What is the importance of milk teeth?
Smile is a precious gift to hold on forever. So preserving that healthy smile is very important particularly in your younger ones
Milk teeth are very crucial for various reasons. They help in proper chewing of the food thereby ensuring availability of all the required nutrients. They influence your child's overall health.
They help in proper development of speech. They are crucial for proper growth of jaws & to establish proper structure for the face.
Milk teeth guide the permanent teeth to erupt in their correct position thereby avoids teeth crowding.
Good teeth at younger age are of paramount importance in building confidence & self esteem in children.
What are the steps to ensure good dental health for children?
The various cavity preventive procedures include:
- Reduce frequent snacking
- Avoid baby sleeping with sweet solutions in mouth
- Brush effectively twice a day with fluoride toothpaste
- Floss daily
- Have sealants applied
- When appropriate Assure proper fluoride through drinking water, fluoride products or fluoride supplements
- Control unhealthy thumb, finger and pacifier habits
- Seek regular dental check-ups
What is tooth decay and how does it affect your child’s teeth?
Tooth decay is one of the most common dental diseases in children.
Germs (bacteria) in the mouth change the sugar in food to acid. The acid can eat a cavity in the tooth. At the initial stages, food can get lodged into the cavity & can be irritating.
In advanced stages, the decay can be quite painful. The pain disturbs sleep, leads to swelling & tooth fracture. These episodes can be recurrent, affecting the growth, studies & confidence levels for the child.
Early loss of teeth can lead to crowding in permanent teeth. Prevention & Early treatment is the best procedure to save teeth.
What is Early Childhood Decay or baby bottle syndrome and how can that be prevented?
Infants and children who sleep with a bottle containing anything but water are in danger of developing early childhood decay or baby bottle syndrome.
Pacifiers dipped in sugar or honeys are equally dangerous. While a child sleeps the salivary process slows, which allows liquids remaining in the mouth to pool around the sleeping child's teeth. Sugars in the liquid combine with bacteria in the mouth to form acid that dissolves the immature enamel. Newly erupted first teeth are highly susceptible to decay.
Unfortunately, it does not take long for extensive tooth decay to develop. Early childhood decay is easy to prevent.
Avoid lulling young children and infants to sleep with bottles and sweetened pacifiers.
Remember to massage and cleanse your infant's gums with a soft cloth or piece of gauze after each feeding.
Visit the dentist at the time of first birthday of your young one.
The tooth development-Stages
The development of teeth starts at approximately 6 to 7 weeks after conception. Tooth development is a continuous process which takes place in many stages.
Each tooth develops through three successive stages
- Bud stage
- Cap stage
- Bell stage
During the early stages, the tooth germs grow and expand and the cells that are to form the hard tissues of the teeth differentiate. This leads to the formation of enamel and dentine. As the crowns of the tooth begin to form and mineralize, the root formation begins. After the roots calcify, the formation of the supporting tissues begin. These supporting tissues are cementum, periodontium and the alveolar bone. Subsequently the completed tooth crown erupts in the oral cavity. Root formation continues until the supporting tissues are fully developed.
Developmentally, missing permanent teeth is usually a result of genetic abnormality. When fewer than 6 teeth is missing in the oral cavity it is termed as hypodontia. When more than 6 teeth are missing it is known as oligodontia.
The primary dentition is made up of central incisors, lateral incisors, canines, first molars and second molars. There is one of a kind in each quadrant making a total of 5 in each quadrant. Hence totally there are 20 primary teeth. All of these are gradually replaced by a permanent counterpart except the primary first and second molars. They are replaced by the premolars. The replacement of the primary teeth starts at about 6 years of age when the permanent first molar develops. This results in mixed dentition. The process of shedding primary teeth and replacing by permanent teeth is called as exfoliation.
Do newborns have teeth?
We would never think of a newborn having teeth. However by birth itself the crowns of the 20 milk teeth are almost completely formed but are not visible as they are embedded in the infant’s jawbones. The primary teeth gradually erupt through the gums by the age of 2.5 years.
Sequence of eruption
The four front teeth, the upper and lower central incisors are the first to erupt and they generally erupt by 6 to 8 months of age. The eruption pattern is as follows.
Generally most children have a complete set of primary teeth by the time they are 3 years of age. Their jaws continue to grow to accommodate the permanent teeth which start erupting by 6 years of age. The primary teeth begin to shed anywhere between 6 to 7 years of age and continues until about 12 years of age.
What is mixed dentition?
Mixed dentition stage is the period in which there is eruption of some of the permanent teeth but before all the deciduous teeth are shed. It usually occurs between 6 and 13 years of age. It is also called as transitional dentition. Mixed dentition can be classified as early mixed dentition stage which is 6 to 9 years of age and the late mixed dentition stage which is 10 to 12 years of age. It is in this mixed dentition stage that dental abnormalities become very visible. Dental conditions such as missing permanent teeth or malformed teeth become obvious. In this stage skeletal and dental malformations will come into view. An orthodontist can be consulted in this stage to make the necessary corrections and treatment.
What happens in the mixed dentition stage?
This period starts when the permanent first molar erupts and lasts till the last primary tooth is shed. There are 32 permanent teeth but the maxillary teeth eruption sequence varies from the mandibular eruption sequence. Since there are no premolars in the primary dentition, the primary molars are replaced by the permanent premolars. If any primary teeth is shed or lost before the permanent tooth is ready to take its place then the posterior tooth drift forward and hence there may be loss of space in the mouth. This causes crowding and malalignment once the permanent teeth eventually erupt. This is referred to as malocclusion and is a very common finding in the mixed dentition stage. Orthodontics play a major role in this stage for functional and esthetic corrections of the malocclusion.
How does the permanent tooth replace the primary teeth?
- The first sign of tooth formation is the development of dental lamina from the oral epithelium.
- 20 areas of enlargement appear on the lamina which form the tooth buds for the 20 primary teeth.
- After the primary teeth develop from the buds the lamina continues to grow to accommodate the permanent teeth which succeeds the 20 primary teeth.
- The lamina continues posteriorly in the elongating jaw and from it come the posterior teeth which forms right behind the primary teeth.
- In this manner 20 of the permanent teeth replace the 20 primary teeth. And the 12 permanent molars develop behind the primary dentition.
- The last teeth to develop are the third molars which form almost 15 years after birth.
This replacement process goes on from 6 years till about 12 years of age. Generally by the 12th year only the permanent teeth will be remaining in the oral cavity.
Reasons why the primary teeth needs to be well maintained
The primary teeth although temporary needs to be taken care of. A child needs strong healthy teeth to be able to chew food properly for good nourishment. Normal speech with proper pronunciation of words is possible only with well-maintained primary teeth. The primary teeth holds a place in the jaw which is gradually replaced by the permanent teeth. The primary teeth should be kept clean and healthy, free from cavities. Otherwise the pain and infection can affect the underlying permanent tooth bud.
Care of the primary teeth
Primary teeth are susceptible to decay as soon as they first appear in the oral cavity. One of the most common types of tooth decay in infants is called the nursing bottle syndrome where the infant’s teeth is exposed to sugary liquids for a long period of time. This can be avoided by not allowing the infant to fall asleep with the bottle containing milk or formula. Wipe your child’s gums with a wet tissue or gauze after each feeding. Begin brushing your child’s first teeth with a minute quantity of a fluoridated toothpaste. Children should be taught to spit out the remaining toothpaste and rinse with water after brushing.
What is the ugly duckling stage?
It is an ugly arrangement of anterior teeth, which is merely a temporary phase during the process of missed dentition. It usually occurs between ages 7 and 12 years preceding the eruption of the permanent canines, when the upper central and lateral incisors are tipped laterally because of the un-erupted crowded canines thus creating a midline gap between the central incisors. This arrangement looks ugly and hence the name. But this stage does not need any orthodontic intervention and is self-correcting. It usually corrects itself once the permanent canines erupt and the midline gap closes.
What are the precautions and points to follow during the mixed dentition stage?
- The exfoliation pattern varies from individual to individual. Hence there is no need to extract the deciduous teeth.
- If the underlying permanent tooth has already erupted and the un-shedded milk tooth is prohibiting it from securing its correct position then it is mandatory to extract that milk tooth.
- It is common to find some wobbly deciduous teeth in this stage but oral hygiene needs to be maintained by proper brushing in order to protect the already erupted permanent teeth.
- Regular dental checkups need to be followed in this stage to be able to correct malocclusions for functional and esthetic purposes.
Why is preventive dentistry important?
Children with a healthy mouth have a better chance of general health.
Oral conditions can interfere with eating and adequate nutritional intake, speaking, self-esteem, and daily activities. Severe tooth decay can affect growth and development.
Children with dental pain may be unable to concentrate in school.
Preventive dentistry means less extensive and less expensive treatment for your child.
What are pit and fissure sealants or dental sealants?
The back teeth or posterior teeth have uneven pits and fissures that are difficult to keep clean as toothbrush bristles cannot reach into them. The pits and fissures hold plaque and food debris. Most tooth decay occurs in these hard-to-clean grooves. Tooth decay is the most widespread disease among children, but also the most preventable.
One of the methods that can be used to prevent tooth decay is a "sealant". A dental sealant is a plastic-like material which is painted on the tooth surface and cured with a special light. Dental sealants keep out plaque and debris and decrease the risk of decay. Dental sealants are also called pit and fissure sealants. Sealants are applied onto the teeth surfaces within a short period after eruption.
How do topical fluorides prevent the onset of tooth decay?
Fluoride application is one of the most effective procedures in restricting onset of tooth decay.
Fluoride is used in small amounts on a routine basis, to prevent tooth decay.
It encourages strengthening of weak areas on the teeth that are prone to decay.
Fluorides induce remineralisation. The remineralisation process significantly increases the size of the enamel crystals. These larger crystals are more resistant to acid attack than even natural enamel.
Fluoride treatments are very effective in avoiding formation tooth cavities.
Procedure of topical fluoride application
Dentist can paint the fluoride on the teeth or apply with the help of a tray. The gel or foam is applied through the use of a mouth tray, which contains the product. The tray is held in the mouth by biting. Application generally takes about four minutes, and patients should not rinse, eat, smoke, or drink for at least 30 minutes after application.
What is cleft lip and cleft palate?
Cleft lip and cleft palate are facial or oral deformities that occur during early pregnancy when the fetus is developing in the womb. The reason for clefting is insufficient tissue in the lip and mouth area and the available tissue is incapable of joining together properly.
A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening in the skin of the upper lip. This opening generally extends beyond the base of the nose and involves the upper gum and the bones of the upper jaw.
A cleft palate is a physical split or opening in the roof of the mouth. It involves the hard palate and/or soft palate.
Cleft lip and cleft palate can occur on one or both sides of the mouth and since the lip and palate develop separately they can appear either together or anyone without the presence of the other.
What causes cleft lip and cleft palate?
In most cases the etiology of both these conditions is not known but generally it is believed to be caused by
- Environmental factors
Clefting is more common in an individual wherein either the siblings or parents or a relative has had a similar condition.
Another attributing factor may be certain medications that the mother might have taken during pregnancy such as anti convulsant drugs, anti-cancer drugs, drugs for arthritis and psoriasis.
Sometimes cleft lip and cleft palate may be a condition of some other medical problem. It can also happen if the fetus during development has been exposed to certain viruses or chemicals.
How can a cleft lip or cleft palate be diagnosed?
Usually since the physical deformity is so obvious, a prenatal ultrasound can detect this condition in an unborn child. If this has gone unnoticed in the prenatal ultrasound, then a physical examination confirms this condition after the birth of the child. And at this time certain other diagnostic procedures are also carried out to evaluate if there is any other medical condition in association with cleft lip and palate.
What are the difficulties associated with cleft lip/palate?
- Eating difficulties: With an opening in the palate, foods and liquids may pass through the nose and enter back into the mouth. But nowadays certain specially designed bottles are available which help in the downward flow of the fluid into the stomach. Until surgical intervention is possible, a cleft palate patient may require using a man-made palate to help eat properly and ensure adequate nutrition.
- Ear infections: In cleft lip and palate there is always a probability of fluid buildup in the middle ear which causes ear infection and if left untreated can even lead to hearing loss. Hence such kids may need to use special tubes in the ear drum to help in fluid drainage.
- Speech problems: The voices of such children take a nasal sound and speech may be difficult to understand. Surgery generally can fix this issue entirely.
- Dental problems: Cleft lip and palate patients are more prone to dental caries and also often have missing, extra or malformed teeth which require dental and orthodontic treatments.
Treatment of cleft lip and cleft palate
Surgeries and bone graft are often necessary to treat both these conditions. Additional surgeries may be required to improve the appearance of the lips and the nose, close opening between the nose and mouth and to realign the jaw.
Dental care for cleft lip and cleft palate patients
- Early dental care: Such patients need special cleaning and fluoride application for healthy teeth. And healthy teeth are important for chewing and good nutrition. Regular dental checkups are mandatory since the initial eruption of teeth. Routine care at home such as regular brushing is also very important.
- Orthodontic care: The first orthodontic appointment should be scheduled even before any teeth eruption so that the orthodontist can evaluate the facial growth and jaw development.After teeth eruption to understand the short and long term dental needs. After the permanent teeth erupt orthodontic treatment can be done to align the teeth.
- An oral surgeon along with a prosthodontist and speech pathologist may be required to manage the associated problems like formation of dental bridges and improvement of speech.
What is the treatment for Cleft lip and Palate?
Surgeries and bone graft are often necessary to treat both these conditions. Additional surgeries may be required to improve the appearance of the lips and the nose, close opening between the nose and mouth and to realign the jaw
What are the effects of oral habits on the growth of children?
Various oral habits like thumb sucking, lip biting, tongue thrusting etc can interfere with the normal growth pattern of the facial bones thus leading to teeth crowding & improper facial structure.
Thumb sucking is perfectly natural and normal. Intervention for a very young child is not necessary. However, when a child still has the habit anywhere from the age to 4-6, it may be time to intervene.
Prolonged thumb sucking habit can result in both narrowing of the upper jaw or maxilla as noted before. Further, a downward growth of the mandible can result in an unattractive lengthening of the face. Thumb sucking can also affect your child's speech resulting in a lisp and the incorrect articulation of certain words requiring the tongue and teeth to come together.
What are the effects of lip sucking or lip biting on children?
Lip sucking and lip biting can procline the maxillary incisors, retrocline the mandibular incisors means can push the lower front teeth towards tongue and increase the amount of over jet.
What are the ill effects of habits like tongue thrusting or mouth breathing?
Tongue thrusting and mouth-breathing may also play a part in the creation of a malocclusion. An anterior open bite is the most common dental problem associated with these anomalies.
If positive reinforcement and encouragement do not work to break these habits, habit breaking appliances are required. Dentist will study the severity of the problem & dispense suitable habit breaking appliances.
When are habit breaking appliances are given to children?
If positive reinforcement and encouragement do not work to break these habits, habit breaking appliances are required. Dentist will study the severity of the problem & dispense suitable habit breaking appliances.
At what age of the child should be the first appointment with an orthodontist?
The American Association for Orthodontists recommends that every child have an orthodontic evaluation by the age of 7.
- Early detection and treatment may give your child an edge: a much better chance for natural and normal development. By working with the natural growth instead of against it, we can prevent problems from becoming worse, and give your child a lifetime of healthy smiles!
- Every treatment may be initiated for: Habits such as tongue thrusting and thumb sucking.
- Jaw growth irregularities like underdevelopment or overgrowth.
- Constricted airway problems.
- Bad bite.
- Early loss of milk teeth leading to space deficiency for permanent teeth to erupt.
What is interceptive orthodontics?
The common practice of correcting bad bites and teeth crowding, is to wait till all permanent teeth erupt. It was often necessary to extract four permanent teeth to correct the bite when growth was nearly complete. In cases with short or too big jaws, the profile correction was often limited because of the lack of growth.
Interceptive orthodontics is a more recent concept where certain problems are treated early (around age 7-11) to take advantage of growth. This can result in:
- Fewer teeth extracted,
- Better profile and facial aesthetics
- Great full smiles.
In this concept, orthopedic appliances are used that guide jaw growth to ideal levels thus allowing the permanent teeth to erupt in their proper places reducing teeth crowding or other teeth alignment problems. This specialty of orthodontics is known as Dentofacial orthopedics.
What are the effects of unequal jaw growth?
Jaw growth is a slow and gradual process. Occasionally, something may go wrong with this process and the upper and lower jaws may grow at different rates.
UNEQUAL JAW GROWTH-A CAUSE FOR CONCERN
One or both jaws may grow too much or too little. The resulting abnormality may interfere with:
- Proper teeth alignment.
- Speaking and chewing.
- The tongue and lips may be forced to move awkwardly during speech and swallowing in an attempt to compensate for the jaw mal-relationship.
- There may be a speech defect or excessive mouth breathing.
An improper bite may threaten
- The long-term health of the gums and teeth.
- The jaw joint (TMJ) can also be adversely affected by a jaw malrelationship.
- In addition, jaws of different sizes-that don't match-can affect appearance.
What is two phase orthodontics?
Two phase orthodontics is a special approach to treat these problems.
In the first phase of treatment, growth discrepancies are taken care of. This is done at the age of 7-12 years for the child.
In the second phase, irregularities in the teeth alignment are corrected. This phase of treatment is initiated after the eruption of permanent teeth.
Two phase orthodontics helps in preventing lot of growth related issues which otherwise need surgical intervention for correction.
What is second phase of treatment?
The goal of the second phase of orthodontic treatment is to place the teeth into equilibrium such that they will function together properly, be healthy, and look attractive.
Each tooth has a location within the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. As was the case in the 1st phase, orthodontic records are necessary to establish the appropriate diagnosis and treatment plan.
This 2nd phase is usually initiated once all the permanent teeth have erupted and usually requires braces on all the teeth for a period of time ranging from 12-18 months.
Two phase orthodontics involves changing jaw structure and jaw relationship to create a more favorable environment for the eruption of a full permanent dentition.
Potential advantages to this approach are a reduction of the overbite or under bite, allowing for more normal future jaw development, and the possibility that future treatment may not be needed.