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Magazine
Paediatric dentistry: The need for early care
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To the general public, the concept of a child dental specialist is new and surprising. For years, most parents have taken their children to their own dentist, or chosen not to worry about a problem until an emergency arises. Dr. SAVITHRI SIVAKUMAR and Dr. T.P. SIVAKUMAR on why this branch of dentistry is important.
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N. SRIDHARAN
... the keywords ... prevention, interception and treatment.
PAEDIATRIC dentistry is a specialised branch devoted to the comprehensive dental health care of the child, as the oral health is vital to its general well-being. The primary axioms of the field are prevention; interception and treatment of existing dental disease.
To the general public, the concept of a child dental specialist is new and surprising. For years, most parents have taken their children to their own dentist, or chosen not to worry about a problem until an emergency. There is a belief is that since teeth in children fall out and new teeth erupt, there is no need to try to treat dental disease. What makes this concept even easier to embrace is the thought of some of the discomfort associated with treatment.
Dental diseases like caries or cavities compromise the proper functioning of the dentition by causing chronic dental sensitivity and pain. This results in reduced intake of food, avoidance of certain foods (that increase the pain or sensitivity) and continuous general discomfort. This nutritional compromise can affect the growth and development of the child. Lack of concentration in school due to chronic pain is a well-documented disadvantage of poor dentition. Not much attention is paid to early development of self-esteem in childhood. As a child grows, so does his/her sense of self-esteem. In addition to other environmental factors, appearance also plays a major role in giving them that extra boost of confidence, even if at a very sub-conscious level.
How are cavities formed? The mouth is a natural environment for bacteria, some of which play a key role in the development of caries (i.e.) cavities in teeth. These bacteria utilise sugars from food to produce a sticky substance, called plaque that adheres to the teeth. This forms a basic coating, to which more bacteria are attached. If the layer of plaque remains undisturbed, more layers are added, providing the bacteria with an area of attachment to the tooth surface.
As the sugars in the plaque are metabolised by the bacteria, acids are produced as a by-product. If in prolonged contact with the tooth surface, these acids cause eventual dissolution of enamel, or the top layer of the tooth structure. Destruction of the enamel results in a cavity through which bacteria can penetrate to the softer layers underneath. This results in sensitivity of the pulp (the nerve) of the tooth. If untreated, the pulp gets inflamed, leading to an infection associated with the root of the tooth. Therefore, identification and control of plaque becomes important in the protection and preservation of teeth.
Prevention of cavities: Plaque formation is very fast, with the first layer easily established 24 hours after a brushing. When undisturbed, this layer is colonised by bacteria. Therefore, the most effective method to control plaque is to disturb its formation. This is done by mechanical aids such as toothbrushes and floss. Plaque must be removed.
Toothbrushes help plaque removal from the gum-tooth margin, the top surface and the sides of the tooth. The correct method of brushing is important in ensuring thorough removal. Floss removes plaque from the front and back surfaces of the tooth. These surfaces are normally in contact with adjacent teeth, and are, therefore, not accessible with a toothbrush. The use of mouthwashes is not advised in young children due to their inability to spit.
Diet and its effect on the formation of cavities: As sugar is the main cause of cavities and chocolates, ice cream, etc., are to be avoided. In truth, "sugars" comprise a large group of foods called carbohydrates. Carbohydrates are what we consume in the largest quantities in foods like rice, wheat, cereals, as well as those made from refined flour such as biscuits, cakes and breads. In addition, sugars are also present in varied forms in fruits, milk, and, of course, regular sugar.
Those foods containing refined carbohydrates that are fine enough to remain on the teeth by sticking to the fissures on the tooth surface are termed cariogenic (capable of causing cavities). Thus, they are accessible to oral bacteria, which break them down to simpler forms of carbohydrates such as sucrose (sugar). Therefore, apart from the known culprits, (chocolates, ice creams, etc.), biscuits, cakes and pastries also cause cavities. In addition, juices reconstituted with sugar and water and aerated drinks are also highly cariogenic.
Controlling the diet of a child is a difficult task and depends on age and personality. Some general suggestions would be:
Do not keep too many snacks in the house. Reduced accessibility goes a long way in modifying diet.
Limit the child's intake of snacks to once a day, say, soon after returning from school.
Strictly limit the intake of carbonated drinks, juices reconstituted from powder or those that have added sugars.
Encourage rinsing the mouth after every meal.
Brush your child's teeth yourself at least twice a day. Use only a wet toothbrush and brush after breakfast and at night before bedtime.
Ensure six-monthly visits to your paediatric dentist to keep an eye on not only on the development of cavities, but also on the growth and development of the face and jaws, the maintenance of general oral hygiene parameters and any variations in the eruption schedule of teeth.
Cavities need to be attended to and treatment could vary from simple restorations up to more invasive procedures such as root canal cleaning and caps.
Sealants: Permanent molars and pre-molars have a surface configuration, which consists of pits and fissures. These areas are difficult to clean even while using a toothbrush. These serve as a nidus for dental caries.
An important preventive measure for these lesions is in the use of what is called sealants. These are tooth-coloured materials and which are used to convert the pits and fissures into shallow concavities. This makes the teeth surfaces easier to clean.
The use of tooth isolation technique using rubber dam material makes the procedure even more fail-proof.
Topical fluoride applications are also considered important for children who have rampant decayed teeth.
Sports injuries and mouth guards: The chances of a child injuring his front teeth are quite high, especially when they protrude, more so in contact sports. Several European countries and the United States have made it mandatory to use mouth guards in basketball, hockey and boxing. These mouth guards come either as stock guards in basketball, hockey and boxing or custom made.
First aid for avulsed teeth: The teeth must be replaced into the socket as quickly as possible and should not become dry. The tooth should not be cleaned with water. Instead, cold milk can be used to rinse and also store the tooth while taking it to the dental surgeon.
Jaw injury and facial deformity: Certain injuries to the teeth can be part of more extensive lower jaw injury and fractures in the region of the jaw joint. In time, they can lead to gradual restriction of the mouth opening followed by an inability to open the mouth. This also leads to an asymmetric growth of the lower jaw and a very noticeable deformity of the lower part of the face.
This condition, known as TMJ ankylosis, needs to be identified and corrected in childhood to restore jaw function and facial harmony.
Teeth discoloration in children could be due to plaque, chromogenic bacteria producing pigments, which impart different colours to the plaque attached to the teeth, and localised enamel hypoplasia.
At the other end of the spectrum, teeth discoloration could reflect an underlining general medical disorder such as liver disease, excess fluoride intake or associated skeletal disorders.
Children with special needs: Physically and mentally challenged children require special dental management skills. More often it is necessary to treat such children under general anaesthesia as a day care procedure. The children are admitted in the morning and the procedure is done under the supervision of a paediatric anaesthetist. The child is usually sent home a few hours later. This also allows for complete dental treatment to be done in one visit.
Why do we need to bring the child to the dentist at age 1?
Acclimatising the child to the clinic set up.
Anticipatory guidance — age-appropriate.
Any developing disease; any developing malocclusion.
Guidelines for general dental safety; how to cope with a dental emergency.
Parental education.
Paediatric dentistry is now recognised the world over as a very important aspect of comprehensive modern dentistry.
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