Pediatric Dentistry

At what age should I first consult the dentist?

It is a good idea to consult the dentist by six months of age when the first milk teeth are expected to emerge into the oral cavity. Regular visits to the dentist every 6 months will help in giving adequate preventive care to the child that will aid in preventing dental decay. If there are any cavities it is good to undertake the treatment at an early stage. These regular visits are advised even if you think the baby's teeth are healthy. These regular visits also helps the child get used to the idea of visiting the dentist before he needs any treatment to be administered.

Are spaces between teeth normal in children?

It is normal to find the milk teeth in children to be spaced. These spaces between the teeth help later in accommodating the bigger permanent teeth. Thus absence of spaces between the milk teeth in children may be a fore warning that the child may not have adequate space to accommodate the bigger permanent teeth which may erupt in a crowded arrangement.

Why do children fall sick during teething and how to manage it?

Teething is often blamed for systemic conditions like diarrhea, vomiting and fever. The possible explanation for this is that during teething the child has a tendency to chew objects for relief, which at times may not be clean and may be a source of microbes.

The discomfort associated with teething can be relieved to a certain extent by using teething gels, which are basically anti-inflammatory analgesics. These gels are massaged over the gums. Teethers of different types are available which the child can chew on for relief.

How do we clean infant's teeth?

Infant's teeth can be cleaned with a soft cloth wrapped around the index finger. Wet the cloth and rub gently over the teeth to clean them. Small soft brushes that can be inserted over your fingers are available that can be used to clean the teeth.

At what age do we start using the toothbrush?

You can introduce a baby- size tooth brush at around 12 months of age encouraging the child to use the brush himself. Though the child may play with it rather than brush his teeth, it will ensure good lifelong, habits in your child. This should be followed by the parent properly brushing the child's teeth for him.

What types of pastes are best for infants?

Initially for a toddler,a wetted toothbrush is sufficient to brush the teeth. Once the child has learnt to rinse his mouth and spit, you can start using a pea-sized helping of fluoride toothpaste. Most dentists advise using fluoride tooth pastes around three years of age. If you think your child may swallow the toothpaste, you can use a non-fluoridated one till he learns to spit it out.

What is nursing bottle caries?

This is a rampant form of dental caries involving several teeth in the mouth and affects those teeth which are generally considered resistant to dental decay. Nursing bottle caries or rampant caries is usually associated with prolonged bottle feeding of sugar containing drinks such as milk and juices. They may occur due to bottle-feeding at bedtime or during sleep and lack of cleansing of the teeth thereafter. Nursing caries can also occur due to prolonged on demand breast feeding at night due to lactose sugar present in the milk. This form of dental decay affects many teeth and may be seen as marked discoloration of the teeth. In later stages the teeth may fracture. The child often experiences pain on brushing and eating cold or hot food substances.

What are pit and fissure sealants?

In some children the grinding surface of the teeth tends to have very deep pits and grooves which predispose to stagnation of food and microbes. For such teeth the dentist may use appropriate sealants to reduce their depth. These are called pit and fissure sealants

What are space maintainers?

Sometimes a milk tooth may have to be extracted (due to dental decay or some other cause) much before the permanent tooth is ready to replace it. In such cases the early extraction of the milk tooth may cause the neighboring teeth to move into the space and thus prevent the underlying permanent tooth from erupting into its correct position. To avoid this the dentist may give the child a device called space maintainer that maintains the space till the permanent teeth that replaces the milk teeth are ready to erupt

Is it normal for the child to suck the finger?

It can be considered quite normal for children to suck their finger upto a certain age. Continued finger sucking beyond 3 years of age may cause serious defects in the developing oral and facial structures

Why do children suck the finger?

Many children develop the habit of sucking the thumb or other fingers. A number of possible causes exist for finger sucking. These include: 1. Lack of adequate nursing or feeding. 2. Feeling of insecurity due to inadequate parental care, love and affection. 3. Sudden change in domestic or work atmosphere which the child cannot cope with. 4. Stress related to school, friends, etc.

Until what age can the finger sucking be allowed?

Finger sucking may not cause irreversible harm in children less than 3 years of age. However much depends on factors such as duration, intensity and frequency of the sucking habit. Continuation of the habit beyond 3 years may pose problem for the developing facial and dental structures. The teeth can come forwards and open bite can occur.

How will the dentist control finger sucking?

Many children stop sucking the thumb when the causative factor is identified and eliminated. Timely nursing, feeding, and increasing the time you spend with the child may to some extent decrease his insecurity. Slightly older children can be reasoned out of the habit by explaining the bad effects of the habit. The dentist may sometimes advice the use of finger bandaging or the use of bitter medicine to make the habit less pleasurable. When these simple steps fail the dentist may advice a habit breaker, which is placed behind the front teeth, and prevent the child from sucking the thumb.

What are the effects of finger sucking?

Thumb sucking can cause problems if allowed to persist beyond 3 years of age. Some of the effects include the front teeth being pushed too far forward, spacing of the teeth and therefore poor facial appearance. Continued indulgence in the habit may cause defects in the developing jaw and facial bones.

Do habits like biting the nails, pencil, etc cause harm to the teeth?

Habits like biting nails, pencils, etc besides causing wear of the teeth can cause injury to the gums and supporting structures around the teeth. In addition the pressures they exert on the teeth may force them into abnormal positions which may necessitate orthodontic treatment.

What is tongue thrusting?

Tongue thrusting is a habit wherein the person forces the tongue against the back surface of the front teeth while swallowing. This habit can produce proclination of the front teeth and spaces between them. The dentist may have to train the patient on the correct swallowing method by some exercises and use of habit breaking devices.

When should we start brushing teeth for children?

Brushing should be started as soon teeth start erupting. This should become a habit. Very little paste should be applied just for the taste of it.

Do children develop cavities?

The causes of tooth decay in children are the same as in adults, but the progress is faster. An important factor in children responsible for causing tooth decay is the child being bottle-fed and put to bed. This type of decay is extensive and is called as nursing bottle caries .Even 2 year old child can develop cavities.

Do teeth erupt with cavities?

Teeth do not erupt with cavities. Cavities form only because of diet and improper oral hygiene.

Can we ignore cavities in milk teeth?

No. Even milk teeth with cavities should be filled. Milk teeth, being very small in size, decay reach the nerve of the tooth very fast and cause pain. Tooth destruction can occur so fast that some parents feel that when the teeth appeared itself, they were decayed. This pain and swelling may make the child averse and scared of dentist. So it is better to check the teeth regularly and fill the cavities when small. Moreover the first permanent molars erupt at the age of 6 and can be mistaken for milk tooth. The cavities easily spread from the milk to permanent teeth and this could lead to irreparable loss of the tooth.

Should the milk tooth be removed, should they be replaced?

Although it is true that all milk teeth are replaced by permanent teeth, this must happen at the right age. There is an appropriate time for each milk tooth to fall and the permanent successor to take its place. If a milk tooth is lost for any reason much earlier than the scheduled time of eruption of the permanent successor, then it is very likely that the space created by loss of the milk tooth will reduce or even close due to drifting of the adjacent teeth, and when the time for the permanent tooth to erupt comes it may have no place, so it may either get locked within the jaws or erupt in an abnormal position. So as a broad guideline, by following conservative treatment procedures, all attempts should be made to avoid removal of the front milk teeth before the age of 4 years, and the other milk teeth before the age of 9 years. Should such early removal of teeth become necessary, an appliance called a space-maintainer should be constructed for the child to wear. The function of this appliance is to maintain the space created by the loss of the milk tooth for the permanent successor.

Why do 1 or 2 old children develop cavities in the front teeth?

An important factor in children responsible for causing tooth decay is the child being bottle-fed and put to bed. This type of decay is extensive and is called as nursing bottle caries .

How cavities in children be prevented?

The child's teeth should be brushed thoroughly twice daily using a fluoridated toothpaste. This brushing has to be done by the parents initially, till the child has mastered the necessary skills.

Allow the child to eat what he/she likes, but with or immediately after meals. This should be followed by brushing or thorough rinsing of the mouth. These measures will ensure that the food particles are cleared from the mouth, thus reducing the incidence of tooth decay.

Sealants should be applied onto the biting surfaces of the permanent back teeth as soon as they erupt. This will prevent decay from occurring in the pits and fissures of these teeth.

Fluoride treatment may be considered if your child has a high incidence of decay, or if the level of fluoride in your drinking water is inadequate

If the milk teeth have cavities will the permanent tooth also have them?

If there is no active caries and the cavities are filled properly and preventive measures are taken, the permanent teeth will not develop cavities. The permanent ones replacing decayed milk teeth will not cavities when they erupt. Cavities develop only subsequently.

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