Paediatric dentistry

Why is it important to treat a child’s dentition before he/she reaches adulthood?

A good dental status in the young age often assures a healthy dental condition even during adulthood. The positive attitude towards dental health more often establishes a healthy diet and prevention of oral health problems.

The treatment plan in children will take account of the following considerations:

1.Behaviour Management

2.Prevention of dental decay

3.Restorative treatment

4.Developing Occlusion

Restorative treatment without prevention is of limited value. Hence,we emphasise on a modified diet. Most often a combination of prevention,restoration and extraction is indicated for most children with caries/dental decay in primary/milk teeth.

 

Other considerations:

Pain or evidence of abscess/infection.

1.Temporization of open cavities

2.Use of medicated fillings

3.reduction of bacterial count(Streptococcus mutans)

4.preliminary coronal seal enhances the chances of pulpal recovery

Delivery of care:      

1.Counselling of the parents

2.LA/Sedation/GA- Risks vs Benefits of each

3.Planning of operative care at a pace appropriate to the child’s ability to cope.

4.Consideration of medically compromised children(like heart diseases, small stature,systemic diseases)

 

The anxious child:

Techniques for behaviour management come with experience of treating children over a period of time.

There are various behaviour modification techniques that we follow at Smileoracles’ Multispeciality Dental Centre to make the child friendly to the Dental office and the staff. Its quite natural with the fear of the unknown and being unable to understand the sequence of events during the procedure, the child remains apprehensive.

The techniques we follow to comfort the child:

1.Sedation

Oral and intravenous drugs like midazolam and chloralhydrate can be used.

2.Hypnosis

3.General Anaesthesia

The Child with toothache:

It is quite natural for a child with toothache to be irritable, uncooperative and not be able to eat comfortably. For children less than 4/5years of age inability to express the discomfort in the oral cavity often aggravates the problem and further makes treatment extensive and complicated.

It is advisable to get periodic dental check up very soon the first tooth erupts.

At Smileoracles’ Multispeciality Dental Centre we take special care to make your child painfree with our specialized team of doctors.

 

Assisted guidance in other problems associated with Oral cavity:

1.Abnormalities in tooth exfoliation and eruption.

2.Abnormalities of tooth number.

3.Abnormalities of tooth structure

4.Abnormalities of tooth form.

5.Abnormalities of tooth colour.

Extraction Versus restoration of primary teeth:

Despite a welcome reduction in the prevalence of dental decay,the dilemma of whether to restore or extract a primary tooth is still familiar. In making a decision at Smileoracles’ number of factors are considered.

1.Age

2.Medical History: Pulp therapy in medically compromised like heart disease is inappropriate. These are possible sources of recurrent  bacteremia. In haemophiliacs, extraction should be avoided IF POSSIBLE.

3.Motivation and cooperation of parents: The parents must understand the benefits of maintaining the child’s primary dentition.Unfortunately, a small proportion of the population still regard a dentist that fills primary teeth with suspicion- after all ,everyone knows that the baby teeth will not stay forever!!

4.Caries rate

5.Pain

6.Extent of the lesion

7.Position of the tooth

8.Presence/absence of permanent successor.

9.Malocclusion

Introduction of Painfree Dentistry -Laser Dentistry

The most promising pain-free system being introduced soon!

Severe Early Childhood Caries

 Cause: Frequent intake of sugary and sticky food stuff.

Nursing Caries/Bottle caries: Frequent consumption of sugar-containing drink especially from a feeding bottle. It is also attributed to prolonged on demand breast feeding, especially at night, from the lactose in breast milk.

Rampant Caries: Rapidly progressing caries affecting many teeth in the primary and permanent dentition.

Deep Dental decay involving the pulp/nerve tissue:

Vital and Non-vital Pulp Therapy-

1.Pulpotomy- For infected tissue limited in the coronal portion

2.Pulpectomy-For infected tissue down below the root canals with possibilities of abscess.

Dental Trauma:

Prognosis is good in cases of dental trauma with immediate treatment.

KEY TO SUCCESS: SEEING THE PATIENT AS SOON AS POSSIBLE

Points to remember-

1.Avulsed permanent teeth should be replanted immediately.

2.Avulsed primary/milk tooth should never be replanted as there are possibilities of ankylosis.

3.Crown or root fractures have different modalities of treatment depending on the position of the fracture.

Principles of Treatment:

1.Emergency Treatment-

Elimination of pain;

Protection of pulp;

Reduction and immobilization of teeth;

Suturing of soft tissue laceration

Antibiotics,Tetanus,Analgesics,Chlorhexidine mouthwash

 

2.Intermediate treatment

Pulp therapy

Orthodontic treatment considerations

Semipermanent restorations

Review-1month/3months/6months /2years

 

3.Permanent treatment

Usually deferred until 16years