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IMPORTANCE OF PHYSICAL GROWTH PERTAINING TO TEETH

Tooth eruption, shedding and development of jaws bones is recognized as an aspect of overall human physical growth and development.

HOW IS IT RELATED?

Developmental milestones are physical skills seen in infants and children as they grow and develop. Thus there are such fixed milestones in children at different ages indicating the right growth of the child. This can be best understood by the ‘growth spurts’ of your child.

There are various factors that affect the growth of your child and creates a deviation from the normal growth spurts which also greatly, in turn, affects the tooth and jaw development of your child.

HOW IMPORTANT MUCH IT IS?

Pertaining to your child’s oral health TEETHING is also one of the main first stepping milestones of his/her overall development.

Teething is a process by which infant’s first teeth erupt.

Some of the conditions you should aware of the importance of overall physical growth and development pertaining to teeth:

1. Down’s syndrome- Condition with Intellectual deficiency.

Dental issues: Increased risk of dental caries and loosening of baby teeth eventually making it fall.

And the teeth look small in size compared to normal tooth size.

1. Ectodermal dysplasia-Condition was common in children with Dry skin and sparse hair.

Dental issues: Missing teeth, jaw bones malformed.

There are also several conditions causing early loss of baby teeth in children:

1. Diseases of bone

2. Diseases of metabolism like juvenile diabetes

3. Hormonal imbalances related to pituitary and thyroid hormones.

Thus there are various physical growth and developmental disturbances which are present from birth and acquired through lifetime most commonly affecting the dental development of children

Referral to a pediatrician for diagnosing and treating the underlying systemic disease is essential for successful dental management.

CHILD ABUSE AND TOOTH TRAUMA

Child abuse/child maltreatment is physical/psychological or / and sexualmaltreatment/neglect of a child especially by a parent or a caregiver.

Various children around India even today face these kinds of abuse that affecting them both physically and mentally.

Among various kinds of abuse, children facing physical abuse, a non-accidental act or behavior causing injury trauma or bodily harm, Facialinjuries are more prevalent in physical child abuse and accounts for about 50% of overall body injuries.

How can you identify?

  • A child facing facial injury during an abuse, he/she will get their teethtraumatized/knockingout indicating a blunttraumaatthesite.
  • Toothdiscoloration is an indication of repeatedtrauma.
  • Stages of healing will be different for each injuries, there will be no uniform healing of all wounds.

“Prevelence of dental injuries in physical abuse”:

Fractured teeth-32%

Fracture of upper/lower jaw-11%

Though in India, child is considered as gift of god, child abuse is still common especially in remote and tribal areas.

However child abuse cases are not reported due to lack of awareness.

Various laws and NGO’s are working against child abuse in India.

STOP CHILD ABUSE!!! LET THE CHILD SMILE BIG!!!

Parental Awareness In Paediatric Dentistry

Oral health in children plays a vital role as it lays down the foundation for healthy adult teeth. Maintenance of oral hygiene should start before the first tooth erupts, and parents play a very important role in influencing their children’s oral health.

PARENTAL ATTITUDE TOWARDS CHILD’S ORAL HEALTH

The parents with proper oral health knowledge and attitude are likely to positively influence their children’s oral health.

For example, if parents brush twice a day in front of their children they will be spontaneously encouraged to brush twice daily.

PARENTS IGNORANCE

Most of the parents are unaware of the consequences of the dental issues of their child that is ignored commonly.

Children with poor oral hygiene develop early childhood caries which is the most serious and expensive ill health condition if ignored.

WHY THEY IGNORING?

Parents usually have a thought that the baby teeth with caries will anyways fall and new teeth will erupt. They are unaware of the causes, the preventive care and treatments of early childhood caries and consequences if left untreated and their child’s health becomes compromised at the end.

Not only with regards to early childhood caries, but children are also developing misaligned teeth and improper placement of jaws in their later years of age due to ignorance in childhood. Most of the teens are having a lack of confidence and facing lots of struggles due to poor dental esthetic appearances as it becomes late for treatment at that stage.

When parents really concern and rush to a hospital if their children suffer from flu and other medical illness, this is to bring awareness among them that the dental issues can also be a major cause for compromised medical conditions.

A parent’s knowledge about their kid’s oral health and its importance and awareness are present but are insufficient.

Your child’s oral health is the basic foundation of his/her overall good health!!!

Tooth trauma in kids. Fix up an immediate appointment with a pedodontist. It will definitely help.

TOOTH DISCOLORATION


Tooth discolouration as a result of trauma/injury is most common among kids.

When your kid’s teeth get injured at a considerable level, that will involve the pulp of the tooth, and usually greyish/brownish discolouration of the baby tooth occurs several days after injury which is due to the main reason of ignorance.

This discolouration often goes unnoticed and leads to loss of baby tooth and creating a problem for the eruption of adult teeth.

So it is mandatory to undergo pulp therapy for the injured baby tooth and restore it with tooth coloured crown with your pediatric dentist.


AVULSION OF TOOTH


Tooth avulsion is the most common scenario that occurs soon after the injury where the tooth is completely knocked out from your kid’s tooth socket.

What should you do when your kid’s tooth was knocked out?


Your pediatric dentist will restore the injured tooth by appropriate pulp therapy and crown placement.


How Tooth chipping affects Kid’s Milk Teeth

How Tooth chipping affects Kid’s Milk Teeth

TOOTH TRAUMA

Your kid’s teeth can become chipped, cracked, broken into pieces and knocked out completely as a result of minor/major injuries.

Kids often knock out their front tooth during fall/injury, this is because the upper jaw for the kids are quietly placed forward compared to the upper jaw of adults. This makes the upper front tooth of the kids to become more prominent and forwardly placed making it easy for the injury.

TOOTH CHIPPING is one of the types of tooth trauma common in children.

TOOTH CHIPPING

Tooth chipping is a complete/incomplete crack to the baby tooth (most commonly front tooth),that may involve chipping only a part of the tooth, commonly involving the lower third of the kid’s front tooth.

Your child may not feel any pain or he/she might have mild sensitivity later. But this gives really a bad esthetic appearance to your kid while he/she smiles,

And hence, it has to be treated with your pediatric dentist to restore your child’s beautiful smile.

In this case a small restoration of the baby tooth can be done if just a part of enamel has been chipped off, or if considerable tooth loss has taken place your pediatric dentist will restore it with tooth colored crown.

Preventing Baby Bottle Tooth Decay

Baby bottle tooth decay is preventable. Here are some simple steps to put you on the path towards healthy teeth:

  • Avoid kissing your child on the mouth or tasting his food before offering the food to him. This will prevent the transfer of decay causing bacteria from the mother to the child’s mouth.
  • Whether you choose to breastfeed or bottle-feedit is important to take good care of your baby’s teeth.
    • Birth to 12 months: Keep your baby’s mouth clean by gently wiping the gums with a clean baby washcloth. Once you see the first teeth, gently brush using a soft damp baby toothbrush.

  • 12 to 36 months: Brush your child’s teeth 2 times per day for 2 minutes. Use a smear (rice grain size) of fluoride toothpaste until your child’s third birthday. Brush the teeth with a pea-sized amount of fluoride toothpaste from the ages of 3 to 6.
  • Avoid feeding your child while he is watching television. Children tend to pouch the food and keep it in the oral cavity for a prolonged time increasing chances of decay.
  • Never fill bottles with sugared milkand soft drinks. Bottles are for plain milk, water and formula alone.
  • Never allow your child to fall asleep with a bottlecontaining anything but water.This not only exposes your child’s teeth to sugars but can also put your child at risk for ear infections and choking.
  • Never give your child a pacifier/teether dipped in anything sweet like honey.
  • Teach your child to drink from a regular cup as soon as possible, preferably by 12 to 15 months of age. Drinking from a cup is less likely to cause liquid to collect around the teeth and cannot be taken to bed.
  • Limit the amount of sweet or sticky foods your child eats, such as candy, gummies, cookies, cakes and toffees. They should be eaten only at mealtime and never as an in between meal snack.
  • Serve juice only during meals or not at all. Never give juice to babies younger than 6 months. If juice is given to babies between 6 to 12 months, it should be limited and diluted with water (half water, half juice). Try to give whole fruit whenever possible.
  • Make sure your child is getting enough fluoride, which helps lessen cavities. Fluoride can be supplemented at home by means of a fluoride tooth paste or at the dentist’s office by application of a fluoride varnish.
  • Ask your dentist about sealants, which can help prevent tooth decay in back teeth.When your child’s first tooth appears, talk to your dentist about scheduling the first dental visit. Remember the best time to see a dentist is before the first birthday. Treat the first dental visit as you would a well-baby checkup with the child’s physician. Remember: starting early is the key to a lifetime of good dental health.

BABY BOTTLE TOOTH DECAY

Tooth decay in infants and toddlers is referred to as baby bottle tooth decay or nursing bottle caries.Though the name suggests it is caused exclusively by bottle feeding, it can occur in breast infants too if the correct technique of feeding is not followed. This type of decay typically affects upper front teeth though other teeth may be affected too.

Childhood Teeth Decay Stages

What causes BABY BOTTLE TOOTH DECAY?

The cause of this characteristic pattern of decay are sweetened liquids or those with natural sugars (like milk, formula, and fruit juice) being in prolonged contact with an infant’s teeth for a long time. Bacteria in the mouth grow rapidly on this sugar and make acids that attack the teeth and destroy it completely over time.

One common risk factor is the frequent, prolonged exposure of the baby’s teeth to drinks that contain sugar. Tooth decay can occur when the baby is put to bed with a bottle or when a bottle is used as a pacifier for a fussy baby.

If baby bottle tooth decay is left untreated, pain and infection can occur which may result in abscess formation and even need hospitalization to treat the infection. If teeth are taken out early without precautions to maintain their space,the child may develop poor eating habits, speech problems, crooked teeth, and damaged adult teeth.

Impaction of a primary mandibular canine : combined surgical and orthodontic management

Introduction

Unerupted teeth are seen more commonly in the permanent and early mixed dentition.Unerupted primary teeth are far less common and commonly involve the lower and upper second molars. Thecauses for the unerupted tooth may include another supernumerary tooth,odontoma, a cyst or tumor and inadequate space foreruption.Primary failure of eruption though uncommon may exist as do syndromic and non-syndromic associations like Gardeners syndrome and Cleido-cranial Dysostosis where often multipleteeth remain unerupted.

Odontomas are developmental anomalies due to complete differentiation of epithelial and mesenchymal cells resulting in fully functional ameloblasts and odontoblasts. They are further classified into compound and complex odontomas depending on the level of differentiation of the hard tissue. Often, they are asymptomatic presenting as routine radiographic findings or may hamper the eruption of teeth. There are very few case reports indicating the association of an odontoma and an unerupted primary tooth, especially a primary canine.

Themost common technique of management of these unerupted primary teeth is surgical exposure or surgical exposure followed by extraction of the unerupted tooth. In this case report, an unerupted primary mandibular canine is managed via a combined surgical – orthodontic approach to ensure optimum position of the tooth. This report documents the first instance of use of use of orthodontic forces to aid in eruption of an impacted primary tooth.

Case report

A 48-month-oId female presented with a chief complaint of anunerupted mandibular right primary canine.The parents reported that the mandibular left primary canine had erupted almost a year previously. Prenatal, natal and postnatal history from the hospital records did not show any need for neonatal laryngoscopy or endotracheal intubation. Nor was there any history of natal/neonatal tooth which might have warranted early extraction. This was the patients first dental visit and patient’s medical history was unremarkable. Patient’s parents did not reveal any family history of similarly unerupted teeth.There was no history of any trauma that might have caused premature loss or intrusion of the tooth.

On examination the patient was found to be uncooperative with a Frankels behavior rating of negative.

Clinical examinationrevealed a flush terminal plane occlusion, adequatearch length, and normal relationships in the verticaland transverse dimensions. The whole complement of primary dentition was erupted except for the right mandibular canine despite presence of adequate space for its normal eruption. Adiscrete hard swelling could be palpated in the gingiva overlying the unerupted tooth.

Anorthopantomogram was advised which revealed the presence of the unerupted primary canine with one third root formation was complete and an age-appropriate complement of developing permanent teeth. A small single discrete mixed radiopacity overlying the unerupted caninecrown was visible on examination of the OPG.The radiopacity was surrounded by a thin radiolucent line. The left mandibular canine was on the other hand was fully erupted with root formation almost complete. The lower right permanent canine tooth germ was also visible on the radiograph. On the basis of clinical and radiographic examination a provisional diagnosis of odontoma was made impeding the eruption of the tooth.

Considering the young age of the child and heruncooperativebehavior, the parents were counselled about the various treatment options available i.e. adopt a wait and watch approach, consider only surgical exposure and surgical exposure followed by immediate bracket bonding and application of orthodonticforces. As per the parents’ wishes, surgical exposure followed by orthodontics under GA was chosen as line of therapy.

The patient was referred to a physician for pre-anesthetic clearance following which the procedure was scheduled in a hospital OT setting. Theentire surgical procedure was done under GA. An incision was made over the edentulous ridge fromthe distal of the right central incisor to the mesial of thesecond molar. A full thickness mucoperiosteal flap wasreflected labially and the overlying alveolar bone wasremoved to expose the crown of the canine. During surgery, a small calcified mass was located labial to and separate from the canine crown which was removed with a periosteal elevator under saline irrigation.

Before closing the surgical site, the option of allowing spontaneouseruption of the canine was considered. The canine in addition to being prevented from eruption appeared to have been rotated around its axis. Since exposurehad been accomplished, in consultation with the parents, we chose to initiateorthodontic treatment immediately.

After ensuring adequate isolation of the deciduous canine, an acid etchant was applied for a period of 20 seconds followed by the bonding agent application and light cured for 20 seconds.In caseof contamination due to blood or saliva was suspected the whole sequence of etching and bonding was repeated.A small amount of orthodontic light cure composite was placed on the bonding surface of orthodontic bracket. The bracket was then oriented on the exposed canine and cured with light curing unit. Followingthis orthodontic bracket were bonded on all the remaining teeth with banding of the 75 and 85.

The surgical incision was closed after bonding a bracket on the surgically exposed canine which was united by an arch wire to the remaining erupted mandibular primary teeth. Surgical suturing was done with 3-0 silk sutures.Force application was delayed for one week to allow the site to heal. The patient was seen everythree weeks, to monitor the status of eruption.

At the time of debonding after six months the teeth had erupted perfectly into occlusion with correction of the initial minor rotation. The OPG indicated the normal development of the permanent canine underneath with continued root formation of the deciduous canine. At follow up after one year the patient was asymptomatic with no changes in the occlusion. Normal development of the underlying permanent canine was also evident from the OPG.

Conclusion

In conclusion, early detection and management of unerupted primary teeth is essential to prevent problems in the eruption of their permanent successors. In this report the combined use of surgical exposure and excision of overlying odontoma under GA followed by orthodontic therapy has improved the chances of tooth eruption into a proper occlusion. This report presents a case for early application of orthodontic forces to ensure an optimum outcome.

Why public seek dental treatment as a last resort in India?

In the entire world there are three categories of countries – Developed , developing and under developed based on the global economic scenario . You might think why am I talking about this in this context?  Do we have some link in this regard to dentistry? Yes definitely there is a strong link cited in the Scandinavian  countries with scientific literature that developed countries take preventive attention to teeth much more than therapeutic attention .

The reason cited in developed countries is that their education background is much better and because of this more awareness to health and they have a better socio-economic balance in the country as a whole .  So the government itself is self-sufficient and people living are self sufficient for their basic needs and health care. Because of the above cited reason a lot of research and awareness activity is carried out in dentistry pertaining to preventive care . That is why they focus more on preventive care than therapeutic care .

In developing and under developing countries like India , China and African countries,  we are the other way round. We are more in the process of getting our basic needs balanced . So people get basic health access only when the problem arises, hence most of them resort at the last movement . Moreover teeth is considered as the most non-important organ in the body even though it is the most utilized organ in the body on a day to day basis . So public please take care of your teeth with a good dentist regularly and make teeth life simpler and healthier.

Note :  God’s given teeth for any reason cannot be matched by your dentist given teeth “

So , again I repeat    “ Take care of your teeth“ . 

How to prevent caries?

  1. Brush twice a day quickly and effectively
  2. Do flossing/ interdental brush based on the space between teeth.
  3. Use fluoride containing mouthwash and toothpaste, if you are prone to caries.
  4. Avoid sugary and sticky food. In case of sugar consumption brush your teeth preferably after every meal.
  5. Drink lots of water and fluoride containing beverages.
  6. Eat crunchy, bright coloured and fibre containing foods like carrot, celery, apple, nuts, sprouts, bran, etc.
  7. Certain foods like cheese, milk, yogurt, seafood are known to prevent caries.
  8. Chew non sugary gums often because it increases your salivary flow.
  9. Avoid frequent snacking as it exposes your teeth to constant bacterial attack.
  10. Visit your dentist every 6 month to make sure no caries develop by applying sealants and fluoride varnishes. Give proper attention to any cavities in the beginning to avoid any pain or discomfort later