Pediatric Dentistry

Pediatric Dentistry; is a branch of dentistry covering the treatment of bruises in children’s deciduous (milk) and permanent teeth, trauma treatment, preventive dentistry practices (fluoride applications, fissure sealant applications, oral hygiene education) and preventive and interceptive orthodontic treatments.

What is Pediatric Dentistry?

Deciduous teeth contain more organic matter than normal teeth, so they are more prone to decay. Children cannot interpret the potential signals, such as heat sensitivity and mild pain, in the early stages of caries. They are likely to recognise caries only when the pain reaches to an intolerable level, which may be too late for the start of the treatment. Children do not attend oral and dental care as much as adults. The child’s manual dexterity, interest, and the attitude of the parent determine the habit of brushing teeth. A commonly observed error by mothers would be to cover the pacifier or baby bottle with sugar or jam, or to provide sugar milk or juice along with different intervals of sleep. Thus, the teeth become susceptible to decay due to nutritional irregularities.

A vaccine or drug that could completely prevent caries has not been invented yet. However, some materials can be used to reduce the number of caries; ‘fissure sealer’ being one of them. Dental caries usually starts forming inside the ‘fissures’, which are found on the chewing faces of molars and small teeth. With the material mentioned earlier, the fissures are covered to block the leakage of germs, food surpluses, and other substances to prevent the early stages of caries. This process can also be applied to permanent molars and premolars from 6 years of age. Another way to prevent caries is to increase the resistance of the teeth to decay. This resistance is achieved by applying superficial fluoride to teeth.

The main use of the deciduous teeth is to ensure proper consumption of food for the child. In addition, the development of speech also depends on the presence of deciduous teeth. Also, in cases similar to the image below, serious aesthetic problems can be observed. Should caries in deciduous teeth be treated.

Untreated deciduous teeth decay leads to pain, bad odour, difficulties in chewing, malnutrition, and unpleasent appearance. If teeth remain untreated around this period, it may lead to teeth distortion, jaw development, and general health problems (from rheumatism to heart disorders) in the future. Therefore, the bruises on the milk teeth should be treated, without relying on the common belief that ‘the milk tooth will be replaced easily’ with permanent ones. Deciduous teeth decay would potentially introduce the child with unbearable pain around a very young age and may result in ongoing phobia in the future. In addition, caries can lead to very early loss of deciduous teeth.

Interventions should be performed immediately after incidents that cause teeth damage or loss in children. In such cases, having an accurate diagnosis is very important. For this reason, your dentist will ask you about the time and place of the accident, the source of damage; whether vomiting, loss of memory, or fainting was present after the accident. The most siutable treatment can only be provided based on correct information. Dental injuries in children may cause permanent tooth to be completely pulled out from its location. In this case, you should go to the dentist immediately with the tooth. The tooth must be kept in a glass of milk, if not present, in clean water.

Breastfeeding for at least for the first four months of infancy will ensure normal development of soft tissue and muscle functions around the mouth. In cases where breast milk is inadequate, it is necessary to use a bottle with a physiological head (with palate, cut ends). The baby should become accustomed to the use of cups and spoons for feeding from year 1. Feeding with baby bottles can be continued until the age of 2-2.5 years. If finger-sucking habit is present, the reason for this needs to be investigated and the habit should be terminated around 3-6 years of age. Problems related to inhalation may have a negative impact on the development of the jaw. If breathing only occurs through mouth and not nose, (this is better understood during sleep), an otolaryngologist consult would be required.

When the baby is 6-8 months old, (when the first few teeth appear in the mouth), the cleaning process should begin. After breakfast in the morning and before going to bed at night, a clean cheesecloth or gauze bandage should be used to wipe off the teeth (at least the chewing surfaces). It is only appropriate to start using a toothbrush once teeth at the back starts appearing (around 2.5-3 years of age). It is difficult to habituate pre-school children with a brushing technique. Therefore, around this stage, it is important to familiarise children with the habit of brushing teeth. Children often brush the visible or easily accessible faces of the teeth. However, to prevent decay, it is necessary to clean inner surfaces and chewing surfaces of the teeth more carefully. Therefore, it would be useful for parents to check the teeth after brushing.

Preferred toothbrushes should be in suitable size for the children with soft and nylon bristles. Hard brushes are not suitable for use, as they are likely to cause tooth corrosion. Similar to how an old broom cannot be used for sweeping, an old toothbrush can also not be used for brushing teeth appropriately. Toothbrushes need to be replaced once the bristles start to wear off (around 6 months after initial use).

How many times shall I make my children brush their teeth in a day?

After breakfast and before going to bed, only three minutes of effective brushing would be sufficient. Like every good habit, the habit of brushing teeth regularly can be established during childhood.

Children with stressed, aggressive, obsessive, and shy personality structures are prone to teeth grinding, if their parents also have the same habit.

Abrasion on teeth, grinding noises during sleep, pain in the facial muscles, problems in the jaw joint, headache, swing, and tenderness in teeth.

First, psychological factors need to be evaluated which may lead to teeth grinding. If this cannot be achieved, a removable night plate is provided to the patient.

Finger sucking is a common habit observed in young ages. This habit often disappears by itself around the age of four. Persistant finger sucking around the period of teething may result in structural defects on the palate and the teeth. The reason for such defects is the pressure applied by the finger onto the teeth and palate. The degree of such defects depends on the duration, frequency, severity of finger sucking, and the position of the finger during the act.

The most effective method to prevent finger sucking is to introduce the child, who is inclined to finger sucking, to the pacifier. The damage caused by the pacifier would be less and the process of quitting the use would also be easier. The success in treatment is only likely if the child personally wishes to break this habit. It would be psychologically more helpful, if the child can break this habit around pre-school age, to avoid being ridiculed or socially pressured by peers. The positive way to direct the child would require encouragement and reward while avoiding explicit pressuring. If the fingersucking habit continues past 6 years of age despite all efforts, professional help would be required along with the dentist’s consult.

Sucking is the most natural way to relax and to feel safe for babies. If the baby demonstrates a tendency for fingersucking, it should be directed to the pacifier immediately. The pacifier is less harmful than finger sucking and can be given away more easily at a later age. The pacifier should not be handed to the baby for a large period of the day but should only be used when necessary. To avoid any structural defects, only the pacifiers that imitate the natural form of nipples should be preferred. The durability of the structure of the pacifiers should be checked daily. The size of the teat should be suitable for the structure of the mouth.

My baby’s teeth decayed as soon as they appeared, what could be the reason?

Sometimes brown spots appear on babies’ teeth right after teething or these teeth may also break and fall out. In fact, these stains indicate tooth decay and breakage due to caries. The cause of the decay in such an early age is called ‘bottle tooth decay’. Breast milk or cow’s milk, being the most important nutrient for an infant, naturally contain sugar. If the baby is given breast milk or bottled milk before or during sleep at night, the milk will accumulate in the mouth and create a favorable environment for germs to cause decay. Therefore, extra attention should be paid to dental hygiene especially after night feeding.

  • Since the treatment of caries in babies is very difficult, preventive precautions should be taken early.
  • Prevent your baby from sleeping at night with a baby bottle.
  • Try to put you baby to sleep after feeding.
  • Do not add sweeteners such as sugar, honey, syrup to the milk in the bottle.
  • Always make your baby drink water after feeding.
  • Following the initial teething, wipe the teeth with a clean, wet gauze after morning and night feedings.

If bottle tooth decay remains untreated, pain and inflammation will be observed. Inflammated and aching teeth cause discomfort to the baby and result in the feeding pattern to be deteriorated. Deformations would be likely for the permanent teeth appearing from the bottom of the inflammated teeth. If these teeth are needed to be removed, speech problems may be observed in the child.

My baby has tooth decay even without the use of a baby bottle, what could be the reason?

  • Besides baby bottles, covering the pacifiers with honey, syrup, jam or other sweeteners to soothe the baby is another reason for tooth decay. In addition, after teething, handing food with high carbohydrate-sugar content to the babies, to keep them occupied, also causes dental caries. The child should be directed to other types of food with higher nutritional values and to food that would not hinder teeth cleaning, such as apples and carrots.
  • The use of toothpaste is not recommended for infants, up to three years of age. Toothpaste use must be initiated after the age of three. However, a pea sized amount of toothpaste would be sufficient unlike the amount of 3-5 cm, as observed in advertisements. At the time when the child begins to use toothpaste, any of the toothpastes with fluoride may be preferred for use. The important thing would be for the child to like the taste of the chosen paste and to enjoy the brushing experience. The brushing technique is a much more important determinant of the effectiveness of brushing than the toothpaste.
  • Clean the area surrounding the aching tooth. Gargle with warm salty water and remove any trapped food residues, if present, with dental floss. Do not put aspirin or similar drugs on the tooth. Give your child a painkiller that you have tested before and take it to a dentist as soon as possible.
  • Put ice on the scar. If there is bleeding, gently apply pressure with a clean gauze. Consult your dentist if the bleeding does not stop within 15 minutes.
  • Find the tooth. Remove it without touching the root, if possible. Milk is the ideal environment for storing teeth until you go to the dentist. Go to your dentist as soon as possible while preserving the tooth in a clean container, filled with milk.
  • Contact your dentist as soon as possible. After the trauma, every wasted hour would likely to result in more damage.
  • Clean the wound with warm water. Apply cold compress to the area. Keep the broken tooth pieces, if present.

The material provided on this webpage only holds informative purposes. Hence, it should not be used to replace any medical diagnosis or treatment provided directly by the patient’s dentist.

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