- What is the difference between pediatric dentists and regular dentists?
Pedodontists or pediatric dentists are specialist dentists who have been trained in child psychology, growth-development and approach to the child, as well as the development of teeth and the solution of their problems, following 5 years of dental education.
Child treatment requires special attention and education. Pedodontists ensure that the fear of the dentist does not occur in children. By knowing the psychological state of children well, by accustoming them to the dentist’s chair without frightening them and informing them about dental health, they support them to live a healthy life. Getting support from a specialist doctor in the diagnosis and treatment of children during this period positively affects their attitudes towards dental treatments throughout their lives.
It is seen that the frequency of caries in children reaches 90% in both primary dentition (between 2-6 years) and mixed dentition (between 7-12 years). For this reason, it is of great importance to apply preventive methods from caries in order to protect the future oral and dental health of the child, and most importantly, the general health. Pedodontists, by making these protective applications at the right time according to the child’s dental and age development, protect children from dental caries, which significantly affect their general health as well as their oral and dental health.
Children are not “little adults”. Childhood, unlike adulthood, has features such as rapid metabolism and rapid growth and development. Similarly, the structure of milk teeth and newly erupted young permanent teeth is quite different from that of an adult tooth. For this reason, pedodontists are the dentists who have the most comprehensive knowledge in pediatric oral health.
- When should the first examination be and what is done in the first examination?
It is recommended that the first dental examination should be performed after the first primary tooth erupts (usually between 6 months and 1 year).
In the examination performed with the eruption of the first tooth, parents are informed about;
- How to clean your baby’s mouth and teeth with which brush and paste,
- Preventing the transmission of bacteria from mother to baby,
- Limits of bottle and pacifier use,
- Harmful habits such as lip and thumb sucking,
- Explaining the child’s oral and dental development, and the necessity of visiting the dentist frequency,
- Nutrition and protective practices that can be done to prevent dental caries.
The first dental examination constitutes a step in the child’s life as it is the first encounter with the dentist. The first dental examination should be done around the age of 1 on average. Visiting at this age can prevent problems that may occur later. In this way, both the child does not develop a white coat phobia, and the mother and father can be given useful information about the child’s oral-dental health and nutrition.
- When do milk teeth come out?
Milk teeth are teeth that start to emerge from the 6th month after the birth of the child and are completed in 30-36 months.
At the 6th month after the birth of the child, two anterior (incisors) teeth appear in the lower jaw. It is also normal for these teeth to prolong the eruption period up to 9 months.
Between the 6th and 15th months, the other primary front teeth in the lower and upper jaws complete their eruption, and thus the child has 8 deciduous teeth in the 15th month. Between 15-24 months, the lateral teeth (molars) begin to emerge. At the end of the 30th month, the eruption of all milk teeth is complete.
A child with complete eruption of deciduous teeth has a total of 20 deciduous teeth, 10 in the lower jaw and 10 in the upper jaw.
- Why should milk teeth be treated?
- It plays a major role in nutrition in the period when the child is most active in terms of growth and development.
- In this period when children learn to speak, it is important for them to pronounce words correctly.
- Another task of the milk teeth is to keep the permanent teeth in place and to ensure that they erupt in their right places. This is of great importance in terms of preventing orthodontic problems that may occur in the future.
- They ensure the normal development of the jawbone and muscles.
- Also, a rotten milk tooth is a source of infection. As long as it stays in the mouth, it causes cavities in other milk and permanent teeth.
For these reasons, they should definitely be treated. Milk teeth guide the permanent teeth that they will replace in the future. Teeth that have reached the age of replacement and teeth that are too decayed and inflamed that cannot be treated can be extracted. However, if there is still time for the new permanent tooth to come out, a PLACEHOLDER must be made to prevent the gap of the extracted tooth from closing.
- What should be done first when trauma to the tooth occurs in children?
One of the most distressing situations for children and their families is the fracture, displacement or complete displacement of the child’s tooth due to dental trauma. In dental traumas, regardless of the shape and size of the trauma, a dentist and, if possible, a pedodontist should be consulted as soon as possible.
Usually, parents may not care much if there is no serious bleeding after a fall or injury. However, it should not be forgotten that tooth loss after trauma is the most late intervention teeth. Especially in dental traumas resulting in tooth displacement and tooth fracture, the time between the event and reaching the dentist and the way the broken tooth piece or tooth is brought play a major role in the success of the treatment. In such a case, the family should try to be as calm as possible and inform the physician about exactly when, how and where the accident occurred. The family should also inform the dentist correctly about the child’s general health status (allergic asthma, epilepsy, blood disease, heart disease…) and whether there is a tetanus vaccine.
Although it is one of the most appropriate carrying methods to bring the displaced tooth in child’s cheek until going to the dentist, this is often not possible due to the panic at the time of the accident. Therefore, it should be washed under running water without touching the root of the tooth, put in milk and delivered to the dentist as soon as possible.
If the front tooth is completely out of place:
Go to your dentist by putting the tooth between a clean gauze pad and wetting it with saliva. If you cannot reach your dentist immediately, moisten the gauze with physiological saline from the pharmacy and try to reach your dentist as soon as possible. The ideal is to start the treatment within 1 hour. If conditions are appropriate, your dentist will replace the erupted tooth (reimplantation).
If one or more of the front teeth are broken:
Try to find the broken parts and contact your dentist immediately. It is important to keep the parts moist at this time. Physiological saline, milk and even saliva are ideal for this. These parts are adhered to their places with very strong tools (bonding).
If you can’t find the parts;
If the broken part is small, a white (composite) filling is made in the same color and form as the tooth. Intraoral durability of composite fillings is limited. They change color by being dyed with drinks such as tea, coffee, cola.
If the fracture is large and covers half or more of the tooth, porcelain laminate veneers are applied. Porcelain laminate veneers are durable and aesthetic. They can be explained as porcelain leaves that adhere to the front surface of the tooth and cover the fractured part.
Porcelain laminate veneers are not suitable for children younger than 17 years of age, since the development of teeth and jaws is not completed. Again, composite laminates that cover the entire front surface of the tooth and the fractured part are done.
The most common form of trauma in children during the primary dentition period is the complete displacement of the teeth or the embedding of the tooth into the jawbone.
Even if the permanent tooth germ is not damaged by the trauma, it may be damaged while trying to place the primary tooth back. For this reason, deciduous teeth that have been displaced due to trauma should never be tried to be replaced. Sometimes, as a result of trauma, the tooth may be embedded in the bone and the tooth may not be visible in the mouth. Parents may think that the tooth has fallen out, but they cannot find the tooth. In such a case, the tooth is detected by radiography and regular intervals are followed, and no intervention is made to the tooth. After a while, it is seen that the tooth embedded in the jawbone re-enters the mouth. In cases where the tooth does not last for a long time, extraction can be applied to eliminate the risk of impacting the tooth. Because the impacted deciduous tooth may cause the permanent tooth to not erupt in the future.
- Çocuklarda dişe gelen travmalar ne gibi sorunlara sebep olmaktadır?
While a slight impact causes damage to soft tissues such as lips and gums, high-speed impacts can cause teeth to wobble, tooth fractures, and sometimes even tooth dislocation. Even if the fracture does not occur as a result of these blows to the teeth, the health of the tooth may be endangered. These teeth may lose their vitality after a while due to compression of nerves and vessels in this area.
In short, if we look at the problems that may occur on the teeth;
- Simple enamel crack or fracture at the cutting edge of the anterior teeth
- Cuts and injuries to the gum, palate or lip as a result of the impact
- Complicated fractures of teeth involving enamel and deeper tissues
- Impacts that cause the teeth to move forward or backward within the jawbone
- Embedding of teeth into the jawbone
- Complete dislocation of the tooth
Even a small blow to the teeth can cause serious problems in the future, even if not at the moment.
Depending on the trauma, only milk teeth may not be damaged. Along with the milk teeth, the jawbone can also be damaged. Therefore, in the formation of milk teeth, dental examination should be done well and traumas should be prevented. Generally, the incidence of trauma increases in children between the ages of 1-5. Traumas can be seen as dislocation of teeth or impacted teeth. Teeth removed by trauma should not be repositioned. This could do more damage.
Families may sometimes complain about the discoloration of their children’s milk teeth, or they may not notice the discoloration. Discoloration in milk teeth may occur after about 2 months due to minor injuries such as shaking or displacement. It is best to monitor discolored primary teeth without treatment.
In primary tooth injuries in children, the damage occurs more in the surrounding tissues than in the tooth, due to the elasticity of the tissues surrounding the tooth and the short root length of the primary teeth. The most important case is the permanent tooth buds under the roots of the primary teeth. For this reason, unfortunately, tooth extraction is usually required in primary tooth injuries. However, even if it is extracted, the permanent tooth bud is damaged, especially in cases of embedding or dislocation. In this period, as the material we call calcification continues in these teeth, as a result of trauma, this development is damaged and developmental defects may occur in that region of the permanent teeth. One of the most important causes of discoloration and structural disorders in permanent teeth is traumas in primary teeth.
- Is anesthesia administered during the applications?
The treatment of children who are compatible with the dentist is performed under local anesthesia in clinical conditions, and the treatment of mentally retarded or anxious children is performed under sedation or general anesthesia.
With the topical anesthesia we use, we first numb the top layer of the skin, then we apply local anesthesia to numb the tooth. Thus, most of the time there is only a pinching sensation. In local anesthesia applied with digital anesthesia techniques, the child feels pain as a fly bite. Before the visit to the pediatric dentist, care should be taken not to create a needle phobia in the child by saying that the child will be given an injection, but it will not hurt at all.
However, it is not always possible to carry out dental treatment in the dental chair for children who have a fear of the dentist or cannot be contacted. In such cases, regardless of the number of decayed teeth, the treatment of all teeth can be performed at once under sedation or general anesthesia without stressing the child and the family.
- Are children with disabilities treated?
In the dental treatment of disabled children, first of all, a loving and patient approach should be displayed in communication. It is important to gain the patient’s trust. It may be helpful to familiarize patients with the clinical environment without any treatment at first appointments. The patient is told what to do, the dental instruments that cause concern are introduced, and then the application is started. It is also important to keep the sessions short. The dental treatments of these patients involve various difficulties in terms of both the patient and the physician, due to the lack of physical or mental adaptation.
Although these difficulties vary according to the type of patient, some patients who can adapt can be treated under local anesthesia or in the patient’s chair with sedation support, while it is not possible to treat people with severe mental or physical disabilities under local anesthesia. In cases where dental treatments are not performed with local anesthesia, it becomes mandatory to perform these treatments in an operating room equipped with general anesthesia. Under general anesthesia, extraction of untreatable teeth, root canal treatments of deciduous and permanent teeth, fillings of milk and permanent teeth and treatment of gingival problems, if any, are performed in the same session. It is aimed to carry out the treatments in a single session by ensuring that the order of the disabled patient and the family is not disturbed by making these applications on a daily basis.