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Your Childs Teeth |
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Know Your Child’s Mouth |
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The
oral cavity comprises of various structures besides the teeth.
They are -
Tongue
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Gums
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Lips
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Palate
Floor of the mouth
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Structure and Composition of Teeth |
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Humans have two different sets of teeth. The first set (called temporary, milk or deciduous teeth) are 20 in number and are replaced during the growing stage of life by the second set (called permanent teeth) which are 32 in number. There are 32 permanent teeth and 20 deciduous teeth (milk teeth) arranged in pairs in the upper and lower jaws.
There are 4 different types of teeth based upon their anatomical shape and position in the mouth
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Incisors - these are located at the front of the mouth
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Canine teeth - these are found behind the incisor teeth at the corners of the mouth.
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Premolars - lie behind the canines and in front of the molars
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Molars
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Functions
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Incisors - are mainly concerned with biting and
cutting(shearing)
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Canines - are mainly concerned with cutting
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Premolars and molars are used for chewing and grinding food (mastication)
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Types of Dentition |
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Primary Dentition
Primary teeth are the first teeth of a child and they are sometimes called Milk, Deciduous Baby teeth.
The primary teeth are twenty in number:
ten in each jaw.
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When a child is born the first teeth are already formed in the jaw although they can't be seen.
Then between at about six months of age when a baby gets his first tooth - and at three years of age, all twenty teeth erupt in the oral cavity. The characteristics feature of the primary dentition is the presence of spaces between the teeth.
Significance of Primary Teeth
The deciduous teeth are important for following reasons
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Mastication
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Speech
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Esthetics
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Space maintenance
Mixed Dentition
At about six years the first permanent molars erupt in the oral cavity. These molars are also called as ‘six year molar’. From six years of age to 12 years of age the dentition consist of both the primary and permanent teeth hence it is called as mixed dentition. By 12 years of age all the permanent teeth except the second and the third molars have erupted in the oral cavity.
The first permanent molars are the most important teeth for the proper development of an adult dentition.
During the mixed dentition at about the age of 9-11 years period the upper anterior appear misaligned. This is called the ugly duckling stage and is self correcting condition.It gets corrected with the eruption of the permanent canines.
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At about
twelve years of age all the primary teeth are exfoliated
and the permanent teeth continue to erupt. The dentition
now consists only of the permanent teeth hence called the
permanent dentition. The second permanent molars erupt at
about 12 -14 years of age and the third permanent molars
erupt at 17-21 years of age that is why they are also
called as wisdom teeth.
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Eruption Timing of Teeth |
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(lower front teeth)
Eruption timing of teeth
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The first to
erupt are the two lower central incisors.
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Central
incisors 6-12 months
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Lateral
incisors 9-16 months
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Canines
16-23 months
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First
molars 13-19 months
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Second
molars 22-33 months
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Importance of the First Permanent Molar
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Lower teeth
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The first permanent molar is a very important tooth, from both the functional and developmental point of view. It usually erupts between the ages of 5 1/2 to 6 1/2 years and is called the 6 year molar.
It is the first non-succedaneous tooth to erupt in the oral cavity. It has a large occlusal surface hence it bears the maximum load of
masticatory/chewing forces.
This tooth being most posterior is often neglected by parents and children alike. Due to the presence of deep, often incompletely coalesced fissures, food lodgement is frequent and development of tooth decay is rapid.
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Upper Teeth
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Destruction of this tooth, if severe, leads to subsequent extraction. This creates problems in space management, tooth movement, mastication and occlusion. Hence, dental surgeons and pedodontists strive to maintain this tooth in the arch for proper guidance of the developing occlusion.
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Oral Health of the Mother and the Baby |
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You may have heard that you lose a tooth for every pregnancy, or that your developing baby will take the calcium he or she needs from your teeth. Both of these are myths; however, they point to the need for good dental care and good nutrition during pregnancy. Tooth loss that sometimes occurs during pregnancy is most often the result of either tooth decay or gum disease. Women are more prone to both of these conditions during pregnancy for a variety of reasons.
Both gum disease and tooth decay are caused by plaque formation. Plaque is the sticky, colorless film that forms on our teeth every day. The acids and toxins produced by the bacteria in plaque are the cause of both tooth decay, and gum tissue inflammation and disease. Brushing and flossing daily are the most effective ways to remove plaque from teeth and keep tooth surfaces and gum tissues healthy.
Hormonal changes during pregnancy make the gum tissues more susceptible to inflammation and bleeding. This condition is called “pregnancy gingivitis.” While the gum tenderness and easy bleeding associated with gingivitis happens more easily during pregnancy, it is still plaque accumulation on the teeth, not the hormone changes, that is the major cause of this condition.
More frequent eating patterns common among pregnant women, lack of thorough oral hygiene practices contribute to increased plaque formation, increased levels of gingivitis and tooth decay sometimes experienced during pregnancy.
There are other good reasons, beside your own dental health, to take extra care during your pregnancy. Some research suggests that serious gum disease (periodontal disease) is linked to premature birth and low birth weight.
Additionally, it is now recognized that mothers are the most common source of transmission of decay causing bacteria to their infants. Babies are not born with the bacteria that cause decay. Instead they are “infected” sometime in their early life. We now know that mothers that have healthy mouths, free of active dental decay, are much more likely to have babies that are healthy and free from early decay, and vice versa. A decision to keep your mouth healthy and treat decay that arises during your pregnancy is also a decision to help protect your baby’s oral health.
Good Nutrition is Important
The foods you eat during your pregnancy affect every aspect of the health of your baby-to-be, including his or her teeth, not to mention your own health.
Your baby's teeth begin to develop below their gums between the third and sixth months of pregnancy, so getting the right nutrients is especially important then. A sufficient amount of protein, calcium, phosphorus and vitamins A, C and D will all help ensure healthy teeth for your baby. Fluoride is also an important mineral for healthy tooth development. Once your baby is born, your dentist and pediatrician will advise you on the optimal amount of fluoride supplementation to protect both you and your baby’s teeth.
Regular dental cleanings and checkups can be done safely at any time during your pregnancy. Be sure to tell your dentist or dental hygienist that you are pregnant. Any pain, swelling or infection in your mouth should be treated immediately because this can affect your health and your baby's health.
Silver Amalgam restoration (Silver Fillings)
The filling material, amalgam, should not present any harm, if proper technique is observed by the dentist and his or her assistant. This should occur whether the patient is pregnant or not! If you have a cavity and your dentist thinks it should be a fairly simple, short procedure, it should be fine to complete the procedure. Postponing dental work due to pregnancy can sometimes cause worse problems than having the work completed. If you do decide to postpone work until after the birth of your baby, have it done soon afterwards so the cavity does not become larger and deeper.
Radiographs (X-Rays)
A full mouth series of dental radiographs (x-rays) is generally taken about every 5-7 years. A full mouth series involves taking between 18-21 films. Dentists need to have the information this full mouth series offers to determine if any conditions, such as cysts, tumors, or abscesses, exist in the bone surrounding the teeth. Full mouth radiographs also help determine the health of the teeth and the nerve tissue within the teeth. If nothing else, the complete set of radiographs will serve as comparison for the future if any problems should arise.
The amount of radiation received from a set of 21 dental radiographs is approximately 3 millirems. Three millirems are equivalent to about 4 days of exposure to radiation received naturally from the environment (i.e. sun). The probability of congenital anomalies and childhood malignancies from this amount of radiation is practically nonexistent. The double lead shield with a thyroid protector will reduce exposure even more.
Minimal radiographs may need to be taken during pregnancy to treat dental emergencies. Having an complete dental examination before pregnancy , will reduce risk of a dental emergency occurring during pregnancy.
Parential Dental Care
It is of utmost importance to strengthen the developing primary dentition during first trimester of intrauterine life. The child gets its calcium, phosphorous and other minerals during odontogenesis from the mother’s blood stream. Hence, a nutritious balanced diet
with adequate supplements of minerals and vitamins for expectant mothers must be recommended. Prenatal fluoride supplement to mothers in the dosage of 0.25-1 mg daily has been shown to render some protection to primary teeth from caries.
For sound primary teeth, during the first trimester, the mother’s health is of paramount importance. Medications like tetracyclines for infection control should be avoided to prevent discolouration of teeth.
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Infancy |
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Gum pads
The alveolar arches at the time of birth are termed as gum pads and are firm and pink.
The upper gum pad is horse shoe shaped lower gum pads/arch is ‘U’ Shaped or rectangular in form. At rest the gum pads are separated by the tongue, which protrudes over the lower gum pad to lie immediately behind the lower lip. At this age the upper lip appears very short. The upper gum pad is wider than lower and when the two are approximated there is a complete over jet all around of the upper over the lower gum pad, with a considerable overjet
anteriorly.
Why Infant Oral Care is Needed ?
Prevention of oral and dental diseases must begin in early infancy and even during prenatal period to ensure a successful outcome.
The primary dentition is more prone to decay than the permanent dentition in children. This could be due to
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Lesser thickness of enamel in primary teeth.
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More cariogenic challenges. (Consumption of chocolates, beverages etc.)
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Non-availability of fluoride (through tooth pastes) unless in systemic form.
Early establishment of oral hygiene procedures, with the development of non-cariogenic dietary habits should begin during infancy.
Infant Oral Health Care Includes Counselling with Regard to:
1.Mother’s diet
The lactating mother must take a well balanced diet rich in supplements of minerals and vitamins.
2.Oral hygiene of the infant
The parents should be counseled regarding cleaning of the infant’s gum pads daily before eruption of the first primary tooth. A moistened gauge square or washed cloth is wrapped around the index finger of the hand and gum pads are massaged gently .The cleaning of gum pads is as important as cleaning of teeth later in life.
3.Timing of the first dental visit
American Academy of Pediatric Dentistry (AAPD) recommends that infants be scheduled for an initial oral evaluation visit within six months of the eruption of the first primary tooth but by no later than 12 months of age.
Early dental intervention provides an opportunity to supplement oral health education for parents in areas such as proper oral hygiene, prevention of dental injuries and prevention of Early childhood caries.
4. Diet management
To cause decay oral bacteria require the presence of a particular environment. Prolonged bottle or breast feeding provides the substrates that provides an oral environment favorables to bacterial proliferation and formation of acidogenic plaque.
It is recommended that nocturnal feeding be discontinued after the eruption of the first tooth and after each feeding, the gum-pads and teeth be cleaned with wet gauze or piece of cloth.
When bottle-feeding is substituted for the breast, the nipple should simulate the natural nipple and breast, by way of having a wider base. Secondly, the hole in it should not be too large to give free flow of milk but just wide enough so that the child has to exert force to draw milk. The milk bottle should be supported with the hand so that it does not cause pressure on the upper jaw. The bottle-feeding should be carried out by the mother, with the child seated reclining and not lying down. The bottle should be withdrawn immediately after finishing and the gum-pads and teeth are cleaned.
The diet management also includes educating parents regarding the following facts.
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Infants and children generally need to eat more frequently than three times a day.
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Between-meal snacks should consist of foods that have least potential for promoting acid production. Sugary snacks and retentive foods should therefore be avoided.
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Potentially harmful foods like cookies, candies, cakes are better offered at meal times, than between meals.
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The total amount of sugar consumed is not the key; the frequency of sugar intake and the retentiveness of the food are the important factors.
Tooth cleaning The following facts about tooth cleaning should be explained to the parents.
Parent, adult or older sibling must assume total responsibility for cleaning teeth in infants and young children. Most of the children are unable to clean their teeth effectively until 5-8 years of age. Oral ; hygiene neglect can lead to deteriorated oral health.
Teeth cleaning must be done in a comfortable location and pleasant environment.
Toothpaste is not necessary for infants, in fact, may be a source of objection, because of taste and foaming action.
Teeth cleaning should be done at least once daily; wiping the teeth of the infant following feeding is however recommended.
The evening teeth cleaning may be easier to accomplish after the infant’s last feeding than just before bedtime, since a tired infant can frequently be cranky and may create fuss during the procedure.
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Oral Health of the Baby |
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Oral health care of the baby should commence soon after birth. Just because the baby doesn't have teeth it doesn’t mean that Oral health should be neglected.
Some conditions that may cause parental concern are.
Epstein's pearls
These are small, white, pearl-like spots that seen along the midline of the palate.They often disappear within a few weeks.
Bohn's nodules
These are small, whitish nodules or cysts similar to Epstein’s pearls, seen along the buccal and lingual aspect of the alveolar ridge and at the junction of the hard and soft palate. They also disappear within a few weeks.
Eruption Cyst of newborn
These small nodules which appear along the crest of the alveolar ridge.
Natal and Neonatal teeth
Some infants are born with one or more teeth (natal) or have teeth which erupt into the mouth within the first 30 days of life (neonatal). Most often, these are the baby's primary (baby) teeth, not extra teeth. These often are very loose. If possible, these teeth are maintained. However, natal or neonatal teeth may have to be removed if they are loose enough that the child could aspirate them. These teeth also may be removed if they interfere with feeding or irritate the child's tongue.
Oral Health for Infants
Birth to 6 months of age
Six to 12 months of age
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During this time, the first tooth erupts. Consult the
Pedodontist.
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Brush teeth after each feeding and at bedtime with a small, soft-bristled brush.
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As the child begins to walk, stay alert of potential dental and/or facial injuries.
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Wean the child from breast or bottle by his/her first birthday.
Twelve to 24 months of age
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Follow the schedule of dental examinations and cleanings, as recommended by your child's pediatric dentist. Generally, dental examinations and cleanings are recommended every 6 months for children and adults.
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As the child learns to rinse his/her mouth, and as most deciduous (baby) teeth have erupted by this age ;brushing with a pea-sized portion of fluoridated toothpaste is appropriate.
Early Childhood Caries
Early childhood caries is a specific term used to describe dental decay in infants and toddlers.
Early childhood caries is also known as
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Nursing bottle caries
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Baby bottle tooth decay
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Nursing bottle syndrome
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Milk bottle syndrome
Some of there later descriptions may be misleading as regarding the specific etiology of the conditions. For example breast milk may be as likely to supply the carbohydrate required for acidogenic bacteria, as the bottle formula does. So the bottle itself is probably not to be blamed. Today, the new name for early childhood caries is ‘Maternally Derived Streptococcus Mutans Disease
(MDSMD)’.
Children who are breast fed on demand-specially at time other than normal feedings and throughout the evening often develop early multiple carious lesions.
During sleep, salivary flow is diminished. Moreover, the swallowing reflex is absent. Hence, milk cannot be eliminated from the oral cavity and it pools around the tooth surfaces. Opportunistic cariogenic microorganisms exploit this conducive environment and this result in tooth decay. This process sometimes occurs so fast that the parents often complain that the child had decayed teeth at the time of eruption itself.
The PSattern of Decay in Early Childhood Caries
A special characteristic of this process is that it typically involves maxillary primary incisors and upper and lower molars, the mandibular incisors are usually spared. This is probably because they are protected by the mechanical cleansing action of the tongue.
This is one of the most severe form of tooth decay, which involves the surfaces of teeth, usually considered immune to tooth decay.
What are the factors which Increase the Chances of Early Childhood Caries ?
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Feeding beyond the weaning age i.e. beyond 12 to 15 months.
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Feeding at night always poses a serious threat especially if the teeth are not cleaned after feeding
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Single parent households. Child neglect could also be one of the major reasons for nursing caries to occur as the parent is too busy coping with financial stress and responsibilities.
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High socio-economic status. It has been seen that some mothers avoid breast feeding.
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The children are left to the mercy of the domestic help who think it their duty to continuously force a bottle into the child ’s mouth.
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Low socio-economic status. Both the parents if working leave the children to be cared by the young siblings and the resultant neglect leads to tooth decay.
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Immunocompromised children are at higher risk due to decreased salivary flow.
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A strong tempered child such as the only child or an overprotected one would always demand and force the parents to give in to its wishes.
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Children who present sleep disorders are found to be affected by nursing caries.
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It is not necessary that milk alone causes nursing caries.
Other Food Products, which are Equally Responsible:
Complications due to Early Childhood Caries
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Nursing caries is a severely disabling condition causing unaesthetic appearance. Due to loss of tooth structure, the child may not be able to chew food properly and subsequent malnutrition may ensue,Shence these children may show retarded growth as compared to normal children.
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Prolonged bottle feeding often displaces other components of staple diet hence this can result in nutritional deficiencies, for e.g. anaemia, etc.
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Rapid destruction of teeth may affect a child psychologically when he compares himself to other children.Early extraction of maxillary incisors can create speech problems.
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Loss of primary teeth can cause space problems, which may result in malocclusion.
How to Prevent Early Childhood Caries ?
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Clean the mouth of infants with a warm wet clean cloth or gauze.
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Don't dip soothers in sugar or honey.
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Brush teeth with soft toothbrush daily, as soon as teeth erupt.
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Check your baby's mouth regularly, lift the lips and check both sides of teeth.
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Don't put your baby to bed with a bottle of sweetened liquid.
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If you notice discoloration or white spots have your child's teeth checked by your dentist or dental hygienist.
What is The Treatment of Early Childhood Caries?
1. Discontinuation of the habit
The first step is to identify the cause. Abrupt cessation of the feeding habit is not advised; rather a gradual withdrawal must be done. The habit must be reduced to 70% at the end of the first week, 50% by the end of the second week, 20% at the end of the third week and so on. Feeding with the cup or spoon should be encouraged. Serial dilution of the contents of the bottle with water has been recommended over a period of 1-2 weeks so that eventually the child drinks only plain water. Feeding at night is to be strictly avoided. Clearance of the milk can be aided by intake of water after the feed.
Infants must be weaned at 12-14 months of age on demand nocturnal breastfeeding must be denied. Consumption of juices from a bottle should be avoided when juices are offered, they should be from a cup
2. Dietary modifications
The mother in particular must know the deleterious effects of sugar. Elimination or at least gradual reduction of additional sugar must be done. Depending on the child’s age and chewing capacity, natural food like fruits should be given to the child. Oral hygiene measures must be implemented by the time the first tooth has erupted.
3. Restorative procedures
These can be done under local or general anaesthesia if necessary and it involves a thorough excavation of the decay followed by placement of sedative dressings. The patient is then given the necessary instructions regarding oral hygiene and diet. On subsequent recall visits, only if it is found that the patient is complying, further treatment is carried out.
Small cavitations are restored with composite resins. Amalgam or glass ionomer restoration are carried out as required. Pulpal treatment as indirect pulp capping, direct pulp capping, pulpotomy and pulpectomy may be performed. Stainless steel crowns and polycarbonate or celluloid crown forms for anterior teeth are also other treatment alternatives.
Extraction of teeth is never to be encouraged. However, if the teeth are beyond repair extraction followed by placement of a suitable space maintainer is advocated. Fluoride supplements can be given depending on the age and need of the child as necessary.
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Child's Dental Treatment |
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Silver Amalgam Restorations
Dental amalgam is a self-hardening mixture of silver-tin-copper alloy powder and liquid mercury and is sometimes referred to as silver fillings because of its color.
Dental amalgam has been used for restoring teeth since the 1880s. Amalgam’s properties, such as ease of manipulation, durability, relatively low cost, and reduced technique sensitivity compared to other restorative materials, have contributed to its popularity. Esthetics and improved tooth color restorative materials, however, have led to a decrease in its use
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Advantages of amalgam
Disadvantages of Amalgam
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Gray coloured, not tooth
coloured.
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May darken as it corrodes; may stain teeth over time.
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Requires removal of some healthy tooth.
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In larger amalgam fillings, the remaining tooth may weaken and fracture.
What are Tooth Colored Restorative Materials ?
These are tooth colored restorations unlike silver amalgam. Commonly used tooth colored materials are:
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Glass Ionomer Cement
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Composite resin
Composite Resin Restorations
Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic, or tooth-colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to repair portions of broken teeth. Composites have excellent esthetic properties and are applied most frequently in anterior tooth cavities.
Advantages
Disadvantages
Glass Ionomer Cement
Glass ionomer cement is a self-hardening mixture of glass and organic acid. As early as 1977, it was suggested that glass ionomer cements could offer particular advantages as restorative materials in the primary dentition because of their ability to release fluoride and to adhere to dental hard tissues and because they require a short time to fill the cavity, glass ionomer cements present an additional advantage when treating young children. It is tooth-colored and varies in translucency.
Advantages
Disadvantages
Stainless Steel Crown Restoration
Stainless steel crowns are prefabricated crown forms that are adapted to individual teeth and cemented with a biocompatible luting agent. The SSC is extremely durable, relatively inexpensive, subject to minimal technique sensitivity during placement, and offers the advantage of full coronal coverage.
Indications
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Stainless steel crowns have been indicated for the restoration of primary and permanent teeth with caries, cervical decalcification, and/or developmental defects
(eg, hypopla-sia, hypocalcification).
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Following endodontic treatment of teeth.
When esthetics is a concern, the facing of the stainless steel crown can be removed and replaced with a resin-based composite (tooth colored) (open-faced technique).
Several brands of primary Stainless steel crowns are available with preformed tooth colored veneers.
Infected teeth
It means the infection has reached the pulp of the teeth.
If you have an infection of the pulp, you may not feel any pain at first. But if left untreated, the infection will cause pain and swelling. In some cases, an abscess will form. Eventually, the tooth may need to be extracted.
Some indications that a tooth may need a pulp therapy
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A tooth that hurts significantly when you bite down on it, touch it or push on it.
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Sensitivity to heat.
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Sensitivity to cold that lasts longer than a couple of seconds.
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Swelling near the affected tooth.
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A discoloured tooth, with or without pain.
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A broken tooth.
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Oral & Speacial Habits |
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When we speak of
oral habits, we are typically speaking of any thumb, finger, or
pacifier habits that may be causing damaging effects to the
normal growth and development due to sucking or biting habits of
the child. This type of sucking is completely normal for babies
and young children. Babies begin to suck on thumbs and fingers
before they are born. It provides security for them.
Most children stop
sucking on thumbs, pacifiers, or fingers on their own between
the ages of two to four years. No harm is done to their teeth or
jaws. However, some children continue these habits much longer,
and this is where problems can occur.
Habits can be responsible for a number of problems.
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Problems
associated with Oral habits
1. Thumb and finger habits can cause an anterior open bite,
facial movement of the upper incisors, lingual movement of
the lower incisors, and constriction of the maxillary arch.
2. Lip sucking and lip biting can procline the maxillary
incisors, retrocline the mandibular incisors and increase he
amount of overjet.
3. Tongue thrusting and mouthbreathing may also play a part
in the creation of a malocclusion. An anterior open bite is
the most common dental problem associated with the
anomalies.
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Bruxism, defined as the habitual nonfunctional forceful contact between occlusal tooth surfaces, can occur while awake or asleep.
Tongue thrusting, an abnormal tongue position and deviation from the normal swallowing pattern, and mouth breathing may be associated with anterior open bite,
abnor-mal speech, and anterior protrusion of the maxillary incisors.
Management may consist of simple habit control, myofunctional appliance therapy, habit appliances, orthodontics, and possible surgery.
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Treatment modalities to control habits
It includes
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patient/parent counseling
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Behavior modification techniques
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Myofunctional / fixed appliance therapy.
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the individualized approach for each child in evaluating oral habits.
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encourages treatment of oral habits to prevent or intercept possible maloc-clusion
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or skeletal dysplasia from occurring.
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intervention for bruxism when the habit is of sufficient persistence,
duration, or in-tensity
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to damage the permanent teeth or cause other complications which affect the
child's well-being.
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Mouth Protectors |
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What are athletic mouth protectors ?
Athletic mouth protectors, or mouth guards, are made of soft plastic. They are adapted to fit comfortably to the shape of the upper teeth.
Why are the mouth guards important ?
Mouth guards hold top priority as sports equipment. They protect not just the teeth, but the lips, cheeks, and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing their mouth protection.
When should my child wear a mouth guard ?
Whenever he or she is in an activity with a risk fall or of head contact with other players or equipment. This includes football, baseball, soccer, hockey, skateboarding, even gymnastics. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports- related mouth injuries occur in basketball and baseball.
How do I choose a mouth guard for my child ?
Any mouth guard works better than no mouth guard. So, choose the mouth guard that your child can wear comfortably. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room.
You can select from several options in mouth guards. First, preformed or “boil-to-fit” mouth guards are found in sports stores. Different types and brands vary in terms of comfort, protection, and cost. Second, customized mouth guards are provided through your dentist. They cost a bit more, but are more comfortable and more effective in preventing injuries. Your pediatric dentist can advise you on what type of mouth guard is best for your child.
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FAQ |
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1 What are Milk Teeth?
Primary teeth are the first teeth of a child and they are sometimes called Milk/ Deciduous/Baby teeth.
The primary teeth are twenty in number: ten in each jaw.
When a child is born the first teeth are already formed in the jaw although they can't be seen.
Then between at about six months of age - when a baby gets his first tooth - and at three years of age, all twenty teeth erupt in the oral cavity.
The characteristics feature of the primary dentition is the presence of spaces between the teeth.
2 Why are milk teeth Important?
The deciduous teeth are important for following reasons
1) Mastication
2) Speech
3) Esthetics
4) Space maintainence
3 What is decay/dental caries?
Your dentist is probably recommending orthodontics so that he or she might treat you in the best manner possible to bring you to optimal dental health. Many complicated tooth restorations, such as crowns, bridges and implants, can be best accomplished when the remaining teeth are properly aligned and the bite is correct.When permanent teeth are lost, it is common for the remaining teeth to drift, tip or shift. This movement can create a poor bite and uneven spacing that cannot be restored properly unless the missing teeth are replaced. Tipped teeth usually need to be straightened so they can stand up to normal biting pressures in the future
4 Why all teeth of my child are decay? What is early childhood caries?
Early childhood caries is a specific term used to describe dental decay in infants and toddlers.
Early childhood caries is also known as:
1. Nursing bottle caries
2. Baby bottle tooth decay
3. Nursing bottle syndrome
4. Milk bottle syndrome
Some of there later descriptions may be misleading as regarding the specific etiology of the conditions. For example breast milk may be as likely to supply the carbohydrate required for acidogenic bacteria, as the bottle formula does. So the bottle itself is probably not to be blamed. Today, the new name for early childhood caries is ‘Maternally Derived Streptococcus Mutans Disease (MDSMD)’.
Children who are breast fed on demand-specially at time other than normal feedings and throughout the evening often develop early multiple carious lesions.
During sleep, salivary flow is diminished. Moreover, the swallowing reflex is absent. Hence, milk cannot be eliminated from the oral cavity and it pools around the tooth surfaces. Opportunistic cariogenic microorganisms exploit this conducive environment and this result in tooth decay. This process sometimes occurs so fast that the parents often complain that the child had decayed teeth at the time of eruption itself.
The pattern of decay in early childhood caries:
A special characteristic of this process is that it typically involves maxillary primary incisors and upper and lower molars, the mandibular incisors are usually spared. This is probably because they are protected by the mechanical cleansing action of the tongue.
This is one of the most severe form of tooth decay, which involves the surfaces of teeth, usually considered immune to tooth decay.
What are the factors which increase the chances of Early childhood caries?
1. Feeding beyond the weaning age i.e. beyond 12 to 15 months.
2. Feeding at night always poses a serious threat especially if the teeth are not cleaned after feeding
3. Single parent households. Child neglect could also be one of the major reasons for nursing caries to occur as the parent is too busy coping with financial stress and responsibilities.
4. High socio-economic status. It has been seen that some mothers avoid breast feeding. The children are left to the mercy of the domestic help who think it their duty to continuously force a bottle into the child’s mouth.
5. Low socio-economic status. Both the parents if working leave the children to be cared by the young siblings and the resultant neglect leads to tooth decay.
6. Immunocompromised children are at higher risk due to decreased salivary flow.
7. A strong tempered child such as the only child or an overprotected one would always demand and force the parents to give in to its wishes.
8. Children who present sleep disorders are found to be affected by nursing caries.
It is not necessary that milk alone causes nursing caries. Other food products, which are equally responsible, are:
1. Honey
2. Fruit juices
3. Sweetened beverages
4. Pacifiers sweetened with jam and jelly
5. Infant milk formulae
6. Milk or water with added sugar.
5 How to prevent decay in children?
The branch of dentistry that deals with the preservation of healthy teeth and gums and the prevention of dental caries and oral disease
Preventive dentistry for children includes:
Importance of Preventive dentistry
Preventive dentistry means a healthy smile for your child. Children with healthy mouths are able to chew food efficiently and more easily. To have good general health a child must have good oral hygiene because disease in the mouth can endanger the rest of the body. A healthy dentition gives children confidence in their appearance. Preventive dentistry ensures less extensive, and less expensive, treatment for the child.
Preventive dentistry begins with the eruption of first tooth
Visit the pediatric dentist when the first tooth erupts. The earlier the dental visit, the better the chance of preventing dental disease and inculcating healthy oral hygiene habits in children which prove beneficial for the rest of their life.
Role of the Pedodontist
The Pedodontist should evaluate the child’s Oral health and accordingly design the Preventive treatment plan which should include oral prophylaxis, topical fluoride application, pit and fissure sealents, early diagnosis and management of orthodontic problems, prevention of sports injuries to the face and teeth.
6 when should the child be first taken to the dentist?
Birth to 6 months of age
Six to 12 months of age
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During this time, the first tooth erupts. Consult the Pedodontist.
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Brush teeth after each feeding and at bedtime with a small, soft-bristled brush.
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As the child begins to walk, stay alert of potential dental and/or facial injuries.
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Wean the child from breast or bottle by his/her first birthday.
Twelve to 24 months of age
Follow the schedule of dental examinations and cleanings, as recommended by your child's pediatric dentist. Generally, dental examinations and cleanings are recommended every 6 months for children and adults.
As the child learns to rinse his/her mouth, and as most deciduous (baby) teeth have erupted by this age, brushing with a pea-sized portion of fluoridated toothpaste is appropriate.
7 what can be done if the my childs teeth are decayed ?
How root canal treatment is done
Measurement of root canals
First, your dentist will anaesthetize the area around the tooth. an access cavity in the crown of the tooth to get to the pulp chamber.
The entire roof of the pulp chamber is removed to gain proper access to the canals and eliminate all coronal pulp tissue. Then the root canals have to be measured to know how long the canals are so that all the diseased pulp tissue is removed and the entire canal is cleaned.
Duration of Treatment:
Root canal treatment can be done in one or more visits, depending on the situation. An infected tooth will need several appointments to make sure that the infection is eliminated. Some teeth may be more difficult to treat because of the position of the tooth, because they have many and curved root canals that are difficult to locate, or for other reasons. An uncomplicated root canal treatment often can be completed in one visit. Once the root canal treatment is finished, you will need to have the tooth restored with a crown or filling.
Possible Complications
As with most invasive medical or dental procedures, complications can occur. Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing, causing inflammation and pain.
Pain after the treatment or between visits: Sometimes during a root canal procedure, bacteria are pushed out through this small hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This is treated with painkillers, and sometimes antibiotics, but the site could be painful until it clears up.
A root canal treatment can puncture the side of the tooth (perforation). This can happen if the canal is curved or if the canal cannot be located. The instruments are flexible so that they bend as the canal curves, but sometimes the instrument makes a small hole in the side of the tooth.
A root canal may be missed or an entire canal may not be fully cleaned out. Locating canals within the tooth can be difficult. If a canal or an offshoot of a canal isn't located and cleaned out, the tooth can remain infected and the root canal procedure will have to be repeated. This also can happen if a canal isn't measured correctly and pieces of infected or inflamed pulp are left near the bottom.
Apexification (root end closure)
Apexification is a method of inducing root end closure of an incompletely formed nonvital permanent tooth by removing the coronal, nonvital radicular tissue just short of the root end and placing in the canal a suitable biocompatible agent such as calcium hydroxide (several treatments with a fresh agent may be necessary) or MTA.
Once apical closure is obtained or an apical barrier is established, root canal treatment should be completed. Indications: This procedure is indicated for nonvital permanent teeth with incompletely formed roots.
8 what should be done if the some primary teeth of my child are removed due to decay?
Indications:
The premature loss of primary molars may require the placement of a space maintainer to prevent the migration of the adjacent teeth, depending upon the teeth present and the arch length. The premature loss of primary canines may therefore require the placement of a space maintaining appliance to prevent midline deviation and/or loss of arch length, perimeter and/or circumference which might cause crowding of the permanent teeth which will erupt in the place of the primary teeth
Contraindications:
A space maintainer is usually not necessary if there is a sufficient amount of space present to allow for eruption of permanent tooth/teeth. A space maintainer may not be recommended if severe crowding exists, such that space maintenance is of minimal effect and subsequent orthodontic intervention is indicated. A space maintainer may not be necessary if the succedaneous tooth will be erupting soon.
Care Of Space Maintainers
To avoid the cost and time of replacement:
Avoid sticky sweets, popcorn, ice and or chewing gum.
Don't tug or push on the space maintainer with your fingers or tongue.
Keep it clean with brushing and flossing.
At night carefully clean around all wires, bands and other areas of the appliance, as it tends to trap food.
After cleaning, please inspect the appliance carefully for damage.
Keep your 6-month check up appointments to monitor oral health and to evaluate the space maintainer to determine when it needs to be removed.
Types of Space Maintainers
The treatment modalities may include, but are not necessarily limited to, the following types of appliances.
A) Fixed appliances:
Band and Loop / Crown and Loop
Distal Shoe
Lower Lingual Arch
Nance Appliance
B) Removable appliances:
Hawley appliance / Removable dentures
9 When do teeth begain to
erupt? By what age all teeth (primary) erupt in moutht?
Eruption timing of teeth
The first to erupt are the two lower central incisors.(lower front teeth)
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Central incisors 6-12 months
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Lateral incisors 9-16 months
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Canines 16-23 months
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First molars 13-19 months
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Second molars 22-33 months
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