Northern Virginia Magazine 2008 - Barakat Orthodontics

Hole
in
One
child dentistry procedures tackle more than cavities
Seven-year-old Maya doesn’t even have permanent teeth yet, but she has spent much
of her life at the dentist. Born with a rare, lifelong condition that causes brittle bones
and fragile teeth, Maya has experienced extractions, fillings, crowns, infections and
fractures. She plays happily in the waiting room and looks forward to her reward
sticker—and she is grinning.
This is not your mama’s childhood dentistry. Area dentists for kids are highly trained
specialists, able to handle it all from the usual, like fillings, fluoride and impacted
wisdom teeth, to conditions like Maya’s. From too many teeth to too few, cleft palates
to facial anomalies, any need has a matching set of specialists.
86 • November 2008 • www.NorthernVirginiaMagazine.com
text by Tracey Edgerly Meloni
istock

courtesy of tammie ferguson
“Barakat
made sure I
understood
every aspect
of this
treatment.
I felt as if
she was
truly doing
what was
best for my
daughter.”
Tammie
Ferguson
aAshleigh Ferguson is active and bubbly,
looking forward to her 12th birthday
with a confident smile. “She gets
many compliments about her teeth and
how pretty they look,” says her mother,
Tammie, of Lansdowne. But that
might not have been the case without
orthodontic intervention and a sound
relationship with Dr. Rana Barakat,
the Sterling-based orthodontist first
consulted when Ashleigh was 8 years
old. Early diagnosis revealed Ashleigh’s
severely impacted upper canines, or
“eyeteeth,” as well as a crossbite.
The American Association of Orthodontists
recommends an initial orthodontic
evaluation around age 7, when
permanent first molars have erupted.
Barakat determined that Ashleigh’s
teeth “did not fit together properly,
that she had severe crowding in her
upper jaw, and she had impacted upper
canines.” Ashleigh’s narrow smile and
misaligned jaw presented problems,
“and the upper permanent eyeteeth
were positioned such that they would
not erupt on their own.”
At the first consultation appointment,
Barakat determined that it was
too early for treatment, and recommended
waiting for further dental
development and growth. “A year later,
I re-evaluated Ashleigh, and she was
ready for treatment. Ashleigh’s dental
development determined the timing
of treatment, and hers was more advanced
than her peers,” she adds.
“Dr. Barakat used X-rays, photos
and models,” Ferguson says. “She used
a computer-simulated program as a
visual aid and explained the pros and
cons of doing this treatment at a young
age compared to waiting until Ashleigh
was a teenager. Barakat made sure I
understood every aspect of this treatment.
I felt as if she was truly doing
what was best for my daughter.”
Barakat’s office is not only state of
the art, but also fun. Parents like the
distraction of computer games in the
reception area as much as kids, and
Barakat’s exciting contests make for
early canine impactions
great rewards.
Barakat says Ashleigh’s treatment
consists of two phases. Phase I lasted
18 months and concentrated on widening
her upper jaw using a palatal
expander, limited braces to manage her
impacted upper teeth. “Once the expander
process was complete, we referred
Ashleigh for removal of her upper
baby canines and exposure of her
impacted upper permanent canines.
This procedure lasted around 30 to 60
minutes, during which the impacted
teeth were exposed, attachments were
placed on the teeth, and the incision
closed,” Barakat explains. “After
healing, I began bringing both of her
impacted canines into position, using
the attachments. Once the teeth were
visible, I changed the attachments to
braces, and aligned the canines.”
After about 18 months of treatment,
Ashleigh was given a retainer to wear
at night “to maintain new tooth alignment,
while the remainder of her permanent
teeth erupt.” The outpatient
exposure procedure was done under
local anesthesia. “Some patients elect
to be put to sleep or given a sedative,”
Barakat says. “Healing from the procedure
is about two to three days, during
which the patient
generally sticks to
a softer diet and
The American
stays away from
Association of
vigorous physical
Orthodontists
activity.”
recommends an initial
To complete
orthodontic evaluation
her treatment,
Ashleigh will be
around age 7, when the
required to go
permanent first molars
through Phase II
have erupted.
in order to finetune
her bite and
get the final tooth
alignment. “She is now
in a position to have
a much shorter
time in full
braces,” Barakat
says.
www.NorthernVirginiaMagazine.com • November 2008 • 87

“Dr. Sharif
has a great
staff, with
gentle
hands,
happy faces
and a kidfriendly
office with
TV and
toys for
distraction.”
Jennifer
Simbulan
s“Seven-year-old Maya Simbulan has Osteogenesis
Imperfecta [OI], along with Dentinogenesis
Imperfecta [DI],” says her mother, Jennifer. These
are going to be “lifelong problems for Maya, and
so we take care of her teeth with good dental care
and hygiene.” Fairfax-based pediatric dentist Dr.
Sherry Sharif was Jennifer’s choice.
“Dr. Sharif has a great staff, with gentle hands,
happy faces and a kid-friendly office with TV
and toys for distraction,” says Simbulan, who has
a good understanding of Maya’s condition thanks
to Sharif.
OI is called brittle bone or fragile bone disease.
“Patients are prone to bone fractures. They have
short stature, triangle-shaped faces and blue
sclerae [whites of eyes],” Sharif explains. “They
have hypermobile joints and vertebral collapse.
Their teeth have yellow/translucent color. They
may also have congenital heart defects.”
Maya’s treatment is ongoing, with regular recall
visits. “Also, she develops dental abscesses
brittle bones, fragile teeth
88 • November 2008 • www.NorthernVirginiaMagazine.com
due to her weak teeth and needs treatment such
as extractions or stainless-steel crowns. She
does not yet have any permanent teeth, but her
primary teeth are yellow-amber/translucent
color particular to DI Type I. Her permanent
incisors should come in with normal length and
contour,” Sharif shares.
Asked about the risks involved, Sharif says,
“risks are very minimal if proper infection control
protocol and minimally invasive technical
procedures are adapted. General anesthesia nowadays
administered by pediatric anesthesiologists
at Fair Oaks Hospital is very safe and effective.”
She adds that it provides peace of mind for the
families of an apprehensive child.
Jennifer is satisfied. “Maya has dental visits every
three months for checkup and fluoride treatment.
She also has cleaning every six months. She
has been on antibiotics on several occasions for
abscesses and currently has one root fracture,
which we are just observing for now.”
courtesy of jennifer simbulan; istock

courtesy of laurie moore
cChildren and adolescents with
special needs find a perfect fit
with Dr. J. Daniel LaBriola of
Fairfax Station. While not primarily
a children’s dentist, the Northern
Virginia oral/maxillofacial surgeon
and his associates can put their
unique talents to work in special
circumstances. They are able to
uncover teeth out of position for
orthodontists to follow up, and
they use case-specific anesthesia
techniques for many types of
special-needs patients.
Laurie Moore of Goldvein
happily traveled some distance
to take her autistic son, Chase,
to LaBriola’s offices. “Chase is a
gentle giant,” explains the proud
mother. But the 18-year-old,
standing 5-foot-9 and weighing
some 240 pounds, needed just
the right practitioner when it
came time to
remove his
teeth extraction
wisdom teeth.
“We had
some pretty
negative
experiences
before finding
Dr. LaBriola,”
she goes on
to explain.
“Right away,
he knew just
what to do,
and to do it
fast. The rapport was wonderful.
He understands Chase’s needs and
anxiety.”
Moore adds that LaBriola will be
her pick to work with Chase again
on anesthesia for any potential
future dental needs.
“We like to have a consultation
visit to get a feel for the needs of a
child with a routine tooth removal,”
says LaBriola, adding that knowing
the child’s anxiety level helps
determine how to proceed: “Local
anesthesia, sedation with nitrous
“Right away, he knew
just what to do,
and to do it fast.
The rapport
was wonderful.
He understands
Chase’s needs
and anxiety.”
Laurie Moore
oxide, or is there a need
for a general anesthetic.”
Consultation, however,
isn’t always a possibility. In
cases of emergencies, where
the child is in severe pain or
has an acute infection, “then
we proceed, maybe starting
with laughing gas.”
“Most children’s procedures
are over in a matter of
minutes—the treatment is
short and sweet.”
LaBriola adds that dental
risks in kids are notably
different from those of adults.
“They can get in trouble fast.
An infection can become lifethreatening
quickly in a child.”
Risks of bleeding and postop
infection are also greater in
children if proper precautions are
not taken.
Further,
“children
have difficulty
communicating
their needs,”
LaBriola
notes,
especially
when a
hospital day
or night visit
is involved. “We
make sure they are
properly hydrated,
taking in calories,
able to go to the bathroom, and
have pain control” before releasing
them, although usually the
hospital stay is no more than a
single night.
All agree that the best way a
parent can ensure lifelong dental
health for a child is to invest time
in conducting the appropriate
amount of research, find a dentist
in your region with the right
rapport, office and training for
you and your child, and to start
visits early.
our dental
experts
Rana Barakat, DDS
45745 Nokes Blvd.,
Dulles
703-433-9330
www.barakatorthodontics.com
DDS, University of Tennessee 1994
Diplomate, American Board of
Orthodontists
12 years in practice
Sherry Sharif, DDS
3700 Joseph Siewick Drive,
Fairfax
703-620-9122
DDS, Howard University 1993
Diplomate,
American Board
of Pediatric Dentistry
12+ years in practice
L. Daniel
LaBriola, DDS
5619 Smoke Rise Lane,
Fairfax Station
703-978-7013
DDS, Georgetown University
1976
Diplomate, American Board
of Oral and Maxillofacial
Surgery
28+ years in practice
89