Children Dental Care

2. Bad baby teeth usually mean frequent visits to the dentist under very poor circumstances. If the child has not slept well, he will be in a bad mood, and the dentist will be the last person he would really want to see. This sets the stage for bad behaviour on succeeding dental visits.

3. Baby teeth are essential for holding the spaces open so that the adult teeth can come into the correct position when they are finally developed enough to erupt. If some of the baby teeth are removed before nature has intended, the adult teeth that develop earliest will move into inappropriate positions, crowding the space necessary for the eruption of other adult teeth which develop at a later date. This can lead to not only ‘crooked teeth’, but to real functional problems as well. These involve chewing difficulties, Tempo-Mandibular Joint problems, and certain asymmetries of the face. In asymmetric face, one side of the face develops more than the other side due to the differences in the way that the muscles on either side are used in chewing and grinding the teeth.

FIRST VISIT
A child first is seen by a dentist when the first baby tooth erupts, or by the age of one year. At this visit, the parent holds the child on his or her knee while the dentist sits facing the parent knee to knee. While the child will not yet have all of his or her baby teeth in place by the age of one, a visual inspection allows the dentist to assess for the beginning of early childhood decay (nursing bottle caries) and to council the parents on any obvious problems that may appear to be developing. Most childhood falls that result in injuries to the teeth happen between the ages of 2 and 3, while the child is learning to coordinate his movements.

For a child it is not a very easy thing to accept somebody operating on them and many times children get very scared. In case, the procedure is to be done on a child many times, it is better that parents do not accompany the child inside the operating room. Children always behave better without the parent in sight.

The behaviour of children in the dental setting depends largely on the child’s trust in an authority figure and his or her willingness to surrender control over his own body, even at the expense of minor pain, to an adult whom he does not know. In cases where children are very uncooperative, they should be referred to a pedodontist.

Nursing bottle syndrome (early childhood caries)
Nursing caries, or tooth decay, can be caused by children sleeping with bottles in their mouth. This is also called baby bottle tooth decay. It is caused when a child goes to bed with a bottle filled with milk or juice or anything except water. It usually affects children between the ages of 1 and 2 years. Breast fed infants who fall asleep while breast feeding are also at risk.
Steps to prevent nursing bottle syndrome

1. Children should not be given a bottle filled with sugary liquids or milk when they are crying. Instead, give plain water or substitute a pacifier. Anything to eat or drink should be given only when the child is really hungry.

2. The pacifier should never be dipped in sugar, honey or any sugary liquid.

3. At bedtime, a child shouldn’t be given bottle filled with sugary liquids (watered-down fruit juice or milk also increases the risk of decay). Give plain water.

4. Avoid nursing continuously throughout the night while sleeping since human breast milk can cause decay. Use a pacifier or give a bottle filled with plain water instead.

5. Don’t add sugar to a child’s food.

6. Use a wet cloth or gauze to wipe child’s teeth and gums after each feeding. This helps remove any bacteria-forming plaque and excess sugar that have built up on the teeth and gums.

7. The fluoride needs of the child should be checked with the dentists which will be decided on the area one lives in. If drinking water of that area is not fluoridated, fluoride supplements or fluoride treatments may be needed.

8. Child should be introduced to drinking milk from a cup from his/her first birthday. Moving to a ‘sippy cup’ reduces the teeth’s exposure to sugars. However, constant sipping from the cup can still result in decay unless it is filled with water.

TEETH GRINDING
One of the common complaints parents come up with for their children is grinding of teeth while sleeping. But the fact is that it is very normal for children under the age of about 13 to grind their teeth at night. It appears to serve two purposes.

1. Grinding places pressure on the roots of the baby teeth over the developing adult teeth which stimulates resorption (natural destruction) of the roots of the baby teeth. This resorption is ultimately responsible for the shedding of the baby teeth when the adult teeth are ready to erupt.

2. Grinding also helps the adult teeth to erupt in their most stable positions in the dental arches.

DELAYED FALLING OF MILK TEETH
In some cases, a baby tooth may remain in place even though the adult tooth is erupting beside it. In this case, the baby tooth must come out or it will interfere with the positioning of the adult tooth. If the child cannot or will not remove it himself or herself by wiggling it, then the tooth has to be extracted.

THUMB SUCKING
Thumb sucking is perfectly normal for infants. Most children stop sucking their thumb by the age of two. If he or she does not, parents should try to discourage the habit by the age of four. Thumb sucking actually places forces on the bone that supports the teeth and causes it to grow outward and upward causing an anterior ‘open bite’ and sometimes a narrow upper arch form. These deformities are easily diagnosed by a dentist. As a rule, the bony abnormalities will correct themselves when the habit is stopped; as long as it is stopped by about the age of six. If the habit persists after the age of six, most of the time the only correction is by means of orthodontics (braces).

Dentists deal with this problem by building a simple habit breaking device. But these devices only work if the child truly wants to stop sucking his or her thumb. By the time children begin to interact with others of their own age, the thumb habit becomes a social liability and the child really does want to stop, but may need a bit of help.

TONGUE THRUSTING
Tongue thrusting is the habit of sealing the mouth for swallowing by thrusting the top of the tongue forward against the lips. Just like thumb sucking, tongue thrusting exerts pressure against the front teeth, pushing them out of alignment which causes them to protrude, creating an overbite and possibly interfering with proper speech development.

LIP SUCKING
Lip sucking involves repeatedly holding the lower lip beneath the upper front teeth. Sucking of the lower lip may occur by itself or in combination with thumb sucking. This practice results in an overbite and the same kinds of problems as discussed with thumb sucking and tongue thrusting.

THE UGLY DUCKLING STAGE
This is a stage of dental development preceding the eruption of the permanent canines in which the lateral incisors may be tipped laterally because of crowding by the unerupted canine crowns. This tipping may cause spacing of the incisor crowns despite the crowding of the roots. The condition may be transitory in an otherwise normal dentition. This is the norm between ages 7 to 12 years of age and usually is not connected with a permanent space between the teeth.

CAVITIES IN CHILDREN
For years, it was never really made clear that ‘the cavity prone years’ as we called them in the years before the health benefits of fluoridation began to kick in, are really just the years when kids discover the wonders of sweet foods and drinks. High sugar intake throughout the day means lots of tooth decay. The end of the cavity prone years always coincide with the time when the child begins to mature and lose his taste for sugar. It’s as simple as that. The less sugar, the less decay. Oral hygiene is certainly important because the germs in plaque are responsible for transforming sugar into the acid that is ultimately responsible for the decay, but without the sugar, the germs have no raw materials to create the acid in the first place.

Children’s oral hygiene for prevention of cavities
Brushing of teeth
Very young children usually want to imitate their parents. The easiest way to introduce children in brushing is to let them watch you do it on a regular basis and then encourage them to imitate the way of brushing when they show an interest. Technique is not important at an early age. Healthy children are not susceptible to gum disease, and if they are not eating too much sugar, the presence of some plaque left over after their early attempts will do them no harm. The point is to get them to start to handle the toothbrush at an early age, and to get them used to having one in their mouth. Parents concerned about their child’s oral health may do some of the brushing for them. But it is always best not to make it an unpleasant experience. Gently done, it can be a bonding experience, especially for mothers. The more comfortable and enjoyable the experience is, the less likely it is that the child will later rebel and begin to associate teeth with unpleasantness.

Fluoride for children
Fluoride is a well accepted fact in dental practice. It is used in toothpastes, mouth rinses, topical applications, for desensitizing teeth, remineralising decay and as a dietary supplement for children.

Topically applied fluoride creates a coating of decay resistant armour which lasts for several days on the surface of the teeth and penetrates into decayed areas of teeth to help remineralise them. Fluoride binds with decayed tooth structure and encourages it to recombine with calcium in the saliva to begin the process of hardening the decay. One word of caution however is that, very young children often mistake the toothpaste placed on their toothbrushes for candy and actually eat it. The amount of fluoride in a toothpaste vastly exceeds the amount recommended for internal consumption, and the child may get too much of a good thing. Excess fluoride in the diet of children with developing teeth can cause fluorosis of the teeth. This causes orange, brown and white spots on the enamel of the adult teeth which are forming at the time of the overdose. It is recommended that the use of fluoride containing toothpastes by young children should be done under supervision, or that they use non-fluoride toothpaste until they are old enough to understand that toothpaste is not candy.

When children come in for a dental examination and cleaning, ideally a fluoride tray application should be used containing prescription strength fluoride for longer lasting protection in order to help stop decay.

Topical sealants
First permanent molars have deep grooves on their biting surfaces. Due to their depth, sticky sweet foods may get stuck in them and remain there for 30 or 40 minutes after the treat is finished. The enamel at the bottom of these grooves also tends to be very thin. Thus, they are often the first places where decay forms in the teeth. A permanent plastic layer is applied to the top of the back teeth to ‘waterproof’ them and seal out germs and sugar. This service is known as ‘dental sealants’. The success of the sealants depends mostly on the cooperation of the child when the sealants are done. Generally, only first permanent molars teeth are sealed. Children under the age of 6 are too young to cooperate in the process. All first permanent teeth can benefit. This includes 8 premolars and 8 molars.

After curing, the covering becomes a hard, thin layer covering the treated portions of the tooth. Despite the incredible pressures on teeth during chewing each day, dental sealants may remain effective for five years or longer, although sealants do wear naturally and may become damaged over time. The disadvantage is that after the wear and tear starts bacteria and food particles may eventually become entrapped under the dental sealants, and can thus cause decay in the very teeth intended to be protected