Handling of child in the Paediatric dental clinic
Children have varying attitudes and temperaments. No two
children are the same. In fact, the same child on different days may behave
Managing different behaviours, at the same time instilling a
positive dental attitude is one of the greatest challenges of paediatric
dentistry and paediatric dental surgeons are specifically trained in child
psychology to manage child behaviour at different ages! So, let us take a small
peek into the various techniques we use to our advantage:
- Audio-visual distraction: Children, especially of the age group of 5-7 years are easily distracted! So a TV screen with brightly colored cartoons or educational videos/ soothing music is a great way to keep the kids occupied while we work in their mouth.
- Modelling- Children learn a lot from their siblings/peers. Generally while treating siblings, we treat the older, more mature one first while the younger one looks on. Works like magic!
Of course, establishing communication is key. Paediatric
dentists generally use soothing voices/ simple words to explain the procedure
to the child. No other technique compares to this! Once we gain the child’s
trust, we can work wonders!
At the same time, slightly changing to a more authoritative
tone is also done in case the child is not behaving properly. Worked for our
What can be done if your child is simply too young or too
anxious or has special health care needs?
- We can use medications like nitrous oxide(laughing gas) delivered through a nose mask to keep your child relaxed throughout the procedure.
- If the child is very fearful and does not allow us to even place the nose mask, we resort to giving medicines either orally (through the mouth) or I.V, in the presence of a certified anaesthetist.
- If multiple treatments are required and we simply cannot manage in the clinic settings, it is better to go for treatment under general anaesthesia where the child is completely unconscious.
- These methods have an added advantage that they cause a bit of amnesia… so the child does not remember the details of the procedure and give an overall “feel-good” factor.
Many parents defer treatment as they feel their child is too
young and finally approach us, when the pain becomes unbearable. This is not a
wise thing to do, as the age of the child does not matter. It is the way we
handle them, that does.
Visit your nearest clinic today and gift your child the smile
Common Causes Of Tooth Decay
Tooth Decay is one among the world’s most common
health problem seen in children and adults. If tooth decay is not treated they
might affect deeper layers of your tooth structure which leads to severe pain,
infection and finally tooth loss. Major causes for tooth decay develops by
eating sugary, sticky food and beverages. The more sugar consumed, the more
acid attacks the tooth leading to decay. Plaque formation is another major
factor of tooth decay. When sugar combines with plaque, it weakens the tooth
layer causing decay. Each time we consume sugary snacks our tooth is more prone
Second factor is poor oral hygiene. It allows
plaque formation which attacks the enamel of tooth eventually causing hole in
mouth is another cause for tooth decay. Food tends to stick to your teeth can
increase risk for cavities. As decay progresses we start getting pain which is
the common symptom for decay, hole or pits can be noticed in the affected
tooth. Most serious symptom is swelling and pus in and around the tooth.
To prevent decay, first step is to maintain good
Oral hygiene. Limit your intake of sugary food and drinks. Rinse your mouth
with mouthwash which helps in removing food that is lodged in between your teeth.
Visit your dentist twice a year for routine examination.
Space Maintainers And Their Types
In the last post, we learnt about
the need for space “maintainers”. There are different designs of space
maintainers and the decision to choose a particular design is based on:
- the number of teeth missing,
- the number of teeth present in the mouth and
- the number of years remaining for the permanent teeth to erupt.
If only a single tooth is
missing, we can go for a fairly simple design called a “band and loop”. This is
very stable and easy to maintain.
multiple teeth from both sides are missing, we may have to give a slightly
sturdier design so that space in both sides of the mouth may be maintained
Generally constructed with
stainless steel wire, these space maintainers may be made of acrylic also. Teeth
can be set in the base so that your child may be able to chew properly.
Removable varieties are available, although majority parents and practitioners
prefer fixed type. Children are very unpredictable, right?
Space maintainers can also
transform your child’s smile and boost their confidence! If there is no other
option but to extract, space maintenance is MANDATORY. After all, a stitch in
time saves nine..
Space maintenance is pretty straightforward. But what can be done in case it has been many years since extraction of milk teeth and space “loss” has already occurred?
That is when we “regain the
space”. Why? Because we do not want the permanent teeth to erupt crookedly!
“If braces are anyway needed, why
should we go through all this earlier? Can’t we correct it in one go?”..This is
another question normally asked by parents. You have to understand, the main
aim is to reduce the severity and duration of orthodontic treatment later.
Also, we are trying to bypass crowding and avoid extraction of permanent teeth
while fixing braces, which may otherwise be required.
designs are similar to space maintainers, except a spring or screw may be
inserted to open up space
How much time should these be worn? Depends on amount of space needed to “regain”. Your dentist will generally start fixed treatment with braces soon after this step.
Contact your nearest clinic today
for more information!
Space “Maintainers”- What, Why, How, When?
Earlier, dentistry used to be synonymous with “extraction” of
badly decayed teeth. Especially in children. The idea was that milk teeth are
going to be replaced anyway, so why not just remove it. But what if I told you
that the thinking has changed now? The permanent teeth especially in the back
of the mouth do not erupt till 10-12 years of age and keeping an empty space in
those areas till that age is not good.
So, what happens if the milk tooth has to be removed pretty
- The permanent tooth developing underneath is not ready to come out… So, the back teeth may “tilt” into this space
- Once the back teeth tilt, space available for the other teeth reduces
- At age 10, the permanent teeth are crowded/ stuck and arranged wherever there is a little space- Braces will definitely be required to align
What can be done, then?
- Space maintainers are given immediately after extraction of the milk teeth.
- These will be in place till the permanent teeth are ready to erupt and prevent loss of space.
- The probability/ duration of orthodontic treatment reduces at a later age.
Medium for Re-implanting tooth
When a tooth completely comes out of socket it is called
AVULSION of tooth. In this scenario the golden time to reach a nearby dentist
is 60 minutes.
Never clean the tooth or root with a scrubber or tooth brush
Never carry the tooth dry or in a box wrapped of paper
Preferable mode of carrying the tooth are regular milk (not
hot), tender coconut water, patients saliva, HBSS, cotton, lens solution, in
patients own mouth saliva, placing it back in the tooth socket etc.
If these above instructions are followed then success rate
for re-implanting the dislodged tooth is very high.
For more details
How safe are the full mouth X-Rays?
last post, we had seen the uses of full mouth X ray called Orthopantomogram (OPG).
benefits are more, agreed, but what about the safety? So let us go back to
basic mathematics here:
a child is having cavities at 4 different places in the mouth.
With a basic intra oral film, we can see a maximum of two /three teeth properly
in a particular area. That means if cavities are there in four
completely different places, we have to take 4 separate films.
Meaning 4 times we have to expose the child to X Rays.
is it not better to take a single large film with single dose to see all the
areas in the mouth?
being said, dental Xrays make up just 1/10th of the
environmental radiation a person is exposed to on a daily basis..
addition, the child is draped with a lead apron and collar for extra
conclusion, an OPG is completely safe. And completely required,
if the full mouth is to be seen at one go.
Kidz ‘N’ Teenz introduces
the world’s smallest OPG machine to address the patient’s time and
travel issues. We are upgrading to provide all treatment in house!
we advise the parent to take a full mouth X-Ray called an OPG or Orthopantomogram.
often, we get this question in return- “Doctor, but why this? Why can’t we go
for the small film?”
So let us have a look at the innumerable uses of OPG:
1. OPGs are extremely useful, especially in children. This is because we can see the status of both the milk teeth and permanent teeth in the child’s mouth. So, we can see if all the teeth are erupting in the right track or there is some delay.
2. If there is some delay in development, we can easily see the cause for it. It may be some infection or tooth may be rotated or there might be some obstruction blocking it.
3.In a child who is very anxious, these are the best because the film is outside the mouth unlike the other type where we have to hold film inside the poor child’s mouth!
4. Not just the teeth, it is possible to see the status of the bones of the jaw and the nose also. Basically any fracture/ breathing problems can be evaluated.
5. Lastly, and the most common reason- cavities! If your child has multiple teeth with “holes”, it is better to take a full mouth X-Ray and see all the teeth in one single film.
further clarifications, contact your Dentist today.
In children aged
6-9 years, it is very critical when it comes to trauma in the front teeth
especially, to know outcome of their problem at later date.
is that front teeth erupt at age of 6-7 years or 7-8 years, but root completion
of teeth happens after 3 years, that is 9-10 years.
window period of 6-10 years if any trauma occurs to pulp of tooth or any trauma
occurring without breakage of pulp, it can be managed by a 2 stage process
called Apexification or Apexogenesis.
followed by root canal treatment and later is an intermediate process usually
done with help of MTA at the level where fracture has happened.
advantage of MTA is that it aids in helping roots to grow so that the root
canal can be carried out effectively.
To know more
about tooth trauma visit www.toothtrauma.in
We always get this question. “Aren’t X-rays harmful?”
or “Does it have any side effects on the brain?”
Well, to answer this question, it is important to know
what “natural background radiation” is. This is basically the radiation
we receive on a daily basis from the environment.
And the doses from intraoral and full mouth
radiographs are lower, less than one day of natural background
Does that answer the question?
Also, consider the benefits of taking a small X-Ray
especially when there is a broken tooth involved. We can:
1. Give emergency treatment :
- Visualize the extent of fracture, and that helps us in planning the treatment.
- If the tooth pieces are loose, we can also use X ray to confirm we have repositioned the tooth in the correct manner
2. Monitor the tooth:
- See if there is any developing infection
- Check if the tooth root is formed nicely or not. In young children with newly erupted teeth, the root may not be formed completely. In such a case, we use a calcium rich material called MTA to seal the root.
3. Monitor the treatment:
Monitor the treatment given to see if the filling is in the correct place and the body is accepting the treatment.
Clearly there are more
benefits and is a must, especially in cases of traumatic injuries!