Paediatric dentistry is the branch of dentistry that involves treating children's teeth. From birth until the age of 6, this is done by looking after their temporary teeth and from the age of 12, by overseeing the end of their mixed dental process and the beginning of their permanent teeth. Paediatric dentists detect anomalies in the position of the maxillaries early so that they can send the patient to the orthodontist and maxillofacial surgeon who can therefore modify or slow down the growth of these bones. Likewise they also detect bad habits in order to re-educate people, undertake restoration treatment in the case of dental caries or apply special coating to prevent future pathologies and also inform patients about oral hygiene procedures in order to achieve healthy growth in the oral cavity. It is important to have a check-up at this stage in order to detect any alterations in the growth of the maxillaries, which would impede correct skeletal development and the changeover to adult teeth.
Treatments at this time of growth are called 1st stage treatments, and aim to resolve any skeletal alterations by taking advantage of the growth of the patient.
Any apparatus that is fitted at this time can be either fixed or removable, and will depend on the malocclusion of each patient.
Questions and answers
At what age should your child start to go to the dentist?
Normally a child’s first tooth erupts at the age of 6 months. From that moment on dental eruption should be monitored as well as your baby's hygiene, and they should also go for occasional check-ups with a specialist. At approximately 2-3 years old your child should have all of their temporary teeth in their mouth and at the age of 6 their first permanent molar should appear. At that point we also recommend a visit to the Clinic in case it is necessary to modify the growth of their maxillaries or to create space for the rest of their permanent teeth, since there is still time to do so.
At what age should children start to brush their teeth?
As soon as their first tooth erupts, usually at the age of 6 months. Teeth should be cleaned for the first few months with a piece of gauze soaked in water and when temporary molars start to erupt, a toothbrush suited to their age should be used. At the age of 6 children should know how to brush their own teeth and then an adult should check them to make sure they are using the correct technique and their teeth are clean. Children should acquire the habit and responsibility of oral hygiene from a young age, so that they can maintain their teeth throughout life.
What should you do if your tooth falls out of your mouth after a blow?
Sometimes quick action can make the recovery of the tooth possible. You should remain calm, pick the tooth up from the floor holding it by the crown, not by the root, and if possible wash it with saline or water, never use soap or brush the root with a toothbrush. You should try to put the tooth back into place, ensuring that it is positioned correctly, and then go to the dentist immediately. This is easier than it seems because the root of the tooth fits perfectly into the dental alveolar (the hole the tooth was in). If it is not possible to put the tooth back into place, during your journey to the Clinic, put the tooth into either a glass of milk (if possible whole milk) or saline. In a worst case scenario you could hold it in your mouth- inside your cheek or underneath your tongue-in contact with your saliva. The time factor is the most important one to be taken into account in terms of a successful tooth replacement.
How do you treat caries in children?
Initially, it is necessary to establish whether we are dealing with temporary or permanent teeth, since, depending on the pathology the tooth has, the treatment may be different, depending on the type of teeth.
If the injury reaches the nerve and teeth are temporary, then either a pulpotomy/pulpectomy will be carried out, or a nerve treatment. If the caries has not affected the tooth's nerve tissue, then it will be sealed with a type of paste (a filling).
If the caries has caused a large hole to appear in the tooth then metal crowns will need to be applied, which are not aesthetically pleasing but they are practical. They maintain the space while at the same time ensuring that the child can chew well. Faced with this, we should be unconcerned about the fact it is not an aesthetically pleasing treatment, because it is highly efficient and does not mean that the permanent teeth that erupt later will have problems. The majority of orthodontic treatments which are undertaken today arise due to a lack of space between temporary teeth.
The tooth will only be extracted when no other option is available; in other words, when the infection makes it compulsory to extract it because its root has been destroyed and the tooth has therefore become non-viable. In this case, it is almost always necessary to fit a space maintainer in order to avoid losing the space required for the correct placement of the permanent tooth.
Can this affect permanent teeth?
Any infection in a temporary tooth which progresses through the root will create a pus sac which will affect the permanent tooth. Sometimes permanent teeth come out deformed, with secondary stains or injuries caused by the infection in the milk tooth in the past and which was not treated correctly. Therefore it is erroneous to think that, since one day milk teeth will fall out, there is no need to be that concerned about looking after them.
Children should be taken to a paediatric dentist every 6 months so that their teeth can be checked and thus any potential diseases that they may have in their mouths can be prevented.
Until they are a year old, it is enough to clean their teeth with a small piece of water-soaked gauze. After the age of two toothbrushes should be introduced, this must have a small head and soft bristles. Parents should teach their children how to brush their teeth, by doing so gently, after each meal. The amount of toothpaste should be minimal-equivalent to the size of a lentil- since they should not swallow any fluoride.
Fluoridation is one of the most effective methods to fight against caries, and should be carried out under the supervision of a paediatric dentist. Tooth enamel can be reinforced and re-mineralised through the application of fluoride. According to the WHO, it can reduce caries by up to 50%.
Whether it can affect other organs or not, this does not occur in healthy children. However, an infection in one tooth will make the caries progress until the microbes reach the nerve and contaminate it. If this continues without treatment, then the affected nerve will produce pus, which will search for an escape route and will cause an abscess which, if not treated, will produce a fistula (a route to the outside). However, any infection within the organism, whether in the mouth or any other location, can affect the heart in patients with vascular problems, congenital heart disease, or those who have for example experienced rheumatic fever as a child. These are extreme cases which paediatric dentists should know about, although they will be monitored by a cardiologist.