DENTISTRY FOR CHILDREN
Last Updated : 1/21/2010
Firdaus P Bativala*, Annie Thomas**
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Dentistry for children is perhaps the most needed, and yet very often the most neglected of all services performed by the dentist. The value of this service cannot be exaggerated, for inadequate or unsatisfactory dental treatment during childhood may damage permanently, the entire masticatory apparatus, leaving the individual with many of the dental problems so common in todays adult population. Therefore, in Dentistry for Children, one is dealing mainly with 'prevention'.




GINGIVITIS
It is the inflammation of the gums around the teeth due to improper cleaning of teeth. Although systemic factors and general health can modify the tissue reaction to local irritants, gingivitis in all age groups is caused primarily by local irritants. It is nearly always reversible. The usual signs of gingivitis are gums which are swollen and bleed on brushing.

Mild Gingivitis



Moderate Gingivitis



Severe Gingivitis



Children by and large are not entirely efficient in cleaning their teeth. Oral hygiene has to be stimulated, supervised, and the end result examined for it to be efficient. Particularly sticky foods (such as chocolates and crispy foods) in the less accessible areas are difficult to remove. Rough and vigorous scrubbing may hurt the child and discourage him from brushing well. (If disclosing rinses/ tablets which stain the debris are used, the child may be motivated to brush till the unsightly stain is removed.) There is no question that the regime of oral hygiene improves gingival health. But in the children, it is advisable for brushing to be supervised by the parent, if it has to be effective.

DENTAL CARIES
Dental Caries is the most common of all oral diseases, and since the average individual has his first experience with this disease in childhood , it is particularly important to deal with it from the 1st to his 12th year of life. For in these years, the milk teeth erupt, function, exfoliate and the permanent teeth excluding the 3rd molars erupt into functional pattern.

For early treatment of dental caries, it is of utmost importance at what age the child gets his first dental checkup. It is recommended that between 1 1/2-2 years of age, children must have their first check-up before any extensive cavities are established.





In children, dentistry is mainly aimed towards prevention of dental cavities. Here, Fissure Sealants are of very great importance. Sealants are flowable composite resins applied onto surfaces of susceptible teeth. They smoothen out the fissures & pits & prevent food entrapment that causes decay.

Fluoride tablets may also be prescribed in the children over 3 years of age, if drinking water consumed is not fluoridated. The fluoride absorbed gets incorporated into the tooth enamel and makes them less susceptible to caries.

Dental Caries very often appears as a white chalky area on the enamel. It later softens and then the tooth structure breaks down. If not treated in the initial stages, it progresses towards the pulp and will then require extensive treatment to save the tooth.

ERUPTION DATES
The primary teeth consist of 20 teeth {4 incisors, 2 canines and 4 molars in each arch}. The eruption sequence in the primary dentition usually follows a definite pattern. Central incisors erupt first, followed by lateral incisors, first molars, canines and 2nd molars.




The upper (maxillary) central incisors erupt at 6 months of age, then the lower (mandibular) lateral incisors at 7-8 months, then the upper lateral incisors at 8-9 months. At about 1 year, the first primary molars appear, followed by primary canines at 16 months. 2nd primary molars erupt at 2 years.

There may be a little variation in the time of eruption of these teeth ; it usually doesn't signify any abnormality in the eruption.

At around 6 years of age, the child's lower first permanent molars erupt. Along with it, the permanent central incisors may also come in.




Variations from these factors coupled with discrepancies in tooth and jaw size and also heredity may be factors in producing certain types of malocclusion.

MALOCCLUSION
Is when teeth do not erupt in the normal position causing unsightly appearance, crowding of teeth & food entrapment (preventing proper cleaning). It is usually caused by discrepancies in the jaws & tooth size, heredity, variations from the usual eruption sequence & finally habits like thumb sucking & mouth-breathing.

Malocclusion may be broadly classified into 2 categories:
- Dental (because of teeth erupting unfavourably)
- Skeletal (because of deformity of the bone - this may need to be corrected surgically.)

Dental malocclusions may be corrected by orthodontic brackets and wires, depending upon the categories they fall under. Not all the cases are treated by extraction of teeth to realign the rest. Removable plates may be worn by the patient for the specified time to correct the tooth position.

Orthodontia (the branch of dentistry that deals with correcting malalignment of teeth) requires constant monitoring by the dentist and the patient is required to be co-operative and motivated. Here, parents play a very important role. Their encouragement & interest can motivate the child into completing the treatment.

For malocclusion to be corrected & treated at the right time, the child's regular visit to the dentist is mandatory.

ORAL HYGIENE PROCEDURES
Brushing is necessary to remove the sticky plaque & debris that collect around the tooth surfaces. Brushing twice a day is usually recommended. Children in particular must be taught to brush & constantly supervised, for their techniques are often ineffective.

Circular strokes on the outer surfaces of the upper & lower teeth, back & forth strokes for the inner surfaces & the chewing surfaces of teeth is usual technique.

Normal brushing only cleans 3 out of 5 surfaces of your teeth. The remaining 2 surfaces (between your teeth), therefore need special attention to avoid build up of plaque food particles. In adult teeth, flossing is the additional cleaning aid used. Because tooth decay and gum disease often start in these areas, you need to use dental floss everyday.

Figure: Brushing



Figure: Flossing



In patients, where the spaces in between teeth becomes wider (either due to gum disease or age) interdental brushes or proxa brushes may be used. Here, a floss may not be as effective as this brush.

In conclusion, it is recommended that 2 visits may be made to the dentist in a year for routine checkups & cleaning. This should ensure good health of your teeth & gums for many years. Do your teeth justice, help them to serve you better.



Contributor Information and Disclosures

Firdaus P Bativala*, Annie Thomas**
*Consulting Prosthodontist and Implantologist, Bombay Hospital, Mumbai; ** Consultant Dentist, Mumbai, India


First Created : 1/17/2001

References

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