Pediatric Dentistry

What is a pediatric dentist?

A pediatric dentist takes care of the oral health-right from infancy through teenage. A pediatric dentist has to take at least two years of training after completing dental course. Infants, pre-teens, and teenagers require different handling because of differences in behavior and oral health needs at various stages. The pediatric dentist ensures that dental problems are prevented in the future through addressing the dental needs of this age bracket at the right time.

Why are baby teeth essential?

Maintaining the integrity and vitality of the primary teeth is essential. If cavities are neglected, it can affect the development of the permanent teeth. Baby teeth/Primary teeth are important because:

  • These teeth help in proper eating and chewing
  • Creating space for permanent teeth and ensuring that they assume the right position
  • Allowing the appropriate development of the jaw structure and muscles
  • Additionally, primary teeth impact the progression of speech and affect the appearance or attractiveness of a person. The front four teeth usually last until six to seven years while the rear teeth are substituted between the ages of 11 and 13 years.

Formation of your child’s teeth

Teeth start forming in children even before birth. The primary teeth (baby teeth) come out through the gums and are known as the central incisors. Usually, all 20 baby teeth emerge by the age of three, but the order and rate of eruption may differ.

The permanent teeth begin to erupt around the age of six. The lower central incisors and first molars erupt initially, and this process continues until the age of around 21. The adult mouth has about 28 permanent teeth or 32 including the third molars (also known as wisdom teeth).

Dental radiographs or x-rays

Dental radiographs/x-rays identify cavities and many more abnormalities of the mouth. For instance, radiographs can be used to analyze erupting teeth, detect bone diseases, understand and injury, or develop a dental treatment plan. Dentists can identify and treat oral health conditions that are not apparent in clinical examinations through using dental x-rays. Detecting dental problems early makes them easier and more affordable to treat.

The American Academy of Pediatric Dentistry (AAPD) advises that children at a greater risk of suffering from tooth decay should undergo radiographs and dental examinations every six months. Most pediatric dentists request for radiographs annually. It is advisable to get a full range of radiographs every three years (panoramic and bitewings/ periapicals and bitewings).

Pediatric dentists are cautious in reducing your child’s exposure to radiation. Modern equipment and safeguards make it possible to obtain dental x-rays with minimal exposure to radiation. This makes the risk associated with dental radiographs insignificant. The fact is that dental x-rays present a minimal risk compared to the oral health problems that they assist in identifying. Shields and lead body aprons ensure that your child will be protected during the process. Contemporary equipment provides that the x-ray beam is restricted to the targeted area and that unnecessary rays are filtered out. Your child will receive an insignificant quantity of radiation with the use of adequate shielding and high-speed film.

The best toothpaste for children

One of the essential tasks to maintain great oral health is tooth brushing. A lot of toothpaste or tooth polishes can damage young teeth. These toothpastes contain strong abrasives that can wear out the delicate enamel in young teeth. When choosing toothpaste, be sure to see that it is recommended by the ADA as indicated on the box and toothpaste tube. These toothpaste are safe for your child having undergone rigorous testing.

It is important to remember that your child needs to spit out the toothpaste after they brush their teeth to prevent ingestion of excessive fluoride. The excessive ingestion of fluoride can lead to a condition called fluorosis. Consider using a fluoride-free toothpaste for young children who are unable to spit out the fluoride. You can also consider not using toothpaste altogether or use a small “pea-sized” amount of toothpaste for young children.

Grinding teeth at night (Bruxism)

Bruxism or the grinding of teeth at night (Bruxism) concerns many parents. Usually, the first indication of bruxism is the sound caused by nocturnal grinding of teeth. Parents may also notice the teeth getting shorter due to grinding. A theory associated with bruxism points to psychological causes including stress due to changes in lifestyle such as a new environment, divorce, school issues, etc. These factors can cause a child to grind his/her teeth in their sleep. Another theory points towards the pressure in the inner part of the ear at night. In case of changes in pressure (for example, when an air plane takes off and lands, chewing gum, etc.), the child can resort to grinding their teeth in sleep to relieve this pressure.

Most cases of bruxism do not warrant any treatment. A mouth guard or night guard may be prescribed if there is too much wear of the teeth. The use of a night guard presents the possibility of a choking hazard if the guard gets dislodged while sleeping. It may also interfere negatively with the development and progress of the jaws. The positive effect of using a night guard is to prevent damage to the primary teeth.

The news is not all bad though. Most children outgrow bruxism without any intervention. Usually, the grinding reduces between the ages of six and nine and stops between the ages of 9 and 12. If your child grinds his/her teeth at night, discuss it with your pediatrician or your child’s dentist.

Thumb sucking

Infants and you children can suck on thumbs, fingers, pacifiers and any other objects. Sucking is a innate reflex in infants and young children. It can help them feel safe and happy by providing a sense of security. Sucking a thumb can feel relaxing to a child inducing them to sleep.

Thumb sucking that continues after the coming in of permanent teeth can create problems in the correct development of the mouth and the alignment of teeth in children. The resulting issues are a factor of the intensity with which a child sucks his/her thumb. Vigorous sucking of the thumb can cause a more challenging situation than just keep a thumb passively in the mouth.

Ideally, children should stop sucking their thumbs when their adult teeth erupt. Most children stop thumb sucking between two and four years of age with peer pressure in school-aged children being a major factor in dissuading them from thumb sucking.

Pacifiers cannot be seen as substitutes for sucking on the thumb. Pacifiers can have a similar effect on the teeth as a thumb or fingers. A distinguishing factor between sucking on a thumb/fingers and a pacifier is that the usage of a pacifier can be managed and moderated more easily. You should consult with your pediatric dentist if you are concerned about your child’s thumb sucking or pacifier habit.

Some suggestions to help you with your child’s thumb-sucking habit are:

  • Children can suck on their thumbs to deal with feelings of insecurity. Channelize your energy in identifying and correcting the source of the anxiety, rather than the thumb sucking.
  • If a child is sucking for comfort, the need for thumb sucking will be reduced if parents provide them with comfort.
  • It is essential to reward your child for refraining from sucking on their thumb during challenging times such as being separated from parents.
  • You can ask your pediatric dentist to counsel your child to discontinue thumb sucking by explaining its adverse effects.
  • If none of these approaches dissuade your child from thumb sucking, you can place a bandage on the thumb or sock on their hand at night. Alternatively, your pediatric dentist can advise you on the use of a mouth device to reduce sucking.

Pulp Therapy

The inner, central core of a tooth is known as the pulp. The tooth pulp has nerves, blood vessels, connective tissue and reparative cells. The main aim of pulp therapy in pediatric dentistry is to maintain the integrity and vitality of the impacted tooth to ensure that the tooth is not permanently damaged.

Cavities and injuries are the primary reasons for the requirement of pulp therapy in young people. This therapy is also known as “nerve treatment,” “children’s root canal,” “pulpectomy,” “pulpotomy.” The two most commonly used methods of pulp therapy in pediatric dentistry are pulpotomy and pulpectomy.

A pulpotomy extracts the affected pulp tissue in the crown area of the tooth. A preventive agent is then placed to deter bacterial growth and placate the remaining nerve tissue. The final step is a restoration which is mostly a stainless steel crown.

A pulpectomy is needed when the complete pulp is affected. In this treatment, the unhealthy pulp tissue is entirely removed from the crown and root. Then the root canals are cleaned and disinfected. If the tooth involved is a primary tooth, it is then packed with a resorbable material. Then a stainless steel crown is placed. If the tooth is permanent, then it is packed with a non-resorbing material followed by placing a stainless steel crown.

The best time for orthodontic treatment

The development of malocclusions (bad bites) can happen as early as two or three years of age. Early intervention can reduce the requirement for a significant orthodontic treatment at an older age.

Phase 1: Early treatment-Children between the ages of two to six years are treated at this stage. The main concerns at this young age are the underdevelopment of dental arches, premature loss of baby teeth, bad habits such as thumb/finger/pacifier sucking. The efficacy of treatment in this phase is quite high reducing if not eliminating the requirement for orthodontic or orthopedic intervention in the future.

Phase 2: Mixed dentition-This phase encompasses the ages of six to twelve years. This stage is marked by the appearance of the permanent incisor and six-year molars. The primary aim of this treatment is to deal with jaw misalignments and dental alignment issues. This is a great stage to initiate treatment because your child’s hard and soft tissues respond well to orthodontic or orthopedic treatments.

Phase 3: Adolescent dentition-This stage is concerned with the adult teeth and the evolution of the final bite dynamics.

Adult teeth erupting behind baby teeth

The occurrence of adult teeth erupting behind baby teeth is common in children. The main reason behind this is due to a lower primary tooth not falling out when an adult tooth is erupting. In many cases, if the child wiggles the baby tooth, it falls out within two months on its own. If it doesn’t fall out on its own in two months, your pediatric dentist can remove it easily. This will then enable the permanent tooth to fall into the right place.

ISOLITE Systems

State-of-the-art dental Isolation

Complete control over the oral system has never been as easy as with Isolite’s Isolation Mouthpiece along with our range of isolation products- Isolite®, Isodry®, and Isovac™. These products give you complete control over every dental procedure that you undertake. You can decide which product best aligns with your practice. Our family of products enables you to implement an Isolation Technique (IT) to improve patient comfort, security, and standardize care.

  • Comfortable for the patient with no feeling of gagging
  • Full control of over-spray when using ultrasonic tools
  • Significant decrease in aerosols in the operatory area
  • Early infant oral care

Perinatal and infant oral health

The AAPD advises that all pregnant women are entitled to receiving oral healthcare and advise while pregnant. Research indicates that periodontal disease may increase the risk associated with preterm birth and low birth weight. You can consult with your doctor to understand ways to prevent periodontal diseases during pregnancy.

Mothers with compromised oral health may pass on the bacteria resulting in cavities in young children. Mother’s should incorporate these simple techniques into their lifestyle to reduce the incident of proliferating cavity causing bacteria.

  • Schedule regular visits with the doctor
  • To reduce plaque, brush, and floss every day
  • Consumer a wholesome diet with limited (if not eliminated) beverages and foods with high levels of sugar and starch
  • Use an ADA recommended fluoride toothpaste and use an OTC alcohol mouthwash with .05 percent fluoride to control plaque
  • Do not share utensils and cups with your children as this can cause a transfer of cavity-causing bacteria
  • Using xylitol chewing gum (four pieces daily by the mother) can reduce a child’s rate of cavities (caries)
  • Your child’s initial dentist visitation and creating a “Dental Home.”

The American Academy of Pediatrics (AAP), the ADA, and the AAPD advise the establishment of a “Dental Home” by the time your child celebrates his/her first birthday. Children who have an established dental home are more probable to receive adequate preventive and routine dental care.

The main objective of establishing a dental home is to provide an alternative to the Emergency Room to parents.

You can make your child’s initial dentist visit an enjoyable experience. If your child is old enough to understand, inform him/her of the impending visit and explain that the doctor and staff will take the child through the procedures and answer related questions.

You should not use words that may incite fear in the child regarding the visit such as needle, drill, hurt, etc. Pediatric dentist offices ensure that they use words that communicate the same expression but do not cause fear and anxiety in the child as a standard practice.

Teething in babies

The process of teething which entails the baby’s primary (baby) teeth coming in through the gums in the mouth varies in individual infants. While some babies get their primary teeth earlier, they can come in late in other babies. As a general rule, the first primary tooth appears on the lower front (anterior) of the mouth. The first baby tooth usually erupts between the age of 6 to 8 months.

Tooth decay caused by the baby bottle (early childhood caries)

Baby bottle tooth decay is a severe form of tooth decay in children. This situation results from frequent and prolonged exposure of the baby’s tooth to sugar-containing liquids. The liquids that can cause tooth decay in infants include breast milk, formula, juices, and sweetened drinks.

Putting an infant to bed with a bottle containing other liquids and not water can cause severe and speedy tooth decay. The sweet fluid gathers around the infant’s teeth providing plaque and bacteria with an ideal environment to proliferate and produce acid that seriously impacts young enamel. If you want to wean your child off the bottle and its common components, dilute the contents of the bottle over two or three weeks substituting it with water eventually.

Make sure to clean the baby’s gums and teeth with a soft, damp washcloth or gauze pad to expunge any plaque. An easy method to do this is to sit down with the baby’s head in your lap. Alternatively, you can lay the child on floor or table and then clean the gums and teeth. It is essential that you have a clear view of the infant’s mouth regardless of the position you choose.

Sippy cups

Sippy cups should be utilized as a transition tool to wean off the child from the bottle and enable him/her to start using a cup. A sippy cup should be used only until the child turns one. In case your child uses the sippy cup all day, fill it up with water other than at mealtimes. If you fill up the sippy cup with sugary liquids such as juices, milk, etc. and let him/her sip it all day, it can significantly increase the risk for caries in the child.

Prevention

Proper diet leads to healthy teeth

A proper, wholesome diet leads to healthy teeth. Just like other parts of the body, the teeth, soft tissues, and bones of the mouth require a comprehensive and balanced diet. Children’s diet should comprise of multiple foods from all the five primary food groups. A high frequency of snacking can increase the chances of developing cavities. The time that the food stays in the mouth is also a factor in the growth of cavity-causing bacteria. For instance, hard candy and gums remain in the mouth for a long time which can cause the production of acid leading to an attack on tooth enamel. You can pick nutritious foods like vegetables, yogurt, cheese, etc. if your child does need to snack. These snacks are healthier for children and better for their teeth.

Prevention of cavities

Practicing good oral hygiene eliminates bacteria and removes food particles stuck in teeth which create cavities in conjunction with each other. Infant’s teeth and gums should be cleaned with a damp washcloth to remove plaque. It is advisable to avoid putting a child to sleep with a bottle containing anything other than water. You can check out “Baby bottle tooth decay” for more information.

Older children should brush their teeth twice daily. You also need to keep track of the number of sugary snacks your child is consuming.

Additionally, the AAPD advises bi-annual visits to a pediatric dentist starting from your child’s first birthday.

Your pediatric dentist can recommend the use of home fluoride treatments depending on what’s right for your child. If you want your child to experience a life with great dental health, periodic visits to the dentists should start early in childhood.

Sealing out decay

A sealant if a protective coating that is used on the chewing surfaces or grooves of the back teeth (premolars and molars). This is the area where four out of five caries in youngsters are located. This sealant efficiently acts as an obstruction to plaque and acid which in turn protects the high cavity risk areas of the mouth.

Fluoride

Fluoride has been proven to be beneficial to oral health. However, if used in excess or lesser than required amounts of fluoride can adversely affect teeth. Smaller than needed quantities of fluoride prevents the teeth from receiving the necessary strength to resist cavities. Too much fluoride can lead to a condition called dental fluoride which is a white or brown permanent discoloration of the adult teeth. Many children are actually getting more fluoride than needed, and often the parents do not realize this fact.

Some sources of excessive fluoride in children are:

  • Highly fluoridated toothpaste in early childhood
  • Misuse of fluoride supplements
  • Hidden fluoride in the child’s food
  • Small children may be unable to spit out excess fluoride while brushing. This leads to the accidental ingestion of too much fluoride. The most prominent risk factor for the occurrence of fluorosis during the crucial time of permanent tooth eruption is toothpaste ingestion.

The inappropriate and unrestrained consumption of fluoride supplements can also lead to fluorosis. Fluoride supplements such as drops and tablets or fluoride containing vitamins are not recommended for infants under six months of age.

Mouthguards

Injuries can occur in children while engaging in various activities and organized sports. A well-fitting mouth protector is an essential piece of equipment that can help in protecting your child’s dazzling smile. Mouth guards should be used during engagement in any activity that can involve an injury to the face or mouth.

Reducing cavities with xylitol

The AAPD agrees with the beneficial properties of xylitol on the dental health of infants, children, teenagers and people with special oral needs.

It has been proven that xylitol use by mothers beginning three months after delivery and till the child is two, can cause a reduction in cavities by 70 percent when the child turns five.

Xylitol is found extensively in nature in small quantities. Berries, fruits, mushrooms, lettuce and corn cobs are good sources of xylitol in nature. The consistent usage of xylitol has shown to produce beneficial results. Ideally, xylitol should be used between 4 to 20 grams daily in 3 to 7 periods of consumption.

Dental Emergencies

Toothaches: Thoroughly clean the area surrounding the impacted tooth. Use warm water to rinse the mouth correctly, and use dental floss to displace any small food particles that may be stuck in the tooth causing pain. Contact your pediatric dentists if the pain persists. Never apply aspirin or heat to the affected tooth or the gums surrounding it. Use cold compresses if the face is swollen, and reach out to your pediatric dentist as soon as possible.
Bitten/Cut tongue, lip, or cheek: Use ice on the affected area to assist with the swelling. In case of bleeding, apply light but firm pressure on the area. If the bleeding persists, call your dentists or hospital emergency immediately.
Permanent tooth knocked out: Find the dislodged tooth if possible. Do not handle it by the root. Instead, use the crown to hold it. If the tooth’s integrity is maintained, try to insert it back into the socket. The patient should be made to bite on a piece of gauze to grip the tooth in place. The tooth can be carried in the patient’s mouth (against the cheek) if he/she is old enough. It is crucial to see the dentist immediately in this case. Time is an essential attribute in attempts to save the tooth.
Baby tooth knocked out: No treatment is needed in most cases, and this situation is typically not an emergency. You can call your kid’s dentist during regular business hours.
Fractured or chipped permanent tooth: You need to contact your pediatric doctor immediately in this case. Taking action quickly can save the tooth and avert infection reducing the need for prolonged dental treatment later. Wash the mouth carefully with warm water and use cold compresses to address the swelling. Locate and make sure to save any chipped tooth pieces and carry them to your dentist.
Fractured/Chipped primary tooth: Reach out to your pediatric dentist.
Acute blow to the head: Immediately take your child to an emergency room in close proximity to you.
Fractured/Broken jaw: It is important to immobilize the jaw and take your child to a nearby emergency room immediately.

Adolescent dentistry

Tongue piercing

Tongue, lips or cheeks piercing is relatively common albeit extremely dangerous for oral health. There are numerous risks associated with oral piercings including chipped teeth, blood clots, blood poisoning, heart infections, etc. The human mouth contains thousands of bacteria and infections are quite common after piercings.

Pain, swelling, and infections are common side effects of oral piercings. Severe and uncontrollable bleeding or damage to the nerves can occur if the needle hits a blood vessel.

The ADA strongly recommends avoiding mouth jewelry.

Tobacco use is bad news

Tobacco use in any variation or form can irreparably damage your child’s dental and overall health. You should make sure that your child is well aware of the dangers of consuming tobacco.

Spit, chew or snuff is smokeless tobacco is frequently used by teenagers who believe it to be a better and safer alternative to smoking. This is, however, far from the truth.

Research indicates that spit tobacco is actually more addictive than smoking tobacco and extremely difficult to quit. The use of snuff is equivalent to smoking 60 cigarettes in a day. Within three months, smokeless tobacco can cause periodontal diseases and precancerous lesions known as leukoplakias.

If your child uses tobacco, you should keep an eye out for these symptoms:

A sore throat that is not healing
Red/white leather-like patches on the lips or on/under the tongue
Pain or numbness in any part of the mouth
Problems in swallowing, talking or mobilizing the jaw or tongue
These early signs of cancer can often be ignored as they are painless. If oral cancer progresses beyond early stages, it can lead to prolonged and disfiguring surgery. In the worst cases, oral cancer can lead to death.

Counsel your child on avoiding tobacco in any variant. This will help your child to avoid causing a direct contact between chemicals causing cancer and their gums, tongue, and cheek.

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