Pediatric Dentistry: An Integrative, Multidisciplinary Approach
As a DMD (Doctor of Medical Dentistry), specializing in pediatric dentistry, Dr. Robbins has years of advanced, post-doctoral academic and clinical training, extending well beyond care for children’s teeth. Dr. Robbins’ training spans the full continuum of childhood development, from infancy, through early childhood and into adolescence.
At Dr. Robbins’ office, we always consider the health and well being of the entire patient, not just the patient’s teeth, gums, and oral cavity. Comprehensive initial exams, diagnostic procedures, prescribed treatments, and recommended patient follow-up take into account, if indicated by patient history or initial findings, the presence not only of common and usually correctable conditions (for example, cavities and tooth crowding), but also, the existence of congenital conditions, the risk or existence of childhood diseases, functional and behavioral issues, and/or special needs.
Also trained in orofacial myofunctional therapy, Dr. Robbins can identify and treat functional factors and behaviors that may affect breathing, speech, breastfeeding, chewing, swallowing, facial development, sleep, posture and movement. Additionally, Dr. Robbins is trained in cranial nerve assessment, neuro-sequencing and cranio-osteopathic concepts relevant to dentistry, in fascial anatomy and function and in management of head and neck pain; fields which can lend important insight into patient diagnosis and treatment, oftentimes including close consultation and active collaboration with other specialists.
Dr. Robbins’ advanced training, experience in private practice, in university based pediatric dentistry at UCLA, and at the preeminent Children’s Hospital of Philadelphia, and her commitment to continuing education means that our patients benefit from Dr. Robbins’ extensive range of clinical knowledge and practical skill.
Note: We provide the following information for educational purposes only, and not for diagnosis or treatment, which must only be done by qualified practitioners. More detailed information can be found in the research and clinical literature, and through online searches of reputable sources, such as those found on our Helpful Online Resources web page. Some of the information below draws upon material covered in New Trends in Myofunctional Therapy – Occlusion, Muscles and Posture. Edi. Ermes s.r.l. 2020, for which Dr. Robbins was an editorial Collaborator.
Oral Myofunctional Therapy
Oral myofunctional therapy (abbeviated OMT; commonly called “myo”) is a technique to treat symptoms relating to breathing disorders, sleep apnea, TMJ (temperomandibular joint) disorder, and other ailments that often emerge in early childhood. Experts in pediatric OMT (myo for children), are professionally trained to diagnose treat conditions and “bad habits” of the lips, tongue, airway, facial muscles and head/neck positioning (posture) that may otherwise persist into adolescence and adulthood. Dr. Robbins is a thought leader in the integration of oral myofunctional therapy into a comprehensive plan of pediatric oral care and development. She interacts with an extensive network of OMT therapists, throughout California, nationally, and internationally.
Functional Appliances: The ALF
Dr. Robbins is highly experienced in the use of the ALF appliance (developed/invented by Dr. Darick Nordstrom). Based on clinical feedback from myofunctional therapists and osteopathic physicians, the ALF (Advanced Lightwire Functionals) is a wire appliance , designed to facilitate natural development of the oral cavity and associated structures, with the goal to achieve optimal function. The ALF provides a more gentle way to expand the maxilla and mandible and to align the teeth, working in harmony with the body’s natural growth patterns and physiologic rhythms. The ALF has been used to treat a range of anatomical and physiological issues, including cranial bone and soft tissue and airway development, orofacial pain (including neck and back pain, and headaches), sleep issues, ear and vision issues, myofunctional disorders and postural alignment issues.
Tongue-tie and Lip-tie
Tongue-tie and lip-tie are two terms in common usage to describe presence in the mouth of connective tissue (known as a frenulum, or, sometimes interchangeably, as a frenum or frenulum), that restricts the normal range of movement of the tongue or lip (upper, lower or both). Presence of tongue-tie or lip-tie can cause or contribute to problems with breastfeeding in infants, and, with later difficulties in chewing, drinking, swallowing, and speech. Tongue-tie and lip-tie may be alleviated via an in-office procedure known as a frenectomy (alternatively, frenulectomy, frenotomy), which involves the careful “release” of the excess connective tissue to improve range of movement of the tongue or lip(s).
The frenectomy procedure can be performed with either a simple surgical implement or a dental laser intended for use on soft tissue of the oral cavity. The procedure itself is relatively quick, as is recovery, although Dr. Robbins emphasizes the importance of parent education to ensure compliance with post-procedure exercises that facilitate healing and encourage proper range of motion. Myofunctional therapy also plays an essential role in treatment success.
Simply stated, sleep-disordered breathing (SDB) describes a group of clinical symptoms and events caused by an abnormal increase in resistance to the passage of air through the upper airway during sleep. Two commonly known examples of SBD in both children and adults are snoring and obstructive sleep apnea. There are other, less commonly known types of SDB. Common symptoms of SDB include nighttime snoring, pauses of breathing during sleep, bruxism, awakening with choking, dry mouth and daytime sleepiness. It is not unusual for SDB to be diagnosed following identification of behaviors in affected children, such as mouth breathing while awake (breathing through the mouth with open lips, rather than through the nostrils), forward head posture, daytime sleepiness, irritability, and inability to concentrate.
The importance of detecting and treating sleep-disordered breathing during childhood cannot be understated. SBD during childhood can be a risk factor for other health problems, including chronic problems in adulthood.. Fortunately, SBD can be properly diagnosed and treated in children, using a multidisciplinary approach that may involve specialists in pediatric dentistry and medicine, sleep medicine, otolaryngology (ENTs), myofunctional therapists, cranio-osteopathic physicians and other practitioners. Dr. Robbins favors a natural, gentle approach to achieve optimal treatment outcomes for SBD, and likes to emphasize the importance of good sleep hygiene for overall health and development in children.
We encourage parents and guardians to discuss any observations or concerns they may have regarding their children’s sleep habits and any signs that may suggest issues with sleep and breathing.
Cranial Nerve Function
Many functions of the mouth, jaw, face, head and neck, such as movement of the facial muscles and the muscles of the lips, tongue, mastication (chewing), and swallowing, as well as salivation (saliva production) and the senses (taste, smell, vision, hearing) are controlled by the cranial nerves. There are 12 pairs (right and left) of cranial nerves that emerge directly from the brain and brainstem, conventionally number I-XII. Cranial nerve X, the vagus nerve, provides both muscle and sensory inputs to the head and to organs in the chest and abdomen. Normally, all the cranial nerves work together in near-perfect sequence, coordinating the exquisitely fine-tuned functions of the head and neck–and especially important to dentists, the mouth! Sometimes, due to developmental issues, injury, or abnormal pathology, the cranial nerves may not function optimally; they may operate “out of sequence,” which affects the ability to integrate muscle and sensory functions.
Dr. Robbins has taken advanced training to assess cranial nerve function, as part of her overall multidisciplinary and integrative approach to pediatric oral care and wellness. Some issues may be addressed through a process of neural sequencing, with the goal to achieve optimal coordination of certain functions and behaviors related to dentistry. Dr. Robbins may also recommend consultation with other specialists, as in the case of injury, anatomical anomalies or pathology that may affect the cranial nerves.
Head & Neck Pain
Head and facial pain, also known as craniofacial pain, and neck pain, can be of neurological or muscular origin., also known as myalgia. As Senior Clinical Instructor in the TMJ/Craniofacial Pain Clinic of the Audiology Foundation at White Memorial Medical Center, Los Angeles, Dr. Robbins has advanced training and experience in the evaluation of pediatric patients who complain or show signs of tooth pain and sensitivity or pain in other areas of the head, face and neck. Pain can arise from a variety of causes, and may also be perceived by the patient at a site or location distant from the actual cause. This particular type of pain is known as referred pain.
The evaluation of pain calls upon a range of methods, including patient reporting, questioning, observation and physical examination by the practitioner (usually done by direct palpation affected areas with the fingers and other exploratory procedures, such as imaging. Evaluating pain in children draws upon the pediatric specialist’s skillfulness in communication and observation, especially because very young children or kids with special needs may not be able to vocalize or explain the location or pain that they feel.
Neurologic pain is usually described as headache, sharp, burning, stabbing, pins and needles or a sensation akin to electrical shock. Muscular pain tends to present as a dull ache, and may persist. Upon palpation of the affected tissues, muscle pain may be reproduced. Muscle pain may result from postural problems, chewing problems, problems with joint function, and also, problems with overuse or maladaptation to repeated stress. Pain may also arise from soft tissue injury (cuts, abrasions) or secondary to infection as with an abscess, and, of course, tooth eruption or cavities.
Using an integrative approach, Dr. Robbins evaluates pediatric head and neck pain by considering not only the immediate symptoms, but also, the root causes and contributing factors, which can include habits, behaviors or activities that place inordinate stress on muscles and joints of the head and neck. Some notable causes of head and neck pain in children include teeth grinding, clenching or bruxism. Another possible source of pain is excessive and/or “ergonomically challenged” use of handheld electronic devices, such as smartphones, tablets, etc.; a problem not limited to children!
Depending upon each child’s individual complaint of pain and initial findings, Dr. Robbins may suggest additional evaluation, recommend certain changes in behavior, and/or advise a particular treatment plan. Because pain may arise from multiple causes, including health issues outside of the pediatric dentist’s typical scope of practice (as may be the case, for example, in certain kinds of neurologic pain), Dr. Robbins may also suggest consultation with other specialists as part of a multidisciplinary approach.
Movement & Posture
Consider this: Kids need move! Physical activity, especially play, is vital to healthful growth and development in children, and pediatric dentists can play an important role in educating parents about the importance of encouraging healthful movement and posture in children.
As part of her everyday patient interaction, Dr. Robbins helps parents to “be on the lookout” for behaviors and activities that, if not addressed or corrected, can lead to later problems, because of untoward muscle strain, repetitive motion, impingement of cranial nerves, mouth breathing, and airway problems. Examples of potential “problem” behaviors and activities include overuse of handheld mobile devices (smartphones, tablets, etc.) that induces unhealthful forward head posture; lack of active, physical play, poor seated posture, and sleeping positions that constrain the airway.
Dr. Robbins is highly trained and experienced in the observation and correction of problematic behaviors and habits related to unhealthful movement (or lack thereof) and improper posture. She is a certified instructor in GYROKINESIS® and GYROTONIC®, which are complementary methods of movement, originally developed to help injured dancers to regain strength and agility.
Don’t be surprised if Dr. Robbins gives you and your children a Prescription for Play!
Breastfeeding in Infants
Dr. Robbins often collaborates with pediatricians, lactation consultants and other early childhood specialists to help address breastfeeding issues in newborn babies and young infants. Lack of desire to breastfeed, failure to latch, difficulty swallowing and excessive or painful irritation may indicate the presence of tongue-tie, lip-tie or other oral anatomical or functional issues that impede optimal breastfeeding and are amenable to safe and effective treatment under the care of a properly experienced and equipped pediatric dentist and other specialists. Part of this experience includes the education of moms and dads on pre-treatment expectations and preparations and the importance of post-treatment exercises, to help ensure successful and lasting results.