Prevention is better than cure.

Main Dental Concerns in Pediatric Patients:

1. TEETHING:

The first Dental Visit:

The first dental concern of the parents is when their child has delayed teething. The first dental visit should be when the first tooth erupts and at the age of 18 months in case of delayed eruption. Timely teething is required for the skeletal development of the jaw, in weaning to solid foods and for proper speech development.

2. BABY BOTTLE CARIES

ISSUE: Tooth decay in infants and very young children is often referred to as baby bottle decay.

CAUSE: Baby bottle tooth decay happens when sweetened liquids or those with natural sugars (like milk, formula, and fruit juice) cling to an infant’s teeth for a long time. Bacteria in the mouth thrive on this sugar and make acids that attack the teeth. At risk are children whose pacifiers are frequently dipped in sugar or syrup. Giving an infant a sugary drink at nap time or nighttime is particularly harmful because the flow of saliva decreases during sleep.

CONSEQUENCES: Baby teeth are necessary for chewing, speaking, and smiling. They also serve as placeholders for the adult teeth. If baby bottle tooth decay is left untreated, pain and infection can result. Severely decayed teeth may need to be removed.

If teeth are infected or lost too early due to baby bottle tooth decay, your child may develop poor eating habits, speech problems, crooked teeth, and damaged adult teeth. In addition, the chances that adult teeth will end up being crooked are greatly increased.

TREATMENT: Baby bottle caries need to be addressed as soon as possible. To prevent severe infection and loss of deciduous teeth, the pediatric dentist will remove the decay on the tooth and fill it with the filling material. However, the type of treatment will depend upon the extent of the decay and the age of the child.

PREVENTION: Baby bottle caries can be prevented by taking the following measures:

• Wipe the baby’s gums with a clean gauze pad or washcloth after each feeding.
• Begin brushing your child’s teeth, without toothpaste, when his or her first tooth comes in.
• Schedule regular dental visits by your child’s first birthday. Dentists also offer special sealant coatings, which can help prevent tooth decay in children.
• Never allow your child to fall asleep with a bottle containing anything but water and never give your child a pacifier dipped in anything sweet.

3. GINGIVITIS

ISSUE: Gingivitis is bleeding gums, especially while brushing or flossing teeth. Bad breath and red and swollen gums are other symptoms of gingivitis.

CAUSE: Gingivitis is caused by plaque. Children with severe crowding and poor oral hygiene habits are at a greater risk for developing this condition. Other causes include Vitamin C deficiency, mouth breathing and tooth grinding.

CONSEQUENCES: If left untreated gingivitis can cause resorptions of the bone and ultimately lead to tooth loss.

TREATMENT: Gingivitis is treated by ultrasonic scaling as well as manual scaling in pediatric patients.

PREVENTION: This disease can be prevented by visiting the dentist when the first tooth erupts. The dentist guides the parents of the correct oral hygiene habits for pediatric patients as well as schedule the first hygiene appointment of the patient. The parents should supervise the brushing routine of the children and use soft bristles or electric toothbrushes.

4. EARLY LOSS OF DECIDUOUS TEETH

ISSUE: Premature loss of deciduous teeth means when a milk tooth is lost due to either trauma or extraction before its time.

CAUSE: Premature loss of deciduous tooth can be due to root resorption or trauma in the anterior teeth and due to cavities in the molars.

CONSEQUENCES: Premature loss of deciduous teeth leads to loss of space for the permanent teeth to erupt. The main consequence is crowding in both arches which can lead to skeletal deformities that take longer treatment time later in life to correct. These skeletal abnormalities involve narrow maxillary arch and crossbite and overjet which leads to Class 2 and 3 malocclusion.

TREATMENT: Timely detection of the effects of premature loss can increase treatment options available and reduce the need of extensive orthodontic treatment later on. The main management of space loss prevention includes the use of space maintainer appliances at an appropriate age. 

PREVENTION: Early tooth loss can be prevented by including good oral hygiene habits as soon as the first tooth erupts. In case of trauma, it is imperative to seek dental help as soon as possible to increase the life of the effected tooth.

5. PARAFUNCTIONAL HABITS

ISSUE: Parafunctional habit in children include digit sucking, nail biting, bruxism, mouth breathing and tongue thrusting.

CAUSE: If psychological needs of children are not being met, they tend to act out and this can become prominent in the form of dento-oral parafunctional habits.

CONSEQUENCES:  All these habits can lead to different outcomes which can cause major psychological stress to the patient. Major consequences are malocclusion, bruxism and sleep apnea.

• Malocclusion: Malocclusion is defined as dysfunctional craniofacial relations which may affect function, esthetics, and general well-being. It is one of the most frequent dental problems.

Malocclusion can present as anterior open bite or lateral crossbite, overbite or overjet. Untreated malocclusion can lead to dysfunctions of the oro-facial muscles and bone changes.

Severe early childhood caries is the leading cause of malocclusion as it can reduce arch space as well as cause asymmetrical facial growth. Early loss of deciduous teeth as well as periapical lesion in the primary teeth can lead to improper eruption of the permanent teeth which can lead to malocclusion.

• Thumb sucking can cause protrusion of the upper incisors and the premaxilla, atypical swallowing, anterior open bite, and posterior crossbite. Tongue thrust and lip sucking habits can cause malfunction of the facial muscles and growth of the upper and lower jaws which leads to malocclusion.
• Airways and Child Development: A much more serious condition with severe consequences than thought previously, sleep apnea is a result of Compromised Airway. Sleep apnea can be due to habitual mouth breathing, narrow palate, narrow tongue space or snoring. It can cause daytime fatigue, high blood pressure or heart problems, Type 2 diabetes, metabolic syndrome, complications with medications and surgery, liver problems, sleep-deprived patterns as well as learning difficulties.
• Habitual mouth breathing occurs due to obstruction of the nasal airways which may be caused by adenoid, rhinitis and hypertrophy of nasal turbinate. Open bite, a narrow maxilla, a deeper palate, and anterior cross bite can all result from mouth breathing. Low academic achievement has also been reported in habitual mouth breathers as compared to nose breathers.
• Narrow Palate: Narrow palate can be caused by tongue tie. Parafunctional habits like thumb sucking and use of pacifiers also contributes to the narrowing of a normal palate. Consequences of narrow palate include crossbites, and crowded teeth. All these concerns can be corrected by early interventions like frenotomy and palate expanders.
• Narrow tongue space and sleep apnea: The narrow tongue space reflects the narrowness of the mandible which compromises tongue space. During sleep, the reduced space causes falling back of the tongue into the pharynx which leads to obstructive sleep apnea. Crossbite due to malocclusion can restrict the growth of the lower jaw which also contributes to loss of tongue space.
• Tooth wear and chipping: Airway obstruction makes it difficult for a child to get enough oxygen while sleeping and the body responds unconsciously by moving the lower jaw forward to open up the airway. Hearing grinding sound at night means that there is habit of grinding and it leads to tooth wear and chipping. It should be identified and treated early to minimize damage.
• Snoring: Habitual snoring in children is indicative of a sleep disorder. Snoring can be due to constricted airway and developmental dental abnormalities. Impacts of childhood snoring include stunted growth, bed wetting, cardiovascular disease, obesity and ADHD. Snoring also contributes to a much complicated condition called sleep apnea.