloped or Overdeveloped Jaws-
Almost 55% of children who need orthodontic treatment due to a bad bite
have underdeveloped or overdeveloped upper or lower jaws. Functional
appliances and/or limited braces can reposition the jaws, improving the
child's profile and correcting the bite problem - within 7 to 9 months!
Of Your Child's Teeth
Note: If you are using Internet Explorer 10 or higher this animated guide may not display properly. Please try a different browser.
Diet = Healthy Teeth
eating habits lead to healthy teeth. Like the rest of the body, the
teeth, bones and the soft tissues of the mouth need a well-balanced
diet. Children should eat a variety of foods from the five major food
groups. Most snacks that children eat can lead to cavity formation. The
more frequently a child snacks, the greater the chance for tooth decay.
How long food remains in the mouth also plays a role. For example, hard
candy and breath mints stay in the mouth a long time, which cause longer
acid attacks on tooth enamel. If your child must snack, choose
nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese,
which are healthier and better for children's teeth.
Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left over food particles
that combine to create cavities. For infants, use a wet gauze or clean
washcloth to wipe the plaque from teeth and gums. Avoid putting your
child to bed with a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a day. Also,
watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends visits every
six months to the pediatric dentist, beginning at your child's first
birthday. Routine visits will start your child on a lifetime of good
Your pediatric dentist may also recommend protective sealants or home
fluoride treatments for your child. Sealants can be applied to your
child's molars to prevent decay on hard to clean surfaces.
Seal Out Decay
AA sealant is a protective coating that is applied to the chewing
surfaces (grooves) of the back teeth (premolars and molars), where four
out of five cavities in children are found. This sealant acts as a
barrier to food, plaque and acid, thus protecting the decay-prone areas
of the teeth.
Before Sealant Applied
After Sealant Applied
Fluoride is an element, which has been shown to be beneficial to
teeth. However, too little or too much fluoride can be detrimental to
the teeth. Little or no fluoride will not strengthen the teeth to help
them resist cavities. Excessive fluoride ingestion by preschool-aged
children can lead to dental fluorosis, which is a chalky white to even
brown discoloration of the permanent teeth. Many children often get more
fluoride than their parents realize. Being aware of a child's potential
sources of fluoride can help parents prevent the possibility of dental
Some of these sources are:
Too much fluoridated toothpaste at an early age.
The inappropriate use of fluoride supplements.
Hidden sources of fluoride in the child's diet.
Two and three year olds may not be able to expectorate (spit out)
fluoride-containing toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of fluoride during tooth
brushing. Toothpaste ingestion during this critical period of permanent
tooth development is the greatest risk factor in the development of
Excessive and inappropriate intake of fluoride supplements may also
contribute to fluorosis. Fluoride drops and tablets, as well as fluoride
fortified vitamins should not be given to infants younger than six
months of age. After that time, fluoride supplements should only be
given to children after all of the sources of ingested fluoride have
been accounted for and upon the recommendation of your pediatrician or
Certain foods contain high levels of fluoride, especially powdered
concentrate infant formula, soy-based infant formula, infant dry
cereals, creamed spinach, and infant chicken products. Please read the
label or contact the manufacturer. Some beverages also contain high
levels of fluoride, especially decaffeinated teas, white grape juices,
and juice drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of
fluorosis in their children's teeth:
Use baby tooth cleanser on the toothbrush of the very young
Place only a pea sized drop of children's toothpaste on the
brush when brushing.
Account for all of the sources of ingested fluoride before
requesting fluoride supplements from your child's physician or
Avoid giving any fluoride-containing supplements to infants
until they are at least 6 months old.
Obtain fluoride level test results for your drinking water
before giving fluoride supplements to your child (check with local
a child begins to participate in recreational activities and organized
sports, injuries can occur. A properly fitted mouth guard, or mouth
protector, is an important piece of athletic gear that can help protect
your child's smile, and should be used during any activity that could
result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries to the lips,
tongue, face or jaw. A properly fitted mouth guard will stay in place
while your child is wearing it, making it easy for them to talk and
Ask your pediatric dentist about custom and store-bought mouth
Xylitol - Reducing Cavities
The American Academy of Pediatric Dentistry (AAPD) recognizes the
benefits of xylitol on the oral health of infants, children,
adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3
months after delivery and until the child was 2 years old, has proven to
reduce cavities up to 70% by the time the child was 5 years old.
Studies using xylitol as either a sugar substitute or a small dietary
addition have demonstrated a dramatic reduction in new tooth decay,
along with some reversal of existing dental caries. Xylitol provides
additional protection that enhances all existing prevention methods.
This xylitol effect is long-lasting and possibly permanent. Low decay
rates persist even years after the trials have been completed.
Xylitol is widely distributed throughout nature in small amounts.
Some of the best sources are fruits, berries, mushrooms, lettuce,
hardwoods, and corn cobs. One cup of raspberries contains less than one
gram of xylitol.
Studies suggest xylitol intake that consistently produces positive
results ranged from 4-20 grams per day, divided into 3-7 consumption
periods. Higher results did not result in greater reduction and may lead
to diminishing results. Similarly, consumption frequency of less than 3
times per day showed no effect.
To find gum or other products containing xylitol, try visiting your
local health food store or search the Internet to find products
containing 100% xylitol.
Beware of Sports Drinks
to the high sugar content and acids in sports drinks, they have erosive
potential and the ability to dissolve even fluoride-rich enamel, which
can lead to cavities.
To minimize dental problems, children should avoid sports drinks and
hydrate with water before, during and after sports. Be sure to
talk to your pediatric dentist before using sports drinks.
If sports drinks are consumed:
reduce the frequency and contact time
swallow immediately and do not swish them around the mouth
neutralize the effect of sports drinks by alternating sips of
water with the drink
rinse mouthguards only in water
seek out dentally friendly sports drinks
Tongue Piercing - Is It
You might not be surprised anymore to see people with pierced
tongues, lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
There are many risks involved with oral piercings, including chipped
or cracked teeth, blood clots, blood poisoning, heart infections, brain
abscess, nerve disorders (trigeminal neuralgia), receding gums or scar
tissue. Your mouth contains millions of bacteria, and infection is a
common complication of oral piercing. Your tongue could swell large
enough to close off your airway!
Common symptoms after piercing include pain, swelling, infection, an
increased flow of saliva and injuries to gum tissue.
Difficult-to-control bleeding or nerve damage can result if a blood
vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental Association and give your
mouth a break - skip the mouth jewelry.
Tobacco - Bad News In Any Form
Tobacco in any form can jeopardize your child's health and cause
incurable damage. Teach your child about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often used by
teens who believe that it is a safe alternative to smoking cigarettes.
This is an unfortunate misconception. Studies show that spit tobacco may
be more addictive than smoking cigarettes and may be more difficult to
quit. Teens who use it may be interested to know that one can of snuff
per day delivers as much nicotine as 60 cigarettes. In as little as
three to four months, smokeless tobacco use can cause periodontal
disease and produce pre-cancerous lesions called leukoplakias.
If your child is a tobacco user you should watch for the following
that could be early signs of oral cancer:
A sore that won't heal.
White or red leathery patches on the lips, and on or under the
Pain, tenderness or numbness anywhere in the mouth or lips.
Difficulty chewing, swallowing, speaking or moving the jaw or
tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are not painful,
people often ignore them. If it's not caught in the early stages, oral
cancer can require extensive, sometimes disfiguring, surgery. Even
worse, it can kill.
Help your child avoid tobacco in any form. By doing so, they will
avoid bringing cancer-causing chemicals in direct contact with their
tongue, gums and cheek.
Children with Special Health Care Needs
Our practice values each child as an individual. We understand
that children with special health care needs require a dental
practice that is open and understanding. We are aware that
they often experience a higher risk of oral diseases with potential
effects to their overall quality of health throughout life. Whatever
your child’s circumstance, all of our patients are treated on a case
by case basis with particular emphasis on their individual needs.
Our staff is committed to:
Each visit begins by listening to the special circumstances of each
child. We understand that parents and caregivers know their
children better than anyone else. By listening to you and
patiently answering your questions we are able to work together in
providing the best possible care for your child.
No two children are the same. Instead of asking our patients
to adapt to an unchanging structure of treatment, we strive to
remain flexible with treatment options by balancing the safety and
emotional well-being of each patient with effective dental care.
Our staff truly cares about each of our patients. Further, our
practice is equipped to care for children with special health care
needs because of expertise gained through additional training. We
chose pediatric dentistry as a dental specialty because we are
passionate about helping children begin a lifetime of good oral
hygiene. This passion is especially present in our treatment
of children with special health care needs.