Children’s Dentistry

What is pediatric dentistry?

Pediatric Dentistry (or Pedodontics) deals with the deciduous and permanent teeth of children and aims to treat any dental conditions resulting from caries, traumas, and hereditary factors. Pediatric Dentistry is a branch of dentistry that provides oral and dental care to infants and children, including preventive measures, and monitors face and jaw development.

When should I take my child for their first dental visit?

On their first birthday, take your child to see a pediatric dentist. It would be beneficial to repeat these visits every 2-3 months. Brush your child’s teeth with a toothbrush without dentifrice before daytime naps and nighttime sleep.

When the baby's teeth begin to erupt, the following precautions should be followed:

Do not put your baby to sleep by breastfeeding.
Put your baby to sleep after wiping their teeth with a damp cloth.
Never put your baby to sleep with a bottle of milk mixed with sugar or honey.
Do not force your baby to finish the food in the bottle. This may cause your baby to vomit.
Do not place your baby’s bottle in your mouth, even if it is for checking its temperature.
Fruit juices, even though beneficial for health, can lead to caries when they are frequently fed from bottles.
When the child is 1 year old, stop breastfeeding and using bottles and transition to a cup.
Brush your baby’s teeth with a toothbrush.

Importance of Deciduous Teeth

There 20 deciduous (baby) teeth. The primary purpose of deciduous teeth is to help feeding. Deciduous teeth also contribute to the proper development of speech. Baby teeth maintain spacing in the dental arch for their permanent counterparts and guide the eruption pathway of the permanent teeth. If a baby tooth is extracted before the permanent tooth erupts, the other teeth may shift to fill in the gap. The primary goal of pediatric dentistry is to prevent dental conditions from occurring and to guide children to a caries-free future with preventive dentistry.

What is a Nursing Bottle Caries?

Early childhood caries (nursing bottle caries) is defined as one or caries, tooth loss, or fillings in children aged 71 months or younger.

What are pediatric dentistry applications?

1. X-Ray

Dental and jaw x-rays are taken to diagnose invisible tooth, bone, or soft tissue pathologies and diseases. Clinical images of teeth, jaw, and face are necessary for the diagnosis of general or mouth conditions, and treatment planning and follow-up.

Different types of X-rays include digital, periapical, occlusal, bitewing, panoramic, joint, jaw, and head X-rays. Your physician will determine the number and type of images that will be required. The X-rays that are used for imaging are actually harmful in high doses. Therefore, your physician will request the minimum number of X-rays for your diagnosis, treatment planning, and follow-up. If you are pregnant or suspect pregnancy, you should not be in the room during the X-ray exam. It is your responsibility to inform your physician or X-ray technician of your pregnancy.

After being informed about the diagnosis and treatment plan, you will be asked to decide whether you would like to proceed.

2. Preventive Treatments

Preventive treatments aim to prevent the formation of caries and gingival diseases.

a) Fluoride Applications:
Fluoride can be applied systemically (orally) or topically (on the teeth). Topical applications are currently more common. These products can be classified as at-home and in-office products. At-home fluoride products include fluoride-containing toothpaste, mouthwashes, gums, and dental floss. Follow your physician’s instructions when using such products. In-office applications mainly include gel and varnish products that are administered by a clinician every 3 to 6 months. Before the application of fluoride products to the teeth, it may be required to remove the accumulated plaque and tartar, which cause gum diseases, and then to polish the teeth using the proper tools. You will be requested to avoid eating or drinking anything after the application for a duration of time specified by your dentist.

b) Fissure Sealants:
Another preventive application is fissure sealing. Fissure sealants are used to fill the grooves on the teeth in order to prevent caries.

3. Scaling And Polishing

An oral examination may reveal gum disease due to plaque and bacteria accumulation which result from inadequate brushing. In scaling and polishing, the plaque and tartar buildup (which may cause gum disease if left untreated) is removed using a scaler, which is followed by polishing with pastes. This procedure may cause some bleeding and soreness. You will be requested to follow the recommended oral care practices after this procedure. Some systemic diseases can result in gingivitis and periodontitis and can further affect the gums and surrounding tissues. In this case, it may be necessary to remove plaque, tartar, and other factors that cause disease under the gums with subgingival curettage (deep scaling) or root planing.

4. Tooth Extraction

Teeth may need to be extracted due to decay, advanced periodontal disease, or prosthetic, orthodontic, or prophylactic reasons. Tooth extraction is usually carried out under local anesthesia but may also be performed with conscious sedation or general anesthesia, if necessary. Tooth extraction is irreversible and tooth loss affects chewing and biting functions. Therefore, you will be offered other possible treatment options (filling or root canal treatment) before deciding on tooth extraction. Nevertheless, tooth extraction may be the only viable option in some cases.

5. Dental Fillings

In teeth that have lost substance due to caries, any dental decay is removed, and the remaining cavity is filled with various materials called “fillings” to restore the function of the tooth. Tooth fillings can be applied under local anesthesia, if necessary. Rarely, a patient may develop a reaction to the filling material. The treatment may cause some damage to the surrounding soft tissue. If your child develops any discomfort following the procedure (such as severe pain, food accumulation, pointed or rough spots, a high filling, etc.), please contact your dentist. After the intervention, there may be some pain or tenderness which can last for a while. Please follow your physician’s recommendations to improve treatment outcome. The success of tooth fillings can vary depending on the structure of the tooth and oral care and eating habits. Depending on the severity of the caries, your physician will recommend one of the following treatment options described below.

Amalgam Fillings

Dental amalgam is a mixture of silver, copper, mercury, and tin and has been in use for over 100 years. Its physical properties make it resistant to the biting forces of occlusion. The metallic color of amalgam does not blend with the natural tooth color. Amalgam fillings may become tarnished over time. Dentists recommend patients who had amalgam fillings installed to wait at least 2 hours before eating or drinking. Otherwise, the filling may fracture or fall off. Amalgam fillings in permanent teeth should be polished after 24 hours. You are responsible for any complications that may occur if you do not show up for a follow-up visit. An amalgam filling lasts 7 years on average. Inadequate oral hygiene can produce more cavities around the margins of the filling. In this event, your physician will not be liable.

Tooth-Colored (Composite) Fillings

These fillings are used for cosmetic purposes in anterior and posterior teeth that have lost substance due to caries. Special adhesives are used to bind these composite fillings to dental tissues. They are not as resistant to biting forces as amalgam fillings. Although they are tooth-colored, they may not always match the natural color of the tooth one hundred percent. These fillings last 4-6 years on average. They may become discolored by smoking, drinking coffee, etc. After the intervention, there may be some pain or tenderness which can last for a while. Inadequate oral hygiene can produce more cavities around the margins of the filling. In this event, your physician will not be liable.

6. Amputation

In the case of deep cavities in deciduous or permanent teeth, the disease can affect the dental pulp (the center of a tooth that contains blood vessels and nerves). Amputation is the removal of the dental pulp using special tools to save the rest of the tooth.

7. Root Canal Treatment

Root canal therapy addresses the root of an infected tooth to preserve the tooth. Despite high success rates (over 90%), root canal treatment is not a fail-safe procedure, as with any medical procedure. Root canal treatment does not prevent future tooth decay, fractures, or gum disease. In some cases, it may be required to repeat the root canal treatment, or to perform surgical intervention or extraction. For a root canal treatment, the affected tooth is numbed with local anesthetics. After makes an opening on the crown, the contents of the root canal are removed with precision instruments. The canals are flushed with chemical solutions to clear the infection. The canal is filled with a root canal filling before placing the permanent restoration. Root canal treatment may be performed in one or more visits, depending on the condition of the tooth.

8. Space Maintainers

If a deciduous tooth is lost before the permanent tooth is ready to erupt, space maintainers may be used to maintain enough space open for permanent teeth to grow in. They aim to prevent the tilting of adjacent teeth into the available space, which may lead to malposition and malocclusion, and cosmetic and functional deformities. It is harder, more costly, and more time-consuming to correct malocclusions. The child may develop malocclusion despite space maintainers. Even if that is the case, space maintainers will help to prevent more severe malocclusions. Space maintainers can be removable or fixed. In some cases, pediatric dentures may be used. Pediatric dentures are similar to removable dentures worn by adults and are used to restore chewing function in pediatric patients.

9. Teeth Whitening

Teeth whitening can be applied to teeth that are discolored from birth or that became discolored later in life. The treatment may take one or more visits, and may not always yield perfect results. Some treatments are not completely successful, and sometimes the teeth may become discolored again after a few years or require repeated applications at intervals. Depending on the bleaching agent, soft tissues may develop an allergic reaction, a burning sensation, turn white, or become tender. You will be asked to avoid foods dark in color for a time specified by your physician. A different method is used to bleach non-vital teeth. Some bleaching agents can cause root resorption.