Let's take a closer look at a tooth. The crown is the part that can be seen in the mouth, and the root is the part inside the gums. The crown of the tooth is covered with the enamel. Enamel is one of the hardest natural substances known and forms the outermost protective layer. The Dentin, which lies just under the enamel is yellowish and is not as hard as enamel. This forms the bulk of the tooth. The soft tissue in the center of the tooth along with the canals that extend down the roots is called the ‘dental pulp’. It contains nerves and blood vessels. Cementum is a thin bone like tissue which covers and protects the tooth root.
There are 20 primary teeth (also called milk or deciduous teeth), which can be seen, in a child’s mouth. There are 8 incisors ( 4 in the upper jaw and 4 in the bottom jaw), 4 canines, 8 molars ( 2molars on each side).
These primary teeth are designed to function during the childhood years - and they have several important jobs to do. Primary teeth are foundation teeth.
They are in fact as important as the permanent teeth.
Lets see why -
• They help in chewing and digestion.
• The milk teeth are necessary for speech development e.g. the words th, f, and lisping sounds require front teeth to pronounce.
• These teeth are important for appearance or aesthetics. Children who have decayed or missing front teeth are reluctant to smile and can grow up to be shy withdrawn children.
• Probably the most important function of the baby teeth is to maintain sufficient space for the adult (permanent) teeth to erupt into the correct position.
• The primary teeth are therefore very necessary in guiding these adult teeth into the correct straight position.
Six months of age is when most babies start teething. However, a lot of infants may start teething as late as 14-15 months. Between 2-3 years of age, they will have all 20 milk teeth.
During teething your child may experience discomfort due to the cutting of the teeth through the gums. Some children may be irritable or cranky and may start biting objects to relieve the pain associated with teething. Teething has often been associated with fever, diarrhea etc. The unclean objects which your child places in his/her mouth is the reason for the teething associated sickness. Symptoms typically last from 4 days before a tooth emerges until 3 days afterward. During these periods, comfort your baby with teething rings or a cold washcloth to bite on. Massaging the gums, increasing fluid intake and providing non-aspirin analgesics will also help provide relief to our youngest of patients.
Although many parents don't think too much about their toddler's or preschooler's teeth, it is important to do so, because a lot of children develop cavities before they are 5 years old.
Good dental hygiene habits should begin before your child's first tooth comes in. Wiping your baby's gums with a soft damp cloth after feeds helps to prevent the buildup of bacteria. When teeth appear, start using a soft children's toothbrush twice a day.
Once your child is preschool-age, start using low fluoride toothpaste (500ppmF). Don't cover the brush with toothpaste; a pea-sized amount is just right as young children tend to swallow most of the toothpaste. This can be minimized by pushing the paste into the bristles so that they swallow only the foam as a result of brushing.
Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often,
the first indication is the noise created by the child grinding on their teeth during
sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One
theory as to the cause involves a psychological component. Stress due to a new
environment, divorce, changes at school, exams; etc. can influence a child to grind
their teeth. Another theory relates to pressure in the inner ear at night. If there are
pressure changes (like in an airplane during take-off and landing when people are
chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to
relieve this pressure.
The majority of cases of pediatric bruxism do not require any treatment. If excessive
wear of the teeth (attrition) is present, then a soft mouth guard (night guard) may be
indicated. The good news is most children outgrow bruxism. The grinding gets less
between the ages 6-9 and children tend to stop grinding between ages 9-12. If you
suspect bruxism, discuss this with your pediatrician or pediatric dentist.
Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use toothbrush or dental floss to dislodge impacted food or debris. If the pain still exists, contact your child's pediatric dentist. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact your dentist immediately.
Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room.
Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
Cavities are holes that are formed when bacteria (germs) in your mouth use the sugar in food to make acid. This acid eats away at the teeth. Cavities are the most common disease in children.
Your child might be at risk for cavities if he or she eats a lot of sugary foods (such as biscuits, cookies and candy) and drinks a lot of sweet liquids (aerated beverages, fruit juices and sweetened drinks). Your child also might be at risk if he or she has any of the following risk factors:
- If the child was born early (prematurely) or weighed very little at birth (low birth weight)
- If the child has ongoing special health care needs
- If the child has white spots or brown areas on any teeth
- If the child does not go to the dentist very often
Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information. For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.
The pediatric dentist is the specialist who is dedicated to the oral health of children from infancy through the teen-age years. They have special training that allows them to provide the most up-to-date and thorough treatment for a variety of dental problems specific to your child. Their training in child psychology helps make your child comfortable during the various dental procedures. They endeavour not only to treat the dental problem but also ensure that the child leaves their clinic with a smile.
It is recommended that your child should visit the dentist by his or her 2nd birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist is only going to have a look at their lovely teeth. The fewer ‘to-dos’ concerning the visit, the better. It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. We, pediatric dentists, make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first molars which erupt behind the set of milk teeth. The lower central incisors are the first milk teeth to fall and they are replaced by the permanent successors. This process continues until approximately age 12-14years.
Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth;18-21 years).
Fluoride is an element, which strengthens teeth and resists cavities. Fluoride is available to your child through toothpastes, mouthwashes and tablets.
Up to the age of 5 years, low fluoride toothpastes are recommended (500ppm) and only a pea size amount is placed on the toothbrush.
Once a child is comfortable spitting out all the toothpaste after brushing then a regular toothpaste containing 1000ppm fluoride maybe used. (6 years +)
Mouthwashes containing Fluoride (0.05ppm) should be used in children only 7 years and older.
Fluoride supplements (tablets/ drops) maybe given to those children living in areas where the fluoride content of the local water is less than 0.3ppm (Mumbai). The fluoride tablets should be started at 24months and given upto 8-9 years. The fluoride which is ingested gets incorporated in the enamel matrix of the developing permanent tooth, thereby making the tooth inherently stronger.
In addition to the above, a biannual application of fluoride gel or varnish applied on the teeth by the pediatric dentist is universally recommended. The fluoride is at a higher concentration and is beneficial in making the teeth resistant to decay. This has helped in reducing decay rates worldwide by almost 50—60%
A sealant is a clear or shaded resin material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a mechanical barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
Application process is usually quick, non- invasive and takes only a few minutes. The tooth is thoroughly cleaned, prepared with a special solution and dried. The liquid sealant is then applied and allowed to set hard by shining a blue light onto it.
Sealants are a recommended and time tested deterrent for cavities in young children.
Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed. Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child.
The ‘dental pulp’ is the inner central core of the tooth. The pulp contains nerves, blood vessels, tissue and cells. Decay if left untreated progresses towards the dental pulp and infects it, causing it to degenerate. Trauma to the teeth due to a child falling or getting hurt can also damage the dental. The purpose of pulp therapy in Pediatric Dentistry is to maintain the affected tooth healthy and functional. Pulp therapy is often referred to as a "nerve treatment", " root canal treatment", "pulpectomy" or "pulpotomy". The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy. A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (stainless steel crown or Zirconia crown). A pulpectomy is required when the entire pulp is infected (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable (dissolvable) material. Then a final restoration is placed (stainless steel crown or Zirconia crown).
Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects to suck. It provides a sense of security at difficult periods and since thumb sucking is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of the permanent teeth (6 years) can cause problems with the proper growth of the mouth and tooth alignment and hence children should cease thumb sucking by the time they are 6 years old. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.
Pacifiers can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through thumb sucking:
● Instead of scolding children for thumb sucking, praise them when they are not.
● Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
● Children who are sucking for comfort will feel less of a need to do so when their parents provide comfort.
● Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
● Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.
● If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance.
Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. It deals with space maintenance when there is premature loss of milk teeth .
Stage II – Mixed Dentition: This period covers the ages of 6 to 11 years. At this young age, we are concerned with correction of harmful habits such as finger or thumb sucking, lip biting, tongue thrusting, mouth breathing; underdeveloped jaw structures, excessive crowding and improper jaw relationships. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive (due to growth spurts) to orthodontic or orthopedic forces.
Stage III – Permanent Dentition: This period covers the age of 12 years and above and deals with the permanent teeth and the development of the final bite relationship.
The key areas of our Pediatric Dental Practice is Preventive Dentistry. Our clinic has three fully equipped treatment rooms with advanced technology to enhance patient care and comfort and help your child get the smile they deserve.
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