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Pediatric Dentistry

Updated: Apr 8, 2020

Kids have 3 period of dentition

1- Primary or Baby Teeth dentition:

The first set out of the two sets of teeth are known as the milk, deciduous teeth or primary dentition. This dentition has 20 teeth in total. The first primary tooth to erupt is the lower central incisor at 6-8 months. The deciduous dentition is completed by the age of 3 years and is present only for a small duration of time until it is lost completely by age 11.

2- Mix dentition:

With the onset of the eruption of the first permanent tooth begins the mixed dentition phase wherein both the milk and the permanent teeth are present. The first permanent teeth to erupt are the first molars and the lower central incisors by 6-7 years of age.

3- Permanent Teeth dentition:

By the age of 13 , kids has all permanent tooth and just The third molars, or the wisdom teeth, are usually the most variable teeth in the oral cavity ranging in their appearance from 7-21 years of age.

How can tooth decay be prevented?

1. Brush and Floss daily.

2. Drink Fluoridated water and use Fluoride toothpaste.

3. Have dental sealants applied.

4. Eat a well balanced diet and avoid sugary foods and drinks.

5. Visit the dentist regularly


Pit and Fissure sealant

Most cavities start on back teeth in the small depressions and narrow grooves called pits and fissures. Germs can hide in the pits and fissures increasing the risk of cavities. Teeth are at risk for cavities and need protection. Dental sealants can provide this protection.

A dental sealant is a white plastic material painted on the chewing surfaces of permanent molars. The sealant bonds to the tooth and forms a thin protective cover that keeps plaque and food out (germs), reducing the risk of tooth decay.

How are Dental Sealants applied?

The placement of a sealant is quick and comfortable. The tooth is cleaned, a special liquid is put on the tooth to get it ready, it is dried, and then the sealant flows into the grooves. It is hardened with a special light. Your child can eat right after the sealant is placed.

Which teeth should be sealed?

The teeth most likely to get decay are the ones with grooves and fissures so the most important teeth to seal are the permanent molars. Children in 2nd grade usually have four permanent teeth to be sealed, two on the top and two on the bottom in the very back. 6th graders may have four additional teeth to be sealed.

How long do sealants last?

Research shows that sealants can last for many years if the teeth are taken care of. Your child’s teeth will be protected through the most decay prone years. The sealants will last longer if your child takes good care of the teeth and avoids biting hard objects. The sealants will be checked once again in 3rd grade or 7th grade and more sealant applied if it is missing.

Will sealants make the teeth feel different?

A dental sealant may be slightly noticeable until normal chewing wears it into place. Since sealants are very thin and only fill the pits and fissures, they will not cause a change in the bite.


Treatment of the Nerve on painful primary teeth ( Pulpotomy ):

When the nerve or pulp tissue of a primary or permanent tooth is infected, it needs to be treated to prevent a dental abscess and loss of the tooth. The ultimate objective of these procedure is to save the tooth, so that it will maintain the integrity and function of the dental arch. Pulpotomy for Primary teeth is the surgical removal of the entire coronal pulp, leaving intact the vital radicular pulp within the canals. The indication for the Pulpotomy is, when their retention is more advantageous than extraction and when inflammation is confined to the coronal portion of the pulp.

Orthodontic Treatment

All children has to be seen by an orthodontist between the ages of seven and nine. Some children require and can benefit from early intervention treatments. If you notice crowding adult teeth or a misaligned bite, it’s a good idea to make an appointment.

An interesting fact about teeth, your chronological age does not always match your dental age! This means your teeth may come in at different times than others and may shift later on in life.

If you are questioning having your child in for orthodontic treatment we recommend you make an appointment for a consultation. The best way to approach dental health is by being proactive! Early treatment can prevent a more complicated treatment later on.

Orthodontic treatment can be suitable prior to issues developing as a proactive approach. Everyone is different and so are their teeth!

The best way to determine if orthodontic treatment is required is to come in for a complimentary consultation.

In case of loosing primary teeth earlier than eruption of permanent teeth by deep caries or accident might effect the pattern of eruption and cause some crowding and space deficiency. So, the best preventive treatment in this situation is keeping the required space for permanent tooth by Space Maintainer appliances.


Traumatic teeth Treatment :

There is different type of trauma on the teeth:

1. Cracked Teeth: Apart from injury to the tooth, habits such as teeth grinding, clenching and chewing on hard objects can cause cracked teeth. Symptoms of cracked teeth include erratic pain from chewing and temperature extremes. Pulp irritation and damage may result. Extensive cracks can lead to pulp tissue infection, which may spread to the bone and gum tissue surrounding the teeth.

Since pulp damage is common with cracked teeth, root canal treatment often is needed. Following root canal treatment, your dentist will restore your tooth with a crown to hold the pieces together and protect the cracked tooth. If the crack spreads below the gum line, or if the cracked tooth has irreparably deteriorated, tooth extraction will be necessary. However, pulp damage and root canal treatment are not always consequences of cracked teeth. For example, when the pointed part of a tooth’s chewing surface (cusp) breaks off naturally or has to be removed by a dentist, the pulp is seldom damaged and rarely needs root canal treatment. Instead, your dentist usually will place a full crown restoration.

2. Chipped, Fractured and Broken Teeth: While minor chips or fractures do not require immediate care, they should be treated to avoid sharp edges that can cut soft oral tissue (tongue, lips) and for esthetic reasons. If a piece of the outer tooth is chipped off, but the pulp is undamaged, your dentist may simply smooth out the rough edges or replace the missing portion using tooth-colored composite. In other instances, it may be possible to bond a broken tooth fragment back in place. If you lose a larger part of the tooth, but the pulp is not irrevocably damaged, your dentist may restore and protectively cover the tooth with a porcelain veneer or crown (“cap”). If the pulp has been seriously damaged, the tooth will require root canal treatment before a crown can be placed. A tooth that is vertically fractured or fractured below the gum line will require root canal treatment and a protective restoration. If there isn’t sufficient structure remaining to hold a crown, tooth extraction may be needed. Your dentist may then recommend placement of bridges, implants or a removable appliance.

3. Dislodged (Luxated) Teeth: When injured, a tooth may be pushed to one side, or out of or into its socket. Luxated teeth need to be re-positioned and stabilized by your dentist as soon as possible. The quicker the stabilization, the better the long term potential for saving luxated teeth. Dislodged permanent teeth usually need root canal treatment; treatment should begin approximately one week after the injury. Children between seven and 12 years old may not need a root canal since their teeth are still developing. Research indicates that stem cells present in children’s pulp tissue can be stimulated to complete root growth and heal the pulp after injuries and/or infection. Consult an endodontist to see if this might be the case with your child’s injured tooth.

4. Knocked Out Teeth: If a tooth is completely knocked out, you must seek dental/medical care immediately. If possible, it’s best to put the tooth back in its socket (except with children under 12 years old, who may swallow it). Hold the tooth by the crown (chewing edge), never the roots. If dirty, rinse with saliva or water. Do not use soap or other cleaning agents; never scrape, scrub or brush the tooth. Making sure it’s facing the right way, place the tooth back into its socket as quickly as possible. The less time the tooth is out of its socket, the better the chance of saving it (two hours is the most for survival). To stabilize the tooth and minimize bleeding, gently bite on clean gauze, a wet tea bag or a wad of cloth until you reach your dentist/hospital emergency room.

If you’re unable to put the tooth back in its socket, it’s critical to keep the tooth moist. Immediately place the tooth in a cup of cold milk, saliva, cool water with saline solution (not contact lens solution or tap water), or special first-aid solutions (such as Save-A-Tooth) available at drugstores. You also can put the tooth between your gum and cheek or underneath your tongue.

If you can get to dental/medical care within 30 minutes and the tooth has been properly preserved, chances are good that it can be successfully re-implanted. In most cases, only permanent (adult) teeth are re-implanted. Primary (baby) teeth usually are not re-implanted to avoid injury to the developing permanent tooth growing inside the bone.

Eventually , the best dental recommendation for everybody , mostly kids , is doing preventive dentistry and providing oral hygiene instruction , instead of any other complicated dental treatment .

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