Pedodontists (pediatric dentist) are dentists who perform all kinds of treatment and preventive dentistry procedures applied to children. They have received special training in this regard.
Pedodontics is basically divided into 2 parts:
A- Treating the problems that have occurred
It is possible to prevent cavities in children with a careful diet (avoiding sticky and sugary foods as much as possible, following healthy eating rules) and applying correct tooth brushing techniques. When a caries occurs, the cause should be tried to be determined and the health of the child’s other teeth should be protected. Children should be taken to the dentist from a very young age (6 months-1 years), so that the child can come to this environment without fear. In addition, parents should learn what to do to keep their children’s dental health at the highest level.
1- Caries
The decayed part of the tooth is cleaned and treated with permanent or temporary filling depending on the situation. In some cases, the tooth is too dilapidated to be treated with a filling. Such teeth can sometimes be kept in the mouth for a while, instead of being pulled out, by covering them with ‘caps’ specially prepared for children. In recent years, colored fillings have been produced to make children love the dentist. With the help of those materials, that also used in our clinic, helps us to make filling a game.
2- Broken Teeth
Children often fall or knock their teeth. As a result, they encounter problems that will damage their front teeth and cause them discomfort for years. A simple mouthpiece prepared by your dentist will prevent the damage caused by trauma to the lower part of the face. Especially in children who play sports such as football, boxing, skiing, basketball, cycling, rollerblade, surfing, skateboarding has more likely to have problems in lower face. So, dental traumas, fractures or lip, tongue biting and tearing are prevented as a result of the cushioning effect of a silicone transparent mouthpiece placed on the upper jaw teeth.
The tooth of a child who does not have a mouthguard and who gets a blow to his/her front teeth either falls out completely or breaks. Most importantly, the pulp which is the living part of the tooth, is damaged in various degrees, depending on the force of the blow. If this damage causes the death of the pulp, the color of the tooth is discolored and a color ranging from light brown to dark gray occurs. Please protect the dental health of your child, especially who plays sports, with a mouthpiece prepared by your dentist.
3-Dash
If the front tooth is completely out of place:
Go to your dentist immediately by placing the tooth between a clean gauze pad and wetting it with saliva. If you cannot reach your dentist immediately, moisten the gauze with 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). With meticulous application and good care, the tooth will stay in your child’s mouth for years.
If one or more of your front teeth is broken:
Try to find the broken parts and contact your dentist immediately. It is important to keep the parts moist at this time. Saline and even saliva are ideal for this. These parts are adhered to their places with very strong bonding agents and become more aesthetic and durable than any filling to be made.
If you couldn’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 foods such as tea, coffee, cola. These need to be renewed at certain times depending on patient’ eating habits and oral hygiene.
- If the fracture is large and covers half or more of the tooth, porcelain laminate veneers are applied to those older than 17 years of age. Porcelain laminate veneers are both very durable and very aesthetic. They can be explained as porcelain leaves that adhere to the front surface of the tooth and cover the fractured part.
Since the development of teeth and jaws is not completed, it is not correct to apply porcelain laminate veneers in children younger than 17 years of age. Again, composite laminates that cover the entire front surface of the tooth and the fractured part can apply to patient. However, there are problems caused by the material and they may need to be renewed after a while as they will change color.
If there is no problem after the impact:
A detailed examination should be made by the dentist and x-ray should be taken from the relevant area. Even if there is no finding after examination, periapical x-rays needs to be taken at regular intervals and compared with old x-rays. The aim here is to determine whether there is a long-term problem in the living part of the tooth. The tooth loses its vitality by changing color even after years. If such a situation is detected, complications that may lead to tooth loss are prevented by applying root canal treatment.
4-Tooth extraction
In some cases, the caries progresses to the living (nerve-pulp) part of the tooth. An inflammatory condition that reaches the jawbone from the roots of the tooth occurs. As a result, the child’s face swells and it is not right for the child’s health to keep this tooth in the mouth. In this case, the tooth is extracted from here. Especially if this is a milk tooth and the eruption time of the permanent tooth coming from below is very close, it is a procedure that has no drawbacks. If the eruption time of the permanent tooth is not close, apparey should be made instead of the extracted tooth.
In a permanent tooth, this decision should be reviewed many times before the extraction process and extraction should be considered in cases where there is really nothing to be done. After the permanent teeth are extracted, if the child’s age is appropriate, orthodontic treatment should be started immediately and this gap should be closed with other teeth and a correct closing relationship should be ensured between the lower and upper teeth. When an extracted permanent tooth is left standing, the adjacent teeth bend towards this space. The tooth opposite the space protrudes into the space and the whole balance of the mouth can be disturbed by a tooth.
5-Cleaning
If the bacterial plaque (whitish, sticky layer consisting of food residues and microorganisms) formed on the teeth has accumulated so much that it cannot be removed by normal brushing, it should be cleaned and removed by the dentist. This process will prevent the formation of problems such as dental calculus and caries, which will be caused by bacterial plaques in the long term. In the same session, the child is also informed about tooth brushing training and prevention of caries and is called for control again.
B-Preventive Dentistry Applied to Prevent the Occurrence of Problems:
Today, preventive medicine has gained importance in dentistry as in every field of medicine. Main aim of this branch is to solve problems before it occurs. Preventive dentistry is of great importance, especially in children. It is preferred that the first encounter of children with the dentist is related to preventive dentistry, as there are effortless, inexpensive and painless applications.
1-Hygiene Training
Complete oral and dental care is only possible with complete information. Hygiene education, which includes teaching tooth brushing, flossing, reviewing nutritional habits and explaining the importance of oral and dental health ensures that there is no missing information. This education is as important for adults as it is for children.
2-Surface Fluorine Application
Fluoride is a natural mineral that we can get from water or many of the foods we eat. It has been noticed that people living in regions with high fluoride content in their waters have encountered less tooth decay since ancient times. When the cause was investigated, it was determined that fluoride made the enamel of the teeth resistant to decay. At first, the optimal dose of fluoridation of city waters was increased by officials in some regions, however this dose was reduced due to some side effects.
Recent studies have shown that surface fluorine applications are more important. It has been found that the effect of fluorine tablets taken by the mother during her pregnancy or given to the child from the 6th month is much less than expected. The crystal structure that makes up the enamel becomes more acid-resistant with the effect of fluoride applied to the surface. Thus, it is more difficult to roughen, and the formation of caries becomes more difficult.
Superficial fluoride applications are a simple, painless procedure that can be started from the age of 3 and should be repeated every 6 months. It is ideal to apply in the child’s first encounter with the dentist. After this process, the fluoride stored on the surface will make the teeth much healthier and stronger.
3-Fissur Sealent
The chewing surfaces of the teeth are indented. These pits and mounds are called as fissures. These areas are quite narrow and are usually where the bruises start. A special fluid filling material is used in order to prevent the accumulation of food and microorganisms in these areas. First of all, this area is completely cleaned and the fluid filling, which we call fissur sealant, is applied to this area. It is hardened by light and polished by correcting the excess. With this process, it is possible to prevent chewing surface caries which constitutes approximately 70% of all caries. Although it can be used for many years under normal conditions, it is beneficial to check it frequently, especially in those who have habits such as ice chewing or teeth grinding. The period when the first permanent teeth appear in the mouth is ideal for application. This is around 6 years old. It is also applied to the others during the eruption of other molars. An important point is that it will be better to have it done shortly after the permanent teeth begin to erupt (within 1-2 years). Because the longer the time, the more likely it is to develop cavities and it may be necessary to fill another material instead of fissure sealant. Although it can be applied to adults without caries, its use in children is more beneficial and important. It is an absolutely painless and very easy procedure.
How is it done?
Before starting this painless process, it is necessary to make sure that the indentations on the surface where the sealant will be applied are completely clean and free from bacteria. For this purpose, your teeth are cleaned and dried by brushing with the help of a special solution. The enamel layer on the top of the tooth is roughened with the help of a gel and bonding is applied. After it is hardened with light, the fissure sealent is allowed to fill the recesses with the help of a brush and is hardened with light again. It is checked whether there is a height, and a protective varnish is applied on it. It is a very simple and inexpensive method. It is a painless and effective preventive procedure.
4-Place holder
Baby teeth can be lost early for various reasons (cavities or accidents). In such cases, until the permanent tooth from below is ready to erupt, the adjacent teeth may turn and cover the area of the lost primary tooth that needs to be protected for the permanent tooth. Even the tooth in the opposite jaw of the cavity begins to elongate. If the development is left to itself after the early primary tooth extraction, these movements will cause no space for the next permanent tooth. Thus, the permanent tooth will either not grow at all or will develop out of its normal place.
The problems that can be caused by losing even just one primary tooth early are as follows:
- As the teeth will be displaced, crowding will occur. Also, these areas will not be cleaned easily and the tendency to decay will increase.
- Chewing will become difficult.
- More serious orthodontic problems will occur.
Fixed Placeholder
Some of the milk teeth must remain in the mouth until the age of 12. However, at this age, the permanent teeth are ready and the milk teeth needs to change. Howeveri it is very difficult to protect the teeth until this time without any problems. This small metal appliance called a placeholder is specially prepared for the child’s mouth, and in cases where the primary tooth is lost early, it preserves this place until the permanent tooth comes in. They are prepared as fixed or recessed (depending on the location of the lost tooth). It is a very simple but very important appliance for the foundation of the child’s future oral and dental health.
To maintain the placeholder:
- Avoid sticky foods and chewing gum.
- Do not try to push and bend the placeholder with your tongue or fingers.
- Keep it clean using a regular brush and thread.
- Make sure to go for a check-up every 6 months.