This specialty involves the detection and management of dental problems in children.
As we are aware that the child gets 2 sets of teeth in a lifetime. First is the set of milk teeth and the other is the permanent set of teeth. The first milk teeth to come in the mouth are the front teeth known as the incisors. These start erupting about 6 to 7 months. By 2 ½ years all the milk teeth are present in the mouth. The milk or deciduous teeth are 20 in number. This is known as the ‘ milk dentition’
From the age of 2 ½ to 6 years no new teeth come in the mouth.
The first permanent tooth to come in the mouth is the first molar also known as the 6 year molar. At 7 years, the incisors start to erupt and then gradually upto the age of 12 years the second molars erupt.
Between the age of 6 to 12 years is the period of the ‘Mixed dentition’, where both the milk as well as permanent are present.
After 12 years normally only the ‘permanent dentition’ is present.
Among the common problems seen in children are Dental Caries, Gum Boils, Irregular teeth, Injuries to the teeth and Cleft Lip and Palate.
Dental Caries in children is the most common problem and is owing to excessive consumption of sweets, chocolates, and not brushing properly twice a day. As the milk teeth in children are small in size as compared to their counterparts, also the first 2 layers the Enamel and the Dentine of the tooth are significantly thinner, the dental decay spreads fast and wide, sometimes leading to the condition of ‘Rampant Caries’
Rampant Caries is the condition where most of the teeth of the child are affected by dental decay. The child may or may not have the symptoms of pain. The teeth appear in different hues ranging from chalky white through shades of brown and black broken and worn out. This condition involves immediate aggressive measures to restore the oral condition. Among the steps to be taken are immediate control of sugar in the diet in any form, proper oral prophylactic procedures like brushing twice a day and rinsing with the appropriate mouth washes. When the nerve of the teeth has not been involved filling is the appropriate procedure. The teeth which have broken need to be capped. Pulpotomy or RCT is the treatment of choice where the nerve of the tooth is exposed depending on the case. Teeth which are damaged beyond repair such as where only the root stumps remain, need to be extracted. ‘Space Maintainers’ need to fabricated to keep the space for the permanent teeth to follow.
‘Gum Boils’ are small swellings in association with a tooth where the pulp is involved. These are sacks filled with abscess. With appropriate medication thses milk teeth are extracted or root canalled.
Irregular Alignment or malocclusion is another common in children. Evolutionary advancement of the human body is an ever evolving process where apart from the other changes in the body, the jaw is reducing and so are the number of teeth. The jaw size is reducing faster than the number of teeth. Therefore the teeth are not getting adequate space to align themselves properly. Apart from the individual genetic predispositions, environmental factors play a major role. Peversive habits such as thumb sucking, nail bitting, lip sucking and mouth breathing are the other common factors which a play role leading malocclusion. Among the cardinal factors for mouth breathing are respiratory obstructions like enlarged tonsils and adenoids.
Milk or deciduous teeth which are present by the age of 2 ½ years have spacing between the teeth. If the spacing is absent between the milk teeth or they are slightly irregular then the chances of the child developing malocclusion are high.
In the mixed dentition around 7 to 8 years when the incisors are erupting especially in the lower jaw, occasionally the permanent teeth are erupting behind the milk teeth which have not fallen. It is advisable to extract the over retained mandibular milk incisors to make way for the mandibular permanent incisors to align.
Today the emphasis is on ‘preventive orthodontics’ and early interceptive orthodontics. Depending on the malocclusion serial extraction procedures are adopted where at particular intervals milk teeth are extracted and space is made for the permanent teeth. This is carried out in conjunction either with myofunctional appliances or fixed orthodontic treatment depending on the case.
There are several advantages of early orthodontic intervention. Most importantly the treatment is completed by 12 years and not begun at 12 years. Results are more stable.
Advantage is taken of the prepubertal and pubertal growth spurts to redirect the jaws into regular alignment. Last but not the least extraction of permanent teeth is avoided in many cases.
Injuries to the permanent teeth are another common feature seen. The face being the most exposed part of the body and the teeth being most prone to facial injuries. In accidents occasionally teeth are avulsed from the mouth. These teeth can be successfully reimplanted after proper treatment.
Teeth that are broken and where the pulp is not exposed can be restored to their original shape by cosmetic dentistry bonding procedures. One sitting RCT procedure is adopted if the pulp is exposed.
Cleft lip and palate is another anomaly seen in children at birth. Orthodontic intervention begins at birth with the fabrication and placement of orthodontic obturaters to facilitate the breast feeding of the baby at birth.