Pediatric Dentistry (Kids Care)

It is good to consult the dentist by six months of age, when the first milk teeth generally emerge. Regular visits will help give adequate preventive care to the child that will prevent dental decay. If there are any cavities, it is good to undertake treatment early on. These regular visits are advised even if you think the baby’s teeth are healthy. Regular visits also help the child get used to the idea of visiting the dentist before he/she needs any treatment to be administered.

It is normal to find the milk teeth in children to be spaced. These spaces between the teeth help later in accommodating the bigger permanent teeth. Thus, absence of spaces between the milk teeth in children may be a forewarning that the child may not have adequate space to accommodate the bigger permanent teeth which may erupt in a crowded arrangement.

Teething is often blamed for systemic conditions like diarrhea, vomiting and fever. The possible explanation is that during teething the child tends to chew objects for relief, which at times may not be clean/sources of microbes. The discomfort associated with teething can be relieved to a certain extent by using teething gels (anti-inflammatory analgesics), which can be massaged over the gums. Teethers of different types are available, on which the child can chew on for relief.

Infant’s teeth can be cleaned with a soft cloth wrapped around the index finger. Wet the cloth and rub gently over the teeth to clean them. Small soft brushes that can be inserted over your fingers are available that can be used to clean the teeth.

You can introduce a baby-sized toothbrush at around 12 months of age, encouraging the child to use the brush himself/herself. Though the child may play with it rather than brush his teeth, it will ensure good lifelong habits in your child. This should be followed by the parent properly brushing the child’s teeth for him.

Initially for a toddler, a wetted toothbrush is enough to brush the teeth. Once the child has learnt to rinse his/her mouth and spit, you can start using a pea-sized helping of fluoride toothpaste. Most dentists advise using fluoride toothpastes around three years of age. If you think your child may swallow the toothpaste, you can use a non-fluoridated one until he/she learns to spit it out.

A.K.A. ‘rampant caries’, it is a form of dental caries which may involve several teeth in the mouth, including ones generally considered resistant to dental decay. It is usually associated with prolonged bottle feeding of sugar containing drinks such as milk and juices. It may occur due to bottle-feeding at bedtime or during sleep and lack of cleansing of the teeth thereafter. It can also occur due to prolonged on-demand breast feeding at night due to lactose sugar present in the milk. This form of dental decay affects many teeth and may be marked by discoloration of the teeth. In later stages, teeth may even fracture. The child often experiences pain on brushing and eating cold or hot food substances.

In some children the grinding surface of the teeth tends to have very deep pits and grooves which tend to accumulate food, plaque and microbes. For such teeth, the dentist may use appropriate pit-and-fissure sealants to reduce their depth.

Sometimes a milk tooth may have to be extracted (due to dental decay or some other cause) much before the permanent tooth is ready to replace it. In such cases the early extraction of the milk tooth may cause the neighboring teeth to move into the space and thus prevent the underlying permanent tooth from erupting into its correct position. To avoid this the dentist may use a ‘space maintainer’ till the permanent teeth that replaces the milk teeth are ready to erupt.

It is considered quite normal for children to suck their finger up to around 3 years of age. Continued finger sucking may cause serious defects in the developing oral and facial structures though.

Many children develop this habit of sucking the thumb/other fingers. Several possible causes exist:

1. Lack of adequate nursing or feeding.

2. Feeling of insecurity.

3. Sudden change in domestic or work atmosphere which the child cannot cope with.

4. Stress related to school, friends, etc.

Finger sucking may not cause irreversible harm in children less than 3 years of age. However, much depends on the duration, intensity and frequency of the habit. Continuation of the habit beyond 3 years may pose problems for the developing facial and dental structures. The teeth can come forwards and open bite can occur.

Many children stop sucking the thumb when the causative factor is identified and eliminated. Timely nursing, feeding, and increasing the time spent with the child may decrease insecurity. Slightly older children can be reasoned out of the habit by explaining the bad effects of the habit. The dentist may sometimes advice the use of finger bandaging/bitter medicine to make the habit less pleasurable. When these simple steps fail the dentist may advice a ‘habit breaker’, which is placed behind the front teeth, and prevent the child from sucking the thumb.

Thumb sucking can cause problems if allowed to persist beyond 3 years of age. Some of the effects include the front teeth being pushed too far forward, wide spacing of the teeth, and poor facial appearance therefrom. Continued indulgence may cause defects in the developing jaw & facial bones.

Habits like biting nails, pencils, etc., besides causing wear of the teeth can cause injury to the gums and supporting structures around the teeth. In addition, the pressures they exert on the teeth may force them into abnormal positions which may necessitate orthodontic treatment.

Tongue thrusting is a habit wherein the person forces the tongue against the back surface of the front teeth while swallowing. This can produce proclination of the front teeth and spaces between them. The dentist may have to train the patient on the correct swallowing method by some exercises and use of habit breaking devices.

The causes of tooth decay in children are the same as in adults, but the progress is faster. An important factor in children responsible for causing tooth decay is the child being bottle-fed and put to bed without brushing. This way, even 2-year-old children can develop cavities.

Teeth do not erupt with cavities. Cavities form only because of diet and improper oral hygiene.