| What
is Pediatric Dentistry ? |
Pediatric
dentistry is an age specific specialty
that provides both primary and comprehensive
preventive and therapeutic oral
health care for infants and children
through adolescence including those
with special health care needs.
It is a combination of several areas
of applied sciences related to general
and dental health of the child.
The word Pedodontics which conceives
the idea of a child and the tooth
appears very simple but for the
intricacies of the relationship
between the Child the Pedodontist
and the Parent.
Pediatric
dentistry
Why?
Prevention of Dental diseases
and behaviour management are two
hallmarks of pediatric dentistry.
As we all know healthy habits should
be inculcated early in the childhood
to bear the fruits of good oral
and general health throughout the
life.
The mind of the child is very tender
and receptive to new ideas. They
need tender loving care in the dental
operatory. To meet such demanding
task it is essential to have a specialist
who learnt the skills of behaviour
management. Pediatric dentist not
only provide dental care to the
child but also shape a child’s
future oral health status and create
a foundation on which adult dental
health depends |
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The oral
cavity comprises of various structures
besides the teeth.
They are -
Tongue
Gums
Lips
Palate
Floor
of the mouth
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Teeth
have a very complex structure. The
outermost layer is the enamel, the
bulk of the tooth is dentin, and there
is a coating of cementum on the outer
surface beneath the gum. In the center
is the 'pulp' a more 'normal' living
tissue with nerves, blood vessels
etc. Enamel, dentin and cementum are
all composite materials composed of
a hard mineral - hydroxyapatite (HA)
and protein + water HA is Calcium
Phosphate (apatite) where some of
the phosphates are replaced by hydroxyls
to give a formula Ca10(OH)2(PO4)6.
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Enamel
It is the hard
outer white layer of teeth which
can be seen in the oral cavity.
The high mineral content makes
it the hardest component and also
most resistant to bacterial attack
since there is little organic
matter present. A flaw, crevice
or fissure in the enamel may be
the starting point for dental
caries (tooth decay).Enamel once
destroyed cannot be regenerated
as enamel has no cells to
regenerate.
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Dentin
It forms
the bulk of the tooth and has
less mineral and it is considered
vital .It has the capacity to
regenerate.It surrounds the dental
pulp.
-
Pulp
It is
the soft tissue encased in the
centre of the tooth. It contains
blood vessels, nerves, fibroblasts
and other cells. Pulp along with
the dentin is considered the vital
part of the tooth.
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Cementum
It is the
outer layer of the roots of the
tooth. It is more like bone in
structure (and is also hydroxyapatite
+ collagen), and its purpose is
to act as the anchorage of the
periodontal ligament - a bunch
of collagen fibers that hold the
tooth in place and act as shock
absorber between tooth and jawbone
(the ligament is what makes it
possible to wiggle a healthy tooth).
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Humans
have two different sets of teeth.
The first set (called temporary, milk
or deciduous teeth) are 20 in number
and are replaced during the growing
stage of life by the second set (called
permanent teeth) which are 32 in number.
There are 32 permanent teeth and 20
deciduous teeth (milk teeth) arranged
in pairs in the upper and lower jaws.
There are 4
different types of teeth based upon
their anatomical shape and position
in the mouth
Incisors
- these are located at the front
of the mouth
Canine
teeth - these are found behind the
incisor
teeth at the corners of the
mouth.
Premolars
- lie behind the canines and in
front of
the molars
Molars
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Functions
Incisors - are
mainly concerned with biting and
cutting(shearing)
Canines - are
mainly concerned with cutting
Premolars and
molars are used for chewing and
grinding food (mastication)
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- Primary Dentition/Milk teeth/Deciduous
teeth
- Mixed Dentition
- Permanent Dentition
Primary teeth are the first
teeth of a child and they are
sometimes called Milk, Deciduous
Baby teeth.
The primary teeth are twenty in
number:
ten in each jaw.
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When
a child is born the first teeth are
already formed in the jaw although
they can't be seen.
Then between at about six months of
age when a baby gets his first tooth
- and at three years of age, all twenty
teeth erupt in the oral cavity. The
characteristics feature of the primary
dentition is the presence of spaces
between the teeth.
Significance
of Primary Teeth
The deciduous
teeth are important for following
reasons
Mastication
Speech
Esthetics
Space
maintenance
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At
about six years the first permanent
molars erupt in the oral cavity. These
molars are also called as ‘six
year molar’. From six years
of age to 12 years of age the dentition
consist of both the primary and permanent
teeth hence it is called as mixed
dentition. By 12 years of age all
the permanent teeth except the second
and the third molars have erupted
in the oral cavity.
The first permanent molars are the
most important teeth for the proper
development of an adult dentition.
During the mixed dentition at about
the age of 9-11 years period the upper
anterior appear misaligned. This is
called the ugly duckling stage and
is self correcting condition.It gets
corrected with the eruption of the
permanent canines. |
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At about twelve
years of age all the primary teeth
are exfoliated and the permanent teeth
continue to erupt. The dentition now
consists only of the permanent teeth
hence called the permanent dentition.
The second permanent molars erupt
at about 12 -14 years of age and the
third permanent molars erupt at 17-21
years of age that is why they are
also called as wisdom teeth. |
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(lower
front teeth)
Eruption
timing of teeth |
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The
first to erupt are the two lower central
incisors.
Central incisors
6-12 months
Lateral incisors
9-16 months
Canines 16-23
months
First molars
13-19 months
Second molars
22-33 months
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Importance
of the First Permanent Molar
Lower
teeth
Upper Teeth
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The
first permanent molar is a
very important tooth, from
both the functional and developmental
point of view. It usually
erupts between the ages of
5 1/2 to 6 1/2 years and is
called the 6 year molar.
It is the first non-succedaneous
tooth to erupt in the oral
cavity. It has a large occlusal
surface hence it bears the
maximum load of masticatory/chewing
forces.
This tooth being most posterior
is often neglected by parents
and children alike. Due to
the presence of deep, often
incompletely coalesced fissures,
food lodgement is frequent
and development of tooth decay
is rapid.
Destruction of this tooth,
if severe, leads to subsequent
extraction. This creates problems
in space management, tooth
movement, mastication and
occlusion. Hence, dental surgeons
and pedodontists strive to
maintain this tooth in the
arch for proper guidance of
the developing occlusion. |
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Tooth
development is the complex process
by which teeth form from embryonic
cells, grow, and erupt into the mouth.
Deciduous teeth begin to develop even
before birth between the sixth and
eighth weeks in utero, and permanent
teeth begin to develop in the twentieth
week in utero.
Overview
The tooth
bud (sometimes called the tooth germ)
is an aggregation of cells that eventually
forms a tooth. The tooth bud is organized
into three parts: the enamel organ,
the dental papilla and the dental
follicle.The enamel organ produces
enamel. The dental papilla contains
cells that develop into odontoblasts,
which are dentin-forming cells.Cells
within the dental papilla are responsible
for formation of tooth pulp.
The
dental follicle gives rise to three
important cell types.
Cementoblasts, osteoblasts, and fibroblasts.
Cementoblasts form the cementum of
a tooth. Osteoblasts give rise to
the alveolar bone around the roots
of teeth. Fibroblasts develop the
periodontal ligaments which connect
teeth to the alveolar bone through
cementum.
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You
may have heard that you lose a tooth
for every pregnancy, or that your
developing baby will take the calcium
he or she needs from your teeth. Both
of these are myths; however, they
point to the need for good dental
care and good nutrition during pregnancy.
Tooth loss that sometimes occurs during
pregnancy is most often the result
of either tooth decay or gum disease.
Women are more prone to both of these
conditions during pregnancy for a
variety of reasons.
Both gum disease and tooth decay are
caused by plaque formation. Plaque
is the sticky, colorless film that
forms on our teeth every day. The
acids and toxins produced by the bacteria
in plaque are the cause of both tooth
decay, and gum tissue inflammation
and disease. Brushing and flossing
daily are the most effective ways
to remove plaque from teeth and keep
tooth surfaces and gum tissues healthy.
Hormonal changes during pregnancy
make the gum tissues more susceptible
to inflammation and bleeding. This
condition is called “pregnancy
gingivitis.” While the gum tenderness
and easy bleeding associated with
gingivitis happens more easily during
pregnancy, it is still plaque accumulation
on the teeth, not the hormone changes,
that is the major cause of this condition.
More frequent eating patterns common
among pregnant women, lack of thorough
oral hygiene practices contribute
to increased plaque formation, increased
levels of gingivitis and tooth decay
sometimes experienced during pregnancy.
There are other good
reasons, beside your own dental health,
to take extra care during your pregnancy.
Some research suggests that serious
gum disease (periodontal disease)
is linked to premature birth and low
birth weight.
Additionally, it is now recognized
that mothers are the most common source
of transmission of decay causing bacteria
to their infants. Babies are not born
with the bacteria that cause decay.
Instead they are “infected”
sometime in their early life. We now
know that mothers that have healthy
mouths, free of active dental decay,
are much more likely to have babies
that are healthy and free from early
decay, and vice versa. A decision
to keep your mouth healthy and treat
decay that arises during your pregnancy
is also a decision to help protect
your baby’s oral health. |
Good
Nutrition is Important
The
foods you eat during your pregnancy
affect every aspect of the health
of your baby-to-be, including his
or her teeth, not to mention your
own health.
Your baby's teeth begin to develop
below their gums between the third
and sixth months of pregnancy, so
getting the right nutrients is especially
important then. A sufficient amount
of protein, calcium, phosphorus and
vitamins A, C and D will all help
ensure healthy teeth for your baby.
Fluoride is also an important mineral
for healthy tooth development. Once
your baby is born, your dentist and
pediatrician will advise you on the
optimal amount of fluoride supplementation
to protect both you and your baby’s
teeth.
Regular dental cleanings and checkups
can be done safely at any time during
your pregnancy. Be sure to tell your
dentist or dental hygienist that you
are pregnant. Any pain, swelling or
infection in your mouth should be
treated immediately because this can
affect your health and your baby's
health. |
Silver
Amalgam restoration (Silver Fillings)
The
filling material, amalgam, should
not present any harm, if proper technique
is observed by the dentist and his
or her assistant. This should occur
whether the patient is pregnant or
not! If you have a cavity and your
dentist thinks it should be a fairly
simple, short procedure, it should
be fine to complete the procedure.
Postponing dental work due to pregnancy
can sometimes cause worse problems
than having the work completed. If
you do decide to postpone work until
after the birth of your baby, have
it done soon afterwards so the cavity
does not become larger and deeper. |
Radiographs
(X-Rays)
A full mouth series of dental radiographs
(x-rays) is generally taken about
every 5-7 years. A full mouth series
involves taking between 18-21 films.
Dentists need to have the information
this full mouth series offers to determine
if any conditions, such as cysts,
tumors, or abscesses, exist in the
bone surrounding the teeth. Full mouth
radiographs also help determine the
health of the teeth and the nerve
tissue within the teeth. If nothing
else, the complete set of radiographs
will serve as comparison for the future
if any problems should arise.
The amount of radiation received from
a set of 21 dental radiographs is
approximately 3 millirems. Three millirems
are equivalent to about 4 days of
exposure to radiation received naturally
from the environment (i.e. sun). The
probability of congenital anomalies
and childhood malignancies from this
amount of radiation is practically
nonexistent. The double lead shield
with a thyroid protector will reduce
exposure even more.
Minimal radiographs may need to be
taken during pregnancy to treat dental
emergencies. Having an complete dental
examination before pregnancy , will
reduce risk of a dental emergency
occurring during pregnancy.
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Parential
Dental Care
It
is of utmost importance to strengthen
the developing primary dentition during
first trimester of intrauterine life.
The child gets its calcium, phosphorous
and other minerals during odontogenesis
from the mother’s blood stream.
Hence, a nutritious balanced diet
with adequate supplements of minerals
and vitamins for expectant mothers
must be recommended. Prenatal fluoride
supplement to mothers in the dosage
of 0.25-1 mg daily has been shown
to render some protection to primary
teeth from caries.
For sound primary teeth, during the
first trimester, the mother’s
health is of paramount importance.
Medications like tetracyclines for
infection control should be avoided
to prevent discolouration of teeth. |
Gum
pads
The alveolar
arches at the time of birth are termed
as gum pads and are firm and pink.
The upper gum pad is horse shoe shaped
lower gum pads/arch is ‘U’
Shaped or rectangular in form. At
rest the gum pads are separated by
the tongue, which protrudes over the
lower gum pad to lie immediately behind
the lower lip. At this age the upper
lip appears very short. The upper
gum pad is wider than lower and when
the two are approximated there is
a complete over jet all around of
the upper over the lower gum pad,
with a considerable overjet anteriorly. |
Why
Infant Oral Care is Needed ?
Prevention of oral and
dental diseases must begin in early
infancy and even during prenatal period
to ensure a successful outcome.
The
primary dentition is more prone to decay
than the permanent dentition in children.
This could be due to
Lesser
thickness of enamel in primary teeth.
More
cariogenic challenges. (Consumption
of chocolates, beverages etc.)
Non-availability
of fluoride (through tooth pastes)
unless in systemic form.
Early
establishment of oral hygiene procedures,
with the development of non-cariogenic
dietary habits should begin during
infancy.
Infant
Oral Health Care Includes Counselling
with Regard to:
1.Mother’s
diet
The lactating
mother must take a well balanced diet
rich in supplements of minerals and
vitamins.
2.Oral
hygiene of the infant
The parents
should be counseled regarding cleaning
of the infant’s gum pads daily
before eruption of the first primary
tooth. A moistened gauge square or
washed cloth is wrapped around the
index finger of the hand and gum pads
are massaged gently .The cleaning
of gum pads is as important as cleaning
of teeth later in life.
3.Timing
of the first dental visit
American Academy
of Pediatric Dentistry (AAPD) recommends
that infants be scheduled for an initial
oral evaluation visit within six months
of the eruption of the first primary
tooth but by no later than 12 months
of age.
Early dental intervention provides
an opportunity to supplement oral
health education for parents in areas
such as proper oral hygiene, prevention
of dental injuries and prevention
of Early childhood caries.
4.
Diet management
To cause decay oral bacteria
require the presence of a particular
environment. Prolonged bottle or breast
feeding provides the substrates that
provides an oral environment favorables
to bacterial proliferation and formation
of acidogenic plaque.
It is recommended that nocturnal feeding
be discontinued after the eruption
of the first tooth and after each
feeding, the gum-pads and teeth be
cleaned with wet gauze or piece of
cloth.
When bottle-feeding is substituted
for the breast, the nipple should
simulate the natural nipple and breast,
by way of having a wider base. Secondly,
the hole in it should not be too large
to give free flow of milk but just
wide enough so that the child has
to exert force to draw milk. The milk
bottle should be supported with the
hand so that it does not cause pressure
on the upper jaw. The bottle-feeding
should be carried out by the mother,
with the child seated reclining and
not lying down. The bottle should
be withdrawn immediately after finishing
and the gum-pads and teeth are cleaned.
The
diet management also includes educating
parents regarding the following facts.
Infants and children generally need
to eat more frequently than three
times a day.
Between-meal snacks should consist
of foods that have least potential
for promoting acid production.
Sugary snacks and
retentive foods should therefore be
avoided.
Potentially harmful foods like cookies,
candies, cakes are better offered
at meal times, than between
meals.
The total amount of sugar consumed
is not the key; the frequency of sugar
intake and the retentiveness
of the food are the important factors.
Tooth
cleaning
The following
facts about tooth cleaning should be
explained to the parents.
Parent, adult or older sibling must
assume total responsibility for cleaning
teeth in infants and young children.
Most of the children are unable to
clean their teeth effectively until
5-8 years of age. Oral ; hygiene
neglect can lead to deteriorated oral
health.
Teeth cleaning must be done in a
comfortable location and pleasant
environment.
Toothpaste is not necessary for
infants, in fact, may be a source
of objection, because
of taste and foaming
action.
Teeth cleaning should be done at
least once daily; wiping the teeth
of the infant following feeding
is however recommended.
The evening teeth cleaning may be
easier to accomplish after the infant’s
last feeding than just before bedtime,
since a tired infant can frequently
be cranky and may create fuss during
the procedure.
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Oral
health care of the baby should commence
soon after birth. Just because the
baby doesn't have teeth it doesn’t
mean that Oral health should be neglected.
Some conditions that may cause parental
concern are.
Epstein's
pearls
These are small, white, pearl-like
spots that seen along the midline
of the palate.They often disappear
within a few weeks.
Bohn's
nodules
These are small,
whitish nodules or cysts similar to
Epstein’s pearls, seen along
the buccal and lingual aspect of the
alveolar ridge and at the junction
of the hard and soft palate. They
also disappear within a few weeks.
Eruption
Cyst of newborn
These small
nodules which appear along the crest
of the alveolar ridge.
Natal
and Neonatal teeth
Some infants are born with
one or more teeth (natal) or have
teeth which erupt into the mouth within
the first 30 days of life (neonatal).
Most often, these are the baby's primary
(baby) teeth, not extra teeth. These
often are very loose. If possible,
these teeth are maintained. However,
natal or neonatal teeth may have to
be removed if they are loose enough
that the child could aspirate them.
These teeth also may be removed if
they interfere with feeding or irritate
the child's tongue.
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Oral Health
for Infants
Birth
to 6 months of age
Clean the infant's
mouth with clean wet gauze after
feedings and at bedtime.
Regulate feeding
habits (bottle feeding and breastfeeding).
Six
to 12 months of age
During
this time, the first tooth erupts.
Consult the Pedodontist.
Brush
teeth after each feeding and at
bedtime with a small, soft-bristled
brush.
As
the child begins to walk, stay alert
of potential dental and/or facial
injuries.
Wean
the child from breast or bottle
by his/her first birthday.
Twelve to 24 months of age
Follow
the schedule of dental examinations
and cleanings, as recommended by
your child's pediatric dentist.
Generally, dental examinations and
cleanings are recommended every
6 months for children and
adults.
As
the child learns to rinse his/her
mouth, and as most deciduous (baby)
teeth have erupted by this age
;brushing
with a pea-sized portion of fluoridated
toothpaste is appropriate.
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Early Childhood
Caries
Early
childhood caries is a specific term
used to describe dental decay in infants
and toddlers.
Early childhood
caries is also known as
Nursing
bottle caries
Baby
bottle tooth decay
Nursing
bottle syndrome
Milk
bottle syndrome
Some of there
later descriptions may be misleading
as regarding the specific etiology
of the conditions. For example breast
milk may be as likely to supply the
carbohydrate required for acidogenic
bacteria, as the bottle formula does.
So the bottle itself is probably not
to be blamed. Today, the new name
for early childhood caries is ‘Maternally
Derived Streptococcus Mutans Disease
(MDSMD)’.
Children who are
breast fed on demand-specially at
time other than normal feedings and
throughout the evening often develop
early multiple carious lesions.
During sleep, salivary flow is diminished.
Moreover, the
swallowing reflex is absent. Hence,
milk cannot be eliminated from the
oral cavity and it pools around
the tooth surfaces. Opportunistic
cariogenic microorganisms exploit
this conducive environment and
this result in tooth decay.
This process sometimes occurs so
fast that the parents often complain
that the child had decayed teeth
at the time of eruption itself.
The PSattern of
Decay in Early Childhood Caries
A special characteristic of this process
is that it typically
involves maxillary primary incisors
and upper and lower molars, the mandibular
incisors are usually spared. This
is probably because they are protected
by the mechanical cleansing action
of the tongue.
This is one of the most severe form
of tooth decay, which involves the
surfaces of teeth, usually considered
immune to tooth decay.
What are the factors
which Increase the Chances of Early
Childhood Caries ?
Feeding
beyond the weaning age i.e. beyond
12 to 15 months.
Feeding at night
always poses a serious threat especially
if the teeth are not cleaned after
feeding
Single parent households.
Child neglect could also be one of
the major reasons for nursing caries
to occur as the
parent is too busy coping with financial
stress and responsibilities.
High socio-economic
status. It has been seen that some
mothers avoid breast feeding.
The children are left
to the mercy of the domestic help
who think it their duty to continuously
force a bottle
into the child ’s mouth.
Low socio-economic
status. Both the parents if working
leave the child | | | | | | |
