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19847 Century Blvd, Lobby B, Ste 215, Germantown, MD 20874

Germantown Orthodontist : Germantown Orthodontics : Germantown Invisalign : Germantown Braces : Germantown Pediatric Dentist : Germantown Pediatric Dentistry : Germantown Kids Dentist : Germantown Childrens Dentist : Dr Echandy : Dr Robles

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The cause of the toothache can be difficult for a parent to determine. The best advice is to call our office immediately. Do not try to treat the problem yourself by placing aspirin or heat on the aching gum or tooth. If swelling is present, immediate attention is necessary.


Apply direct firm pressure with gauze or cloth to stop or slow bleeding. If the wound is severe and does not stop bleeding, call the office or immediately go to the emergency room at the hospital. To treat a bruised lip where there is little or no bleeding, apply an ice pack to injured area to help control swelling.


Call the office so a determination can be made regarding the need to see your child. The need for treatment will be determined by the degree of mobility of the loosened tooth and whether the tooth is a primary (baby) or permanent tooth. The injured tooth may be allowed to “tighten- up “on its own or may need to be stabilized. An injured tooth may turn dark or abscess after an accident. These changes may happen immediately, or years later.


Call the office so a determination can be made regarding the need to see your child. The need for treatment will be determined by the degree of the fracture and whether the tooth is a primary or permanent tooth. Remove the fractured piece to prevent choking and do not have your child chew on anything hard. Chipped teeth can sometimes be bonded to restore proper esthetics and function. A very small chip can be corrected by enamel shaping. A severely fractured tooth may need a crown (cap) and root canal therapy.


Find the tooth and call the office. Control bleeding with direct firm pressure with gauze or cloth. The knocked out primary tooth cannot be re-implanted.


Find the tooth and call the office. Sometimes if the tooth is placed back in its socket soon enough, the tooth can be saved. Time is critical. Do not handle the root of the tooth or wipe the tooth clean. If tooth is intact, try to reinsert it in the socket. Have your child hold the tooth in place by biting on gauze or a cloth. If you cannot reinsert the tooth, place the tooth in a cup containing the child’s saliva or milk. If the child is old enough, the tooth may be placed in the mouth besides the cheek while you are transporting the child to the dental office.

For after hours emergencies, please call Alex Sanchez (301) 760-0283.



Bonding is a restorative dental technique used most often to repair a broken tooth. It can also be used to cosmetically improve the appearance of a misshapen tooth or to fill the gap between front teeth.


Cleaning (oral prophylaxis) is part of a child’s “check-up” appointment. At this appointment, the Dentist, or Dental Hygienist removes harmful plaque and tartar (calculus) both above and below the gum line. Smile Team members give special instructions to parents and children on proper brushing and flossing to keep the teeth cleaned in areas where significant build-up is found. Since our practice is dedicated to prevention we believe in the importance of early detection and treatment. During the check-up appointment your child will be screened for: Cavities, Gum Disease, Oral Cancer, Abnormal eruption of primary and permanent teeth.


Stainless steel crowns are used to save a primary tooth until a permanent tooth can erupt and takes its place. A crown protects, seals and strengthens a tooth in the following situations:
• After a large cavity has been removed
• After a pulpotomy has been performed
• Correction of a malformed tooth
• Preservation of a tooth with severe attrition

Placing a stainless steel crown requires one appointment. Tooth colored crowns can be placed on front teeth.


Extraction is the complete removal of a primary or a permanent tooth and can be either surgical or non-surgical. An extraction can be done at the office or may be referred to an oral surgeon. Extractions may be necessary because:
• A primary tooth might be in the way of an erupting permanent tooth
• An abscessed tooth is too infected to be saved
• A tooth has a cavity that is too deep for it to be saved
• A tooth is broken at the gum line
• A tooth is impacted (usually a “Wisdom Tooth”)
• It is necessary to facilitate orthodontic treatment
• Advanced gum disease is present


Fillings are the most common restorative procedures for teeth that have cavities. They fill the void in the tooth when the decay is removed and restore the tooth to normal function. Fillings can be silver (amalgam) or tooth colored (composite).


Fluoride is an element which helps reduce cavities. In the past, cavities were a fact of life, but dental decay has been reduced dramatically due to fluoride. In fact, research has shown that fluoride reduces cavities up to 40% in children.

Children’s teeth benefit from fluoride both systemically (by ingesting fluoride) and topically (the fluoride that gets on their teeth). Systemic and topical fluoride work together to keep teeth strong and work best in children while teeth are forming. The fluoride helps both primary (baby) and permanent teeth. Starting at six months of age, and until all permanent teeth have fully erupted, ingested fluoride helps strengthen teeth as they are forming. Topical fluoride is beneficial to people of all ages.

It is important that a child gets the right amount of fluoride. Too little fluoride will not strengthen the teeth to help them reduce cavities, while too much fluoride ingestion by preschool aged children will lead to fluorosis which is a chalky white discoloration of the permanent teeth. Being aware of the amount of fluoride a child receives can help prevent the possibility of fluorosis.

To ensure that your child receives the appropriate amount of fluoride, the following steps should be taken:
• Establish whether your city water supply is fluoridated. Check with your water supply company
• If your family uses well water or bottled water you should have your water tested to see if there is adequate natural fluoride
• Brush your baby’s teeth with a small amount of training toothpaste (non-fluoride)
• Supervise and brush a very young child’s teeth with a small amount of children’s fluoride toothpaste
• Account for all sources of ingested fluoride before requesting a fluoride supplement from your child’s physician or pediatric dentist.


The frenum is a piece of soft tissue that attaches the muscles of the cheeks and lips to the gums and tissues of the mouth. The frenum under the lip can sometimes be attached too high on the gums causing either recession or spaces between the top front teeth. There is another frenum under the tongue that can be attached too close to the end of the tongue and can adversely affect swallowing and speech. This is sometimes referred to as being “tongue tied.”

A frenectomy is a procedure where either part or all of the frenum is removed in order to return a health balance to the mouth.


Our office adheres to the standards established by the Center for Disease Control (CDC). We share your concern about the spread of disease and work hard to safeguard our patients and staff against infection. Our Smile Team always wear gloves and protective wear during their procedures. After each patient, we discard our gloves, wash our hands, and wear new gloves. We also begin protection against infection long before your child enters the treatment room. All surfaces are cleaned, disinfected and all instruments are sterilized after their use or disposed of.


Mouth guards fit over the upper teeth to prevent broken or chipped teeth due to tooth contact which can occur as a result of trauma to the mouth or face. They are also effective in moving soft tissue in the oral cavity away from the teeth, preventing laceration and bruising of the lips and cheeks especially for children who wear braces. There are two types of mouth guards, one is an “over the counter” mouth guard and the other is a custom, “professional quality” mouth guard. This mouth guard requires an impression of the mouth and is fabricated by a dental laboratory. It is smaller in size, fits more securely and provides several advantages, including:
• More comfortable fit – more likely to be worn consistently
• Less restricted breathing
• Clearer speech

Although mouth guards are required for contact sports like football and hockey they are also appropriate for “non contact” sports such as baseball, basketball, soccer, lacrosse, and gymnastics where incidental contact with objects and other participants is common.


A night guard is an appliance made to fit over the top or lower teeth to prevent wear to the teeth caused by bruxism (grinding teeth). When worn at night, the patient cannot grind his teeth together and cause further damage.


Pulp therapy is often referred to as nerve treatment (children’s root canal), pulpotomy or pulpectomy.

The pulp of the tooth is the inner part of the tooth which contains nerves, blood vessels, connective tissue, and reparative cells; it is the living part of the tooth. When the pulp becomes infected or abscessed due to cavities or traumatic injury, a pulpotomy or pulpectomy may be necessary to save the tooth.

During a pulpotomy the diseased pulp tissue within the crown portion of the tooth is removed and a sedative medication is placed inside the tooth to prevent bacterial growth, prevent sensitivity, and to promote healing.

A pulpectomy is often referred to as a root canal treatment. During a pulpectomy the diseased pulp tissue is completely removed from the crown and root. Following pulp therapy, a tooth becomes more brittle and must be crowned to give the tooth strength for chewing pressures.


Sealants are white or tooth-shaded plastic material that is bonded to the chewing surfaces of the back teeth where teeth are most susceptible to cavities. The sealant acts as a barrier to food, plaque, and acid, thereby protecting the decay prone areas of the teeth. They can be used on permanent or primary teeth. Applying sealant is a painless, non-invasive procedure that doesn’t require (drilling) or anesthetic.


When a child loses a tooth prematurely, the adjacent teeth can shift into the new space crowding the permanent tooth that is supposed to erupt into that space in the future. The space maintainer is made to keep the primary teeth from shifting into the space where the tooth was lost so the permanent tooth can erupt into its natural proper place. When the permanent tooth erupts, the space maintainer is removed. Space maintainers are important because they can help avoid the need for future orthodontic treatment.


Radiographs (X-Rays) are important to identify problems that aren’t externally visible. They are an essential part of a complete and thorough dental examination. Without them, certain dental conditions can be missed. X-Rays show cavities that can’t be seen visibly, and they are important to diagnose the extent of cavities and whether a tooth with a cavity has an abscess. They also are helpful in the early diagnosis of growth and developmental defects, and this early diagnosis can often prevent the need for more extensive treatment. Our practice is particularly careful to minimize the frequency of x-rays. A lead body apron and thyroid shield is used along with high-speed film to assure that your child receives a minimal amount of radiation exposure. The x-ray represents a far smaller risk than an untreated dental problem.


Whitening is a mild bleaching procedure that restores stained or discolored teeth to a healthy natural color. Tooth discoloration can be caused by frequent drinking of coffee, sodas, or tea, inadequate oral hygiene, some antibiotics and use of tobacco products.

Bleaching can be done with an “over the counter” product or by use of custom bleaching trays.


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Patient Testimonials

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I don’t have to hide my smile anymore!
I love my smile more and more everyday! Thank you Dr. Robles!

- Jennifer


19847 Century Blvd, Lobby B, Ste 215
Germantown, MD 20874