Pedodontics (Children’s Dentistry)

0-13 years of age is a branch of science aimed at maintaining the baby and permanent teeth of children healthy, and to treat the problems posed by cavities, trauma, hereditary and similar factors in these teeth. The treatments and preventive dentistry practices related to this subject;pediatric dentists who are specially trained in children’s psychology, growth and development are called Pedodontist.

Importance of Baby Teeth

Baby teeth are 20 in total. The first task of baby teeth is to provide feeding in child. In addition, the proper development of the talking also depends on the presence of baby teeth.Baby teeth protect the area they cover for the permanent teeth that will replace them and guide it while permanent teeth are erupted. When the baby tooth is pulled early, this natural placeholder function is also eliminated.

The primary purpose of Children’s Dentistry is to take precautions to prevent dental problems from occurring and to direct children into the cavity-free future.The procedures applied for this purpose are called Preventive Dentistry Applications.

In protective applications aimed at preventing teeth cavities,attach great importance to educated of the child and his family about oral-dental health and nutrition.In our clinic, tooth brushing techniques are explained practical to our patients.Preventive dentistry applications include topical fluorides and fissure sealants.

Fissure Sealant

It is a fluid filler that closes deep and decay prone fissures (grooves) on the chewing surfaces of permanent teeth and does not allow bacteria to reach here, thus preventing decay. Fissure sealant applications should be checked every 6 months.

Fluoride Applications

Fluoride is an element that prevents tooth decay and strengthens the structure of the teeth.Since tooth enamel does not mature fully when the teeth eruption, the grow new teeth are generally have low resistance to decay and prone to decay. Fluoride strengthens tooth enamel, protects against to acid attacks and thus helps prevent tooth decay from occurring.Professional fluoride applications are a protective method that can only be applied by dentists. Fluoride should be applied by the dentist every 6 months.

What are Fissure Sealants?

Fissure Sealants are called fissure on the chewing surfaces of large and small molars grooves are filled with transparent or white colored fluid matter.These fissures are deep,narrow and the nutrients are barely cleaned by brushing, so 90% of the cavities occur in this region.In fissure sealants applications, these fissures are filled with fluid filler material, creating easy-to-clean flat surfaces and hardened with a special blue light.

When should we have fissure sealant applications?

Especially in children, the enamel of the emerging teeth does not mature, so the teeth are more prone to decay.Therefore, in this period when the teeth are least resistant at an early age, protecting teeth with a short and simple application such as fissure sealant will reduce or eliminate the need for future decay and filling procedures. Therefore, we can also call fissure sealants “protective fillings”. The ideal time for fissure sealant is when the teeth eruption completed. First permanent molar erupt between 6-7 years old, while the second molars erupt between the age of 12-13 years.Fissure sealant applications are required in small molars in a low rate and these teeth erupt between the age of 10-11.Since teeth eruption times can vary from person to person,changes can be seen for a year or two. Therefore, your physician will tell you the best time to have a fissure sealant after examination. But fissure sealant can always be applied to the caries-free teeth that have completed the eruption time.

My kids teeth are starting to have cavities,can a fissure sealant be applied to my child?

Fissure sealant can be applied if there is slight coloration in the teeth; however, if cavitations (loss of substances in the teeth) have started to occur, preventive resin restoration (PRR) or filling should be performed.

Does my child feel pain in fissure sealant application?

No, there is no corrosion in the tooth because there is no caries tissue like fillers in fissure sealant application. In fissure sealant application;after applying a gel that allows the fissure sealant to stick to the fissure sheet in the enamel of the tooth, the fissure sealant is applied and hardened with light. Your child does not feel any pain.Fissure sealant application is performed anesthesia-free so the tooth is not narcotized.

Why is fissure sealant?

Fissure sealant application is an easy, painless and take approximately 5 minutes to complete. Therefore, when applied in children who have been first visit to dentist, it also helps the children not to be afraid of the dentist and to ensure that other treatments are performed easily.This gradual approach in pedodontics is very important for the child,to love his physician and adapt to their treatment.They reduce filling requirements by provides protection against cavities, as well as more economical than dental fillings. With an easy short-term application,can be prevented long-term treatments requiring anesthesia.

Can fissure sealant also be applied to baby teeth?

Fissure sealant can be applied to baby teeth in the high risk of cavity or even permanent teeth of adults.

Does my child feel any discomfort after fissure sealant application?

Since the indented sections of the teeth are covered with fissure sealant, there is no feeling of high after the procedure, and there is no feeling groggy because anesthesia is not performed.

When can my child eat something after fissure sealant application?

After fissure sealant application,your child can eat or drink something immediately.

Should Fissure Sealant (Protective Filler) be done continuously?

No, you just need to get the fissure sealant once. However, fissure sealant should be checked routinely every 6 months. Fissure sealant can wear or break over the years. But studies show that even in this case, fissures remain largely in their deepest parts and provide protection for years. During the procedure, the child’s harmony, the protection of teeth from saliva will increase the success of the treatment and the success of the fissure sealant.Even if the fissure sealant is fell out,they are more resistant to decay than teeth that have not been applied to fissure sealant because they still cover the invisible indentations.

Note:

In addition to all this, if your child does not provide oral hygiene; your child’s tooth can decay.It should be noted that in high-risk of caries, teeth can also decay from their flat surfaces.Even if the fissure sealant is applied, the teeth always need to be brushed for 2 minutes at least 2 times a day.

The European Academy of Paediatric Dentistry fissure sealant guideline:

https://www.eapd.eu/uploads/D052751D_file.pdf

The American Academy of Pediatric Dentistry fissure sealant guideline:

https://www.aapd.org/media/Policies_Guidelines/G_Sealants.pdf

What are Fluoride Applications?

The basis of preventive dentistry are fissure sealant and fluoride applications.

Fluoride is a natural mineral also found in the water, meat, tea and eggs. Fluoride also provides the most effective protection for decay prevention mechanisms. Fluoride joins the structure of the tooth enamel, ensuring that the tooth is structurally stronger and more resistant to cavities. In the first 4 years when teeth begin to appear in the oral environment, the enamel of the teeth does not mature, they can not be resistant to cavities and make structures stronger with fluorine applications.

Can cavities are prevent with fluoride applications ?

Fluoride toothpastes play an active role in preventing teeth cavities.

In individuals with high and moderate risk of cavities,fluoride applications and good oral hygiene can be greatly reduced teeth cavities.Every day, it is reported that at least 20-40% decrease in tooth decay is recorded by regular use of fluoride toothpastes. But even if fluoride is applied, the most important point is that, should provides good oral hygiene for your child. If your child provides good oral hygiene after cavities treatments and preventive treatments, your child will be able to maintain oral and dental health for many years. Of course, good follow-up is important in ensuring oral hygiene. Therefore, please do not disrupt the check appointments that your doctor will make.

How many ways can the fluoride applications be done?

Fluoride applications can be done systemically and topically in two ways.Systemic application take effect by the spread of fluoride throughout the body such as fluorine tablets and drops.These applications are not preferred because its affect the whole body and the effect in the teeth is very low.The type of application that provides the actual effective protection in the teeth; topical fluoride applications,that is to say fluoride gel, foam or varnish directly apply to the teeth.

Fluoride in the form of gel, which can have different aromas and odors in the fluoride gel application, are applied to the teeth after get dry for 1-4 minutes with the help of carrier spoons. After the application of fluoride gel, excess fluoride in the mouth is pulled with saliva absorber, because the remaining fluoride in the mouth should spit, so gel applications are not preferred in children under 6 years of age because they cannot provide it properly.In children 5 years and under, fluoride varnish applications that dry by covering the teeth are preferred.

Fluoride varnish application is to apply the fluoride in the cream consistency to the teeth with a special brush after the teeth are dried.

What should I pay attention to after Flouride Applications?

After the Flouride applications, your child should eat or drink something for 30-60 minutes. If fluoride varnish application is applied should not brush the teeth on the evening of the application, the next day from the morning should start the process of brushing regularly again.

How Often Should I Apply the Fluoride Applications?Is it sufficient to apply fluoride application once?

Fluoride treatment can be done every 3-6 months depending on your child’s risk of cavities. According to the guideline published by the American Academy of Pediatric Dentistry (AAPD) for fluoride application, fluoride application should be applied every 3 months in individuals in the high risk group,children in the middle risk group should be applied fluoride every 6 months. In children in the low-cavitiy risk group, the amount of fluoride in toothpaste provides adequate protection and no extra fluoride is required.

In addition, the tooth replacement period of children starting at the age of 6-7 continues until the age of 12-13, and new teeth can be protected with the application of fluorine during this period.Considering that the maturation period of the teeth is 4 years, even if the fluoride application is done at the age of 16-17, the structure of the second molar tooth in the maturation period of your child will be strengthened with the applied fluoride.The fluoride applied after this period will not be able to join the tooth structure, but will only have effects such as reducing sensitivity and treating the first stage of cavities. Fluoride, which was applied before the age of 6-7 years, affects the baby teeth.

Is fluoride application harmful?

In fluoride varnish application, fluoride hardens by contact with saliva immediately after being driven into the teeth, so the risk of ingesting and fluoride intoxication is almost nonexistent. For this reason, it can be used safely even in children under 6 years of age.Ingestion of fluoride 2 mg or more per day can cause white spots in the teeth,that is to say fluorosis. (The most critical period for Fluorosis is when the child is 15-30 months old.)However, it is impossible for your child to reach these doses by brushing their teeth with fluoride toothpaste or applying fluoride varnish.In order for fluoride to have an effect on the digestive system, a child of about 10 kg must swallow 45g of toothpaste(1 tube of adult toothpaste-about 1-5 mg/kg).The fluoride rate on adult toothpastes is high for children, so you should choose toothpaste with fluoride suitable for your child’s age. In this regard, you can find out the appropriate paste for your child by consulting your physician.

Make sure your child uses the right toothpaste to avoid the negative effects of fluoride and does not swallow the toothpaste. Use as much toothpaste as a grain of rice in children up to age of 3, as much as toothpaste a grain of pea in children between the ages of 3 and 6 is enough. Also, spreading the toothpaste on the brush like in the picture will reduce the possibility of swallowing the toothpaste.

Turkish Dental Association Fluoride status report:

http://www.tdb.org.tr/userfiles/files/DURUM_RAPORU_Florur_08_06_2016.pdf

The European Academy of Paediatric Dentistry flouride guideline:

https://www.eapd.eu/uploads/82C0BD03_file.pdf

The American Academy of Pediatric Dentistry flouride guideline:

https://www.aapd.org/globalassets/media/policies_guidelines/bp_fluoridetherapy.pdf

When Should A First Dental Examination?

The first dentist examination should be done within 6 months after your child’s first baby teeth are erupted.The American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA) and the World Health Organization (WHO) also recommend that the first dental examination should be done between the months of 6 and 12 . In addition to evaluating the structure of your child’s teeth in the first dental examination, your physician will also provide information about how to ensure oral hygiene and what to pay attention to in nutrition. Starting routine checks without any cavities or pain in children provide that your child get used to and trust the dentist and ensure that the problem is avoided only by protective measures before problems begin. Having toothache when children first come to the dentist can cause them to be more stressed during treatment.

In children ages 0-3 years old in Brazil; It was reported that 27% of 13-24 months old children and 50% of 25-36 months old children had teeth cavities.In our country, the existence of teeth cavities in children age of 5 is reported to be around 69.8%. These rates show that the cavities began at a very young age and emphasize the importance of performing dentist checks from an early age.

Should I prepare my child before the dental examination?

Explain the process and positively direct your child before taking him/her to a dental examination,that will help your child to spend his appointment more comfortably. If you trick your child about nothing will be done for your appointments, you will make it difficult for the child to accept treatment. Don’t use expressions to your child suchlike;that will not hurt,it may hurt a little, no needles, then your tooth is pulled. Because such expressions cause your child to be more afraid.In fact, your pediatric dentist will explain to your child what to do before the procedure in a way your child will like.

You can tell your child with such as phrases that a dentist appointment will be a lot of fun, will look at the teeth with a tiny mirror, that check is necessary to have good teeth, and learn how to brush your teeth.

For an age recommendation from The American Academy of Pediatric Dentistry (AAPD):

http://www.mychildrensteeth.org/assets/2/7/GetItDoneInYearOne.pdf

Time of Teething In Babies

Babies first teeth to start coming in between the ages of 6-9 months. However, personally, this time may be earlier or later, this process is very normal. There is no harm in the late or early coming in the teeth, it can only be a little more difficult to maintain oral hygiene due to age if your baby’s teeth come out earlier. Babies who have reached the age of 1 but have not yet had a tooth, should be checked by the dentist. Some babies are also born with teeth. If your baby was born with teeth; you must go to pediatric dentist for examination.

While the lower central incisors usually coming in first, the average eruption times of the teeth are as follows.

The eruption and shedding times of the teeth are shown approximately in the table. When your child turns 3 years old, 20 baby teeth(10 in the upper jaws,10 in the lower jaws)eruption are completed.

Symptoms of Teething Period

During the teething period in your child,some or all symptoms can be seen such as inappetence,irritability, itchy gums, increase in the amount of saliva, crying,sleeplessness, fever (up to 38.5 degrees), diarrhea.However, it should be noted that these symptoms may be symptoms of other diseases in cases that conditions such as fever and diarrhea take longer or fever is more than 38.5 degrees, and a physician should be visited for check.

What can I do make comfortable my child during the teething period?

The best way to relieve your baby during this period is cold compress. You can do the cold compress by giving your baby food such as carrots or teether filled with water, after a little hold in the fridge.Be sure that,keep a close watch on your baby during the application, in case of the break-up of food. Or you can gently massage the area where the tooth will come out with the back of the silicone finger brushes. In addition, hugging your baby in the process will give her a sense of confidence and help her relax. If your baby is still not relieved after these methods, you should consult your physician. Drugs such as painkillers and gels that can be used during the teething period,should be used on the advice of a doctor.

In 2014, the American Food and Drug Administration (FDA) reported that oral gels with 2% lidocaine content used for toothache in infants can cause side effects, so it should not be used. During this period, they recommend cold compress and finger massage as mentioned above.

For The American Academy of Pediatric Dentistry (AAPD) guideline to dental development:

https://www.aapd.org/globalassets/media/policies_guidelines/r_dentalgrowth.pdf

The U.S. Food and Drug Administration (FDA)’s description of drug safety on the use of lidocaine during teething period:

https://www.fda.gov/drugs/drugsafety/ucm402240.htm

Dental trauma in children

Dental traumas are more common in toddlers and school-age children between the ages of 7 and 10. The most common traumas are the traumas that cause the upper incisors teeth to break or completely dislodged.If children have general health problems such as bleeding, loss of consciousness, vomiting, nausea after trauma, an emergency room should be referred as soon as possible. If if the child is in good condition, a dentist should be consulted as soon as possible.In dental traumas, the time period of the patient reaches the dentist is great importance for treatment.

After trauma, the tooth that is broken or exiting must be found first, and it should be delivered to the dentist in milk,without touching the root part.The first hour after trauma is very important for the success of the treatment,so it is very important that you reach your dentist without delaying.

If the tooth is broken,broken part can be pasted in the same place or the broken part can be completed with filling.Different treatments such as canal treatment depending on the level of the broken may be required.

If the tooth is completely dislodged from the place,after washing the tooth with clean water without touching the root part, it should be delivered to the dentist in milk as soon as possible. Depending on the time of access to the dentist, after some procedures, permanent teeth can be placed in own place and fixed with wires.However, if the tooth dislodged from the place by trauma is the baby tooth, the tooth do not put in place.

If the tooth is not completely dislodged but it is longer/shorter or swaying,should go to the dentist before the teeth are touched. Even if the amount of swaying in the tooth is very few,radiographic control may be required to detect the fractures in the roots of the teeth. Depending on the condition of the teeth, the swaying teeth can be fixed.

Factors such as the form of trauma,location,time,child has a tetanus vaccine are very important for treatment and you should inform your physician about these factors.

In addition,may be a need for treatment in teeth that are traumatized, whether or not there is visible fracture or swaying,even after the trauma. Therefore, it is very important that you go to examinations at the intervals specified by your physician. Clinical and radiographic examination should be done regularly of the tooth that traumatized.

What can I do to prevent dental trauma?

If your child do sports that is a high probability of trauma to the mouth area, using a sports mouthguard to protect the teeth will prevent dental trauma and soft tissue traumas that may occur in the mouth.

In addition, in cases that the front teeth are too slanted and forward, mouthguard may be required because of the high risk of trauma.In these cases, it is also important for an orthodontist to evaluate the  orthodontic treatment need and the time of treatment.