CHILD DENTISTRY

One of the most important ages to get teeth checked & followed up is during childhood. A child’s first visit to the dentist should be at around 4 years of age.
During this first visit, a child should be just introduced to the dentist & clinic. Let him get adjusted to the environment & become comfortable. Next visit onwards his treatments (if any) can be planned and started. It is advised not to scare your child with respect to any dental / medical visits so as to avoid any phobia development for future.

Children are more open to acceptance. He may be a little scared during his first 2-3 visits but as he becomes more comfortable, the responsibility of taking care of his teeth will grow in him automatically.
At such a small age, the child starts getting his milk teeth & soon will enter into a transition phase where new permanent teeth will start erupting in his mouth. A check up at this age becomes important to see that his permanent teeth erupt in their proper position & at the correct time.

A dentist will check the following:
• Have all milk teeth erupted in his mouth (should be 20)?
• Is there any extra tooth which is present? (natal/neonatal teeth – teeth present from birth)
• Is there enough gap in his teeth to make space for the permanent teeth to erupt?
• In case, the child is in his mixed dentition period, the dentist may ask for a full mouth X-ray to see if all his permanent teeth are forming & going to erupt in their proper place. This can help him evaluate if his teeth would require any kind of orthodontic correction in future, and in case he does require, can it be started at the correct time. During childhood, the teeth can be easily guided into its correct / desired position, thereby reducing time for the orthodontic correction & the results are more desirable.
• Is any tooth decayed?
• Is a round of cleaning required?

Yes, milk teeth too require filings, whether it’s small or big. Each milk tooth has a specific time to fall off. It has a successor that it has to guide to its correct place. So loss of a milk tooth before its actual time could result in migration of adjacent teeth in the missing area and the permanent tooth ends up erupting in improper positions.
If a milk tooth is decayed, filling it becomes essential because the infection could result in falling off of milk tooth before time or may spread to adjacent tooth.

Milk teeth are small in size as compared to the jaw of your child, which enlarges as he grows. Over a period of time the gaps in your child’s mouth (between milk teeth) tend to increase which is normal. His permanent teeth will be bigger than his milk teeth & therefore these gaps will ensure that the permanent teeth have enough space when they erupt & there is no crowding. If gaps arise in his permanent teeth & continue to persist even after 12 years of age, an orthodontic consult could be of help to evaluate & understand if the spacing would get corrected on its own over time or some orthodontic wire treatment will be required.

You don’t need to arrive on that conclusion immediately. Until & unless the tooth is completely out of arch, you could give it some time to get into its proper place and angulation. Sometimes small alterations in teeth position happen on their own during this time. Some teeth especially the upper front teeth, initially come at an angulation & then automatically get placed correctly. That’s their normal path of eruption. If in doubt, get a full mouth X-ray done to understand better & get an orthodontic consult for your child.

You should brush your child’s teeth till 3-4 years of age & at this age start gradually transferring this habit onto him. This will help him learn brushing quickly & correctly. Teach him the proper method of brushing at this age. Small kids might be a little lazy and may simply chew on their brush but that’s okay, let them take charge, motivate them to brush properly. Do not scold them over this. Once he is done you could spend 1 minute brushing his teeth, if you feel the need.

Use a soft kids brush for your child. Make sure that the head of your child’s brush is not too large for his mouth & the bristles are soft enough that they don’t hurt his gums. Till he is 8-9 years of age, use a kids toothpaste for him (pea size quantity). At such a small age avoid using mouthwashes for him, until advised by the dentist. Also get regular check-ups & cleaning for him as is done for adults.

Yes, if the grooves in your kid’s teeth are deep, they could be prone to cavities, in that case getting pit & fissure sealants and fluoride application is a good option. They will make the grooves shallow & more cleanable thereby preventing cavities. They usually have a life of 2-3 years & may come off but they can prevent early stage cavities in your kid’s permanent teeth.
Fluoride application is again a preventive procedure which makes the teeth cavity resistant. Fluoride being an anti-cavity mineral is present in our toothpastes to help prevent cavities. In this application, a more concentrated gel is applied onto newly erupted teeth in sessions (4-5 minutes each). It should be done once at around 6-7 years of age & another session at around 12-13 years of age (1 session could have two or more sittings) or as advised by the dentist.

Yes, pulpectomy / pulpotomy are 2 treatments, similar to a root canal, done for milk teeth which are decayed to a very large extent at a very early age. The kind of materials placed in the tooth during pulpectomy / pulpotomy are different from the materials used for root canal. They do not harm the tooth underneath. The basic steps of these 2 procedures are more or less the same as for a root canal.

A number of appliances could be advised for your child depending from case to
case.
Space Maintainers – appliances required to maintain space in areas where a milk tooth has fallen before its actual time. It will prevent crowding of teeth in that area & maintain space for the permanent tooth to erupt.
Space Re-gainers – appliances required to gain space in areas where the milk tooth had fallen before time and the adjacent teeth have occupied that space leaving no room for the permanent tooth to erupt. Early fall of a milk tooth would result in an empty space, which over a period of time gets occupied by adjacent teeth. This would result in loss of space for the permanent tooth which was supposed to come in that space. Early detection of such areas & timely use of these re-gainers can prevent major malalignment & orthodontic treatment.

Habit breakers – appliances required to break an incorrect habit that your child might have developed during his growth. As a child is growing, he is learning a lot of new things, he is learning to swallow, talk, speech changes, etc. These changes are not under his control but take place on their own to help him adapt to his growing jaws, tongue, changes in his face, neck, etc. In some cases a child is unable to adapt to the changed mouth & therefore develops incorrect habits like mouth breathing, lisping, tongue thrusting. These habits need to be controlled and corrected at the earliest so that they do not result in major malocclusions.

Nursing bottle caries and Rampant Caries are two common causes of multiple cavities in a child’s mouth.
Nursing Bottle Caries = It is usually seen in children from 3-5 years of age. This type of tooth destruction occurs in infants who sleep off while being bottle fed or breast fed at night before going to bed. The kid sleeps off without cleaning his teeth.
Problem arises due to presence of sugar in the milk which acts as a breeding ground for bacteria. Since the child does not rinse his mouth before sleeping off, the bacterial activity continues over-night and all exposed teeth get decayed. A specific decay pattern is observed in children suffering from nursing bottle caries in which all upper teeth and lower back teeth get infected whereas the lower front teeth are protected from cavities (by the tongue).
Rampant Caries = It may be seen in children of any age. Here extensive tooth destruction occurs due to high cavity formation.
Improper brushing / eating lots of sugary foods / high cavity index can result in such extensive decays.

Before your child starts to lose his teeth, you should visit your dentist and start with restorative treatments.