Child Dentistry

The happiness is to put a smile back on someone’s face & its a bonus if that someone’s a child.

Dentistry for children is driven by compassion & can only succeed if we win the confidence of children, treat them without traumatizing them psychologically & teach them the importance of good oral hygiene. If we’ve achieved that , the concept of child dentistry is fulfilled.

Children get their 1st tooth in the mouth at the age of 6 months. They have all their milk teeth by 2 1/5 years of age, when they are too young to take care of them.

The permanent teeth start appearing by 6 years of age & a total change over has occurred b/w 10-12 years of age.

Child Dentistry at a parent’s level is always surrounded by myths & dilemma to do or not to do.

Humans have 2 sets of teeth in a lifetime.
1. First set is called Deciduous dentition or Milk Teeth.
2. Second set is called Permanent Dentition.

Actually, inception of milk teeth of a child that are visible in the mouth at the age of 6 months onwards, takes place in the third month of pregnancy which takes shape during the next one year between birth & till the child is 6 months of age. The root formation still keeps taking place. A balanced diet for the mother is very crucial at this stage for an overall development of the child.

The inception of the First permanent molars that appear at the age of 6 years takes place at the time of birth followed by the inception of the rest of the permanent teeth according to their time of eruption ( appearance in the mouth). What the child eats at this time affects the future of his permanent teeth. Effects of some medicines or fluoride consumed in theses years as well as of a deep injury are seen in the teeth.

Order of Eruption of milk teeth

The deciduous teeth contain more of soft organic matter & less of calcified or hard tissue, a child’s teeth are always more prone to caries or cavities. A child is often given milk by a feeding bottle while he’s sleeping or he’s breastfed till he sleeps leaving the milk to pool & curdle in the mouth. This leads caries or cavities in his upper front teeth, a condition called Nursing Bottle Caries. This can further progress to involve more & more teeth if not well taken care of.

A child with good milk teeth not only looks cute, he learns to speak well too. Where the back teeth for the child are important for chewing, maintaining space for permanent teeth,

As well as for the growth of the jaw bones & muscles, the front teeth are more for biting, lip support, for looks & for development of the right speech.

Teething Woes

Most of the children get loose stomach or fever during the teething period which is closely associated with the eruption of the teeth but it is not completely true. During eruption of teeth, there is mild inflammation or irritation of the overlying gum leading to itching.

Thus the child tends to put anything into his mouth, he gets his hands on, thereby leading to stomach infection or fever. This period incidentally coincides with the exploratory beginning of the child whose favorite investigation device is his tongue thereby worsening the teething troubles.

Overlapping Teeth

The permanent teeth develop just below their respective milk teeth. As the permanent tooth gains mass by virtue of its root formation, it starts advancing towards the area of least resistance i.e. the gum line by pushing the root of the milk teeth. This dissolves the root of the milk teeth & gives direction to the permanent teeth to erupt in the right place. However, in some cases the permanent teeth miss the direction of the deciduous teeth & start erupting parallel to it on the inside thus giving rise to double teeth or overlapping teeth. In such cases, care must be taken to get the milk teeth removed, so that permanent teeth can take their position with the help of tongue pressure.

Any discrepancy in the alignment can be later corrected by the orthodontic treatment with removable devices (plates) or braces.

Habits

Thumb sucking is the most potential of all the habits, that every child is likely to have. This is more seen in children who are breastfed for a very short period of time or not breastfed for any reason. This gives the child a physical pleasure & psychological security forming a seal between his thumb & his palate which is hard to break once it develops. So it is important to distract the child from taking his thumb into his mouth as early as the time of birth. Once this habit is established, it is known to cause the constriction (narrowing) of the upper jaw with deep palate, open bite etc.. It can also lead to other habits like tongue thrusting & mouth breathing which can be present independently too because of some nasal obstruction. Other habits are digit sucking, nail biting etc.

These habits can be treated initially by counseling & then with the help of habit breaking appliances. But in most of the cases, it has to be followed by oral orthopedic & orthodontic treatment, to correct the bony & muscular deficiency thus caused.

Tooth Loss & Space Maintainers

Nursing bottle caries or cavities due to an increased consumption of sweets in a child’s day-to-day life coupled with softer milk teeth are a reason for the increased incidence of tooth loss in children. Moreover , parents pay less attention to the non-painful problematic tooth thinking that it is going to shed anyway. This leads to an increase in the orthodontic problems in the children. So , prevention is the best cure. Cavities if taken care of in time can save a lot of trouble to the child & a lot of money to the parents. If the cavity is too deep to be filled, a root canal treatment is recommended followed by a crown to act as a natural space maintainer If a tooth has to be taken out for some reason, it has to be replaced with a space maintainer (a mechanical active or passive device), to save the space for the permanent tooth to erupt.

As the child grows up, changing over of the teeth from milk to permanent takes place. This phase of mixed dentition takes place between the age of 6- 12yrs. This is the time to watch for because the fate of a person’s oral journey from here to old age would be determined in this period. A good Orthodontic supervision & timely treatment can definitely change the course of this journey & lets us retain our ivory for as long as we live.

Injury

Young children are more prone to injuries due to their involvement in contact sports, fist fights & other heroic acts they do to have fun or to gain attention. Commonly seen troubles are broken edges of the front teeth , avulsion of one or two teeth or submerging of a tooth. A dental evaluation is a must at this stage. An avulsed tooth is the one that comes out due to the impact of the injury & should immediately be kept in contact lens solution if available or in milk & taken to the dentist along with the child so as to re-implant the tooth. If care is taken to preserve the tooth rightly & it is transplanted correctly, chances of its survival become high.

In case of a submerged tooth that is pushed against the bone due to the injury , has to be attended as early as well. The dentist can bring it down & splint it for 3-6 weeks. Survival rate is relatively higher here. Whereas broken edges are not an absolute emergency, but they should be attended to in time to rule out any damage to pulp. They have to be fixed up in time too. Any injury to the jaw bones or other associated structures invite for an oral surgical evaluation.

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