Teeth treatment in children (pedodontia)

Why do children’s teeth decay?

Milk teeth contain much more organic matter in comparison to regular teeth, and rather prone to decay; they decay more easily and rapidly.

Besides, children cannot interpret early decay signals such as hot/cold sensitivity or mild ache. They only notice unbearable levels of pain, which is too late almost every time.

Children cannot attach importance to mouth care as much as adults do. Tooth brushing habits would be determined by their hand skills, curiosity, and parents’ attitude.

A common mistake among mothers is to dip pacifier or baby bottle mouth piece in sugar, jam, etc. sweet food before giving it to children, or making a habit of sweet midnight snacks (sugar milk, fruit juice, etc.) in sleep breaks. This nutritional irregularity makes teeth prone to decay.

Can cavity formation be prevented?

No drug or vaccine to prevent tooth decay completely has been discovered yet. However, these days certain materials are used to decrease number of cavities, one of which is a material called “fissure sealant”. Tooth decay generally starts in grooves called “fissures” on chewing surfaces of premolars and molars. This material covers over these grooves to stop microbes, food pieces, etc. to creep here and trigger the series of events leading to a cavity. This procedure can be applied to permanent premolars and molars, which start coming out after age 6.

Another way to prevent tooth decay is to increase teeth resistance against decay, which is provided by introducing fluoride to teeth surface.

What is the importance of milk teeth?

Primary purpose of milk teeth is to help the child acquire proper nutrition. Milk teeth also have a significant role in developing proper speech. In addition to this, a scene like the one pictured isn’t a problem anybody wants their children to suffer from.

Milk teeth preserve the area they occupy for the permanent teeth, and guide them as they erupt. If milk teeth were extracted early, this natural placeholder function would be lost.

Should we get milk teeth decay treated?

Untreated milk teeth decay may cause pain, bad breath, chewing difficulties, malnutrition, and an unpleasant appearance. If teeth defects are not treated in this period, it may cause future crooked teeth, problems in jaw development, and even general health disorders (from rheumatism to heart conditions).

Therefore, you should not neglect milk teeth decay with a misconception like, “they will be replaced soon”.

Milk teeth decay may be the first pain your child experiences at an early age and even suffer from trauma. These cavities may trigger early loss of milk teeth. 

Tooth injuries in children

Children teeth injured in accidents must be treated immediately. Making an accurate diagnosis is essential. Your dentist will ask you when and where the accident happened, which direction the impact came from, and whether the child fainted, threw up, memory loss, etc. Please provide accurate information for correct treatment.

Tooth injuries in children may sometimes cause permanent teeth to be removed from original location. In such cases, you must immediately see your dentist with removed tooth. Until you see your dentist, removed tooth must be kept in a glass of milk, if that is not possible, a glass of clean water.

Baby Mouth Care

Breastfeeding babies for at least 4 months will help soft tissue and muscle functions around mouth area to develop properly. When breast milk is at insufficient level, a baby bottle with physiological cap (palate, Y-cut) should be used.

Babies should be encouraged to use glass and spoon from age 1.

Baby bottle use can continue until age 2. Thumb sucking or teat use may be permitted until 2 – 2.5 years. If child persistently keeps thumb sucking, reasons of this should be determined and this habit should be broken between ages 3 to 6, as it may affect respiratory problems and/or jaw development. If child breaths through their mouth and not their nose (this can be observed better during sleep), you must definitely consult a rhinolaryngologist.

When should we start brushing children’s teeth?

When the baby is 6 -8 months old (i.e. first teeth erupt in baby’s mouth), cleaning must be started. It would be appropriate to wipe baby’s teeth (at least chewing surfaces) with a clean muslin or gauze patch twice a day, after breakfast and before going to bed at night.

Toothbrush use should start when child’s back teeth erupt (around 2.5 – 3 years).

It is difficult to adopt tooth-brushing techniques for preschool kids. What matters at this age is to help the kid develop a brushing habit. When brushing their teeth, children tend to brush visible or easily reachable surfaces. However, in order to prevent cavities one must brush interdental spaces and chewing surfaces properly. Hence, we recommend parental control after brushing.

How to Choose a Toothbrush for Children?

Toothbrushes made of soft and nylon bristles suitable for the child's mouth size should be used. Hard bristle brushes are not suitable for use as they will abrade the teeth. Just as you cannot sweep with an old broom, you cannot brush your teeth with an old brush. Brush should be changed as soon as bristles are worn out (approximately 6 months).

How many times should I make my child brush his/her teeth?

Two three-minute sessions, after breakfast in the morning and before bed at night, should be sufficient. Like any other good habit, tooth-brushing habit should also be adopted in childhood.

Some common mouth and teeth health problems in children include:

1. Teeth grinding

Reasons

Stressed, aggressive, obsessive, or depressive personality, as well as teeth-grinding parents make children prone to teeth grinding.

Symptoms

Abrasion in teeth, grinding noises during sleep, facial muscle pain, jaw joint problems, headache, loose teeth, and sensitivity.

Treatment

Initially, the psychological factors triggering teeth-grinding need to be removed.

IF this attempt fails, a removable night plate can be prepared for the patient.

1. Thumb sucking

Reasons: Thumb sucking is a commonly encountered problem at early ages. Normally it just disappears before age of four. Keeping this habit in ages when permanent teeth erupt may cause structural problems with permanent teeth or gums. These problems are caused by the pressure of fingers on gums and front teeth. Level of disorder depends on period, frequency, severity, and angle of finger while sucking.

Treatment

The most efficient method to prevent thumb sucking is to make the child adopt a pacifier habit to replace thumb sucking. Pacifiers are much less harmful, and much easier to quit.

• Treatment timing is very important. If the child isn’t willing and cooperative, treatment is doomed to fail.
• It would be psychologically very beneficial for child to drop this habit before school age to avoid bullying and mockery.
• Child must be rewarded and encouraged with positive approach, not oppressed.

If the habit isn’t broken despite all efforts by age 6, you may need to visit a dentist to seek for professional help.

1. Pacifiers

These are the most natural item for babies to relax and feel safe. If baby tends to suck on their fingers, they should be encouraged to use a pacifier. Pacifiers are much less harmful, and much easier to quit.

• Do not give them a pacifier all day long, only when necessary.
• In order to avoid structural problems, try to choose natural nipple form teats.
• Check on integrity of pacifier every day.

Nipple (teat) size must be consistent with mouth shape.

Baby Bottle Cavities

My baby’s teeth decayed right after eruption, why?

Sometimes, parents observe brown spots or falling of baby teeth right after eruption. These brown spots are in fact tooth decay, and teeth are broken before falling off due to these decays. The primary reason of such early decay is baby bottle decay. Breastmilk or cow’s milk are essential in baby development, and both naturally contain sugar. When baby is suckled or given a bottle before or during night’s sleep, milk can accumulate in mouth to provide a very suitable environment for microbes to gather and decay teeth. Therefore, teeth cleaning after night feeding session is really important.

What should I do to avoid baby bottle decay?

As treating cavities in babies is extremely difficult, preventive measures become even more important, and must be taken rather early. What are these?

• Prevent your baby from developing a habit of sleeping with bottle in their mouth.
• Try to put them to sleep after feeding.
• Do not add sugar, honey, molasses or any other sweetener to the milk in the bottle.
• Make sure to give your baby some water after feeding.

After first teeth erupts, start wiping their teeth with a clean wet muslin after morning and night-time feeding sessions.

Are baby bottle cavities important?

If teeth decayed due to baby bottles are not treated, they will cause pain and get infected. Infected or aching teeth makes the baby uncomfortable and disrupts nutrition. The infection may also affect the upcoming permanent teeth and misshape them. If these teeth are extracted, the child may develop speech disorders.

My baby’s teeth have cavities without using baby bottle, why?

Another reason of baby bottle decay is giving your baby pacifiers dipped in honey, molasses, or jam. Carbohydrate-sugar snacks given to amuse the baby after their teeth erupted may also cause tooth decay. Instead of these, you may give your child high nutritional food that help clean the teeth, such as apples and carrots.

Which toothpaste to use for children, and how much?

Toothpaste use is not recommended during babyhood, until the age of three. Toothpaste use should start after age of three. But you should not use 3-5 cm of toothpaste as shown in commercials, a chickpea sized toothpaste should be enough.

Any fluoride toothpaste can be selected when your child starts using toothpaste. What matters here is that your child likes the taste of toothpaste and willingly brushes.

Keep in mind that brushing method is much more effective than type of toothpaste.

Emergency in children teeth

Toothache

Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. Do not place aspirin or other drugs on the aching tooth. If necessary, give your child an approved painkiller and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek

Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a clean cloth. If bleeding does not stop after 15 minutes take the child to a dentist.

Teeth Knocked Out Permanently

Find the tooth. Avoid touching the root of the tooth. Ideal environment to preserve the tooth is milk, put it in milk in a clean cup and see a dentist immediately.

Trauma in Milk or Permanent Teeth

Contact your dentist immediately. Each hour after trauma increases the damage.

Until you reach your dentist

Clean the wound with warm water, and apply cold compress. Save broken pieces if any.

Which tooth erupts when?

First tooth will erupt around 6 months. And wisdom teeth will erupt around ages 18-20. So teething takes roughly 20 years of our life. But which teeth erupt when? A summarizing table is provided and given below. However, please note that ages given in the table are estimates: teeth can come out untimely, as early/late as 1 year or even more.

• There are a total of 20 milk teeth.
• It is normal for milk teeth to have gaps between the teeth; this is to reserve room for upcoming permanent teeth.
• Milk teeth can have cavities. These cavities must be treated.
• If milk teeth are infected, first root canal treatment must be tried, and if this doesn’t work, the infected tooth must be extracted.

If milk teeth are extracted before their time, there may not be enough room for upcoming permanent teeth and lack of space can be observed.