DENTISTRY
Periodonty (Children Dental Health)
Teeth have an important place in the picture of children’s general health. As they are growing in every aspect, they are in need of good nutrition and hence, healthy teeth. Acute decay and bad oral hygiene may cause gingivitis in children, and this in turn may lead to consequences such as fatigue and fever, etc.
Milk teeth (primary teeth): The milk teeth in babies start appearing from the 6 months of age onwards. Generally, the lower incisors erupt first. The period of eruption of milk teeth gets completed between 18-30 months. When all the teeth are erupted, there are 20 teeth in total in the mouth of the child.
Permanent teeth: permanent teeth appear with the eruption of 1st molars from the age of 6 onwards. These teeth erupt behind the milk-molar at the very back of the mouth and, are often ignored by the parents, as they think that these are the milk teeth. Thus, premature losses occur. Permanent teething period gets completed, when the wisdom teeth erupt.
FUNCTIONS OF MILK TEETH
- They ensure proper nutrition and speech, until the eruption of permanent teeth.
- They protect the seeds of the permanent teeth, growing underneath them, against small traumas encountered often with the children.
- Nowadays, as the children are sent to the nursery schools at an early age; teeth decay or losses, distinct from that of their friends, may lead to psychological problems especially amongst girls.
- One of the most important functions of milk teeth is to act as space keeper for the permanent teeth which are going to replace them subsequently. Even though prematurely lost milk teeth are shrugged off, other teeth advance towards this region with gap. This narrows the space where the permanent teeth to be erupted and, causes this tooth to erupt crooked or never erupt. In the end, orthodontic problems (misshapen teeth) emerge.
TEETHE IN CHILDREN
When do teeth erupt?
On average, the first tooth appears in the middle of 7th month. However, while the first tooth sometimes erupts in the third month, sometimes it erupts in the twelfth month and sometimes even erupts in later ages. Eruption of teeth generally complies with the genetic order; in other words, if your or your spouse’s teeth are erupted early, it is most likely that the same thing happens to your child. You can see the average eruption times of the milk teeth in the figure below:
What happens during teething?
The symptoms of teething may appear two-three months before the teeth themselves. These symptoms vary from baby to baby and, in fact, the opinions about what these are and how much pain they cause vary from doctor to doctor. However, in general, it can be assumed that a teething baby may experiences the followings:
Saliva: Many babies salivate starting from two and a half to three months of age. Teething increases saliva flow more in some babies than the others.
Reddening on the jaw or on the face: reddening or cracking of the skin around the jaw and the mouth, contingent to the irritation caused by continual contact with saliva in a baby, who salivates a lot, is not that surprising. To prevent this, periodically clean the saliva gently throughout the day and, also place a towel underneath the bed sheet to soak the saliva flow while your baby is asleep. When drying appears on the skin, keep that area continually moisturized with a skin cream.
Gentle coughing: Excessive saliva flow may cause baby to gasp for breath and cough occasionally. If your baby is not showing any symptoms of a chill, common cold or allergy; there is nothing to worry about. It is commonly seen that the babies prolong their coughing either to attract attention or to enrich their acoustic repertoire.
Biting: Under these circumstances, biting is not a sign of hostility. A baby with erupting teeth tries to relieve his/her gum by putting everything–this can be its own hand, mother’s breast, finger of a stranger- into their mouth.
Pain: Inflammation develops in the gums under the pressure of an erupting tooth. This situation while causing unbearable pain in some babies, it may not cause any problems in some. The first and molar teeth eruptions cause the most difficulty.
Discomfort: As inflammation increases and the sharp tooth gets closer to the surface, the pain in the gum of the baby becomes chronic. Baby may be uncomfortable as everybody with a chronic pain and drift apart from his/her normal behavior. This discomfort sometimes may last for weeks.
Refuse feeding: A baby with a teething problem may refuse feeding. A baby, who started to eat solid foods, may loose his/her interest in these foods for a while. However, you should not be worried about this. Because, you baby receives the necessary nutrients from the fluid food and after the eruption of the tooth, his/her appetite shall be restored again.
Diarrhoea: Its relation to teething is very dubious. Some mothers say that their baby always suffers from diarrhoea every time a tooth erupts. Some doctors think that there is a likely connection between teething and intestinal activities due to increased saliva flow. Whereas, some doctors dissent from the existence of such a connection; the reason for this dissent may be due to doctors getting cold feet about mothers disregarding the gastrointestinal disorders by interconnecting every diarrhea case to teething. Know that your baby’s excrement may be watery. But, without fail, inform your doctor about the diarrhoea which lasts longer than two defecations.
Fever: fever is also a symptom like diarrhoea that doctors approach with caution about its interconnection with teething. A fever below 38 C may accompany teething due to inflammation in the gums. At any rate, if your baby has a fever, act like what you do at other times and, if the fever does not drop within two days, inform your doctor.
Insomnia: Even the babies, who sleep like a log throughout the night, might awake at nights when teething. In such a case, do not try to feed the baby immediately. Instead try to put the baby asleep again by him/herself. Weakening at nights is seen more often during the eruption of first mandibles and molars as in the case of other problems.
Gum haematoma: Sometimes an erupting tooth may cause bleeding in the gum. And this is seen as a bluish stain. There is no reason to worry for these haematoma and they clear up automatically without any medical intervention. Cold compress may relieve pain and enhance recovery.
Pulling ears, scratching cheeks: The pain in the gums may be reflected to ears and cheeks through nerve system. Please don’t forget that babies also pull their ears when they suffer from ear infection. If you suspect an ear infection, consult your doctor even if your baby is teething.
What to do during teething?
There are dozens of tried therapy methods. Some work, some doesn’t. You may also try some of these indicated below:
Give something to chew: the objective here is to relieve the pressure on the gums rather than giving something with nutrition value. For this reason, if the chewed thing is cold, its benefit increases. Frozen biscuit, a cold banana or carrot, a piece of ice wrapped in a cloth, a plastic tooth ring will do nicely. Whatever you give to your baby to chew, without fail, stay with him/her and make sure that he/she is in a sitting position.
Give something to scratch their teeth: Some babies may reject these due to initial pain. But after a while the pain yields its place to relief.
Give cold drinks: Give your baby a feeding bottle with cold water. If he/she refuses the bottle, try to give it in a glass. In this way, the water need of your baby is also met and, you also replace the fluids lost through diarrhoea or increased saliva flow.
Give cold food: Peach puree, apple puree, yogurt cooled in the refrigerator may be more attractive to your baby than the foods in room temperature.
Give something to relieve the pain: If nothing else works, paracetamol shall featherbed your efforts. Consult your doctor for adjustment of the dosage. Do not rub any thing else on your baby’s gums, unless recommended by your doctor. These also include beverages with alcohol.
CARE AND PROTECTION OF TEETH
Due care must be provided for the teeth from the time of eruption of milk teeth onwards. It is wrong to neglect the care and treatment of milk teeth by thinking “it will be replaced anyway”. Filling of the milk teeth and performance of other treatments, under necessary circumstances, prevent this tooth to be lost prematurely.
Teeth must be brushed for two minutes at least two times a day. Especially the brushing of the teeth before going to bed is very important. During sleep, the amount of saliva flow reduced to a minimum and hence the characteristic of saliva in washing and cleansing the teeth surfaces is reduced. For this reason, the number of bacteria, and parallel to this, the acid environment in the mouth increases. And this, in turn, causes teeth to decay.
Another way of protecting milk teeth against decay is the covering of the chewing surfaces of deeply indented milk teeth and permanent molar teeth inclined towards decaying with fissure covering material by the dentist. Fissure covering materials discharge flour into their environment. And hence, surfaces form which are more resistive to decay. As the application is very easy, it is the easiest way in terms of children getting acquainted with the dentist. As the areas, which are difficult to clean, are covered, the risk of decay also minimized.
Dentists and the parents must collaborate for the children to have a better oral health in the future.
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