Children’s and preventive dental care

Children’s and preventive dental care are the most important dental care areas for oral health of the general population, and they have the strongest impact on public health.
When good hygiene habits and visits to a dentist are introduced for children at an early age, it is highly likely that they will maintain those habits throughout their life as well.
That part of influence on a child starting teething requires a certain level of education and awareness that it is of utmost relevance for the child.

Teeth have multiple functions, with overall health depending on their and oral cavity status.
The primary function of teeth is to chew food and prepare it for digestion. Teeth also have a speech function. Their eruption and development affect the formation of jaws and, consequently, facial aesthetics, thus influencing a child’s psychological development and self-confidence.
Therefore, it is vital for teeth to be preserved and healthy, whereas any form of pathological change of trauma condition complicates a child’s consistent growth and health.

Children’s and preventive dental care

Represents a special branch of dental care since children differ as patients from adults and require an adequate approach.
Basic functions of children’s and preventive dental care include:
1. Therapeutic function – to prevent and treat pathological changes in children and manage traumas
2. Control function – to establish habits in children and commit a child and parents to dental control
3. Advisory function – to explain to a child and parents everything that is in the interest of maintaining oral health

Based on these children’s dental care functions, it is important for children’s dentists to:
– Be receptive to children,
– Be ready to establish trust,
– Be patient in work,
– Explain everything a child should understand and accept in an appropriate manner.

Why is it important to preserve deciduous teeth?
In addition to being important for chewing and enabling proper bone development, deciduous teeth in children also “keep space” for permanent teeth and direct their eruption.
Also, it is important to prevent deciduous tooth inflammation in order to ensure a healthy environment for permanent teeth eruption. Furthermore, deciduous teeth should remain healthy with a dentist’s assistance, so that a child does not meet a dentist for the first time because of pain, namely an inflammatory process, because that may result in an unpleasant experience that generates aversion to a dentist in future life.

Procedures applied in children include the following:

Removal of soft debris

This procedure is executed using rotating brushes and an adequate paste in a way that soft debris is slowly removed from all teeth surfaces. In this manner, children get accustomed to a dentist and dental care devices and procedures in a pleasant and painless way.

Fissure sealing

This is a totally painless procedure, where fissures – canals on chewing – occlusal surfaces are sealed with sealants containing fluorine and specific adhesive substances. Thus tooth canals become shallower, preventing building up of food and, consequently, food decay and emergence of cavity. Fissure sealing is not a permanent method and it should be controlled once a year and repeated as recommended by a dentist. Fissure sealing is important for permanent– first molars.

Fluoride treatment

Fluoride treatment is a totally painless procedure applied on deciduous and permanent teeth in order to retain healthy dental tissue as long as possible. Fluoride is ideal for preventing cavity by protecting enamel and making it more resilient. Fluoride reduces cavity incidence and participates in re-mineralising an initial carious lesion. Fluoride in the form of varnish, gel or foam is most commonly applied on teeth in dental practice.

Cavity removal and filling of deciduous teeth

Cavity is the most frequent pathological process in oral cavity. Unfortunately, deciduous teeth cavity appears very early, due to bad hygiene habits, inadequate diet and putting children to sleep using a bottle with a sweetened beverage. Cavity often affects several deciduous teeth and spreads quickly because of specific anatomic and histological features of those teeth. Deciduous teeth as covered with a much thinner layer of enamel with lower mineralisation, with under-enamel dentin having wide dentin canals and lower capacity of creating reparatory dentin. All this contributes to fast spreading and more frequent incidence of deciduous teeth cavity complications. Cavity often affects maxillary incisors and is then called circular cavity. Initial symptoms include white stains on front incisors close to gums. Over time, the stains deepen and cavity progresses. As soon as white stains appear, it is important to contact a dentist in order to prevent further cavity progression. Early occurrence of cavity can be detected at regular controls and thus prevent pain and complications. It is important for deciduous teeth to be healthy and to remove cavity and treat a tooth with a filling. Anaesthesia is applied and composite, compomer or glass ionomer fillings are used in that procedure.

Treatment of deciduous teeth

Treatment of deciduous teeth includes removal of coronal pulp – amputation, and covering of the root with medicaments. Amputation paste containing cresol and paraformaldehyde is applied on the amputated remains at the tooth root, followed by a layer of zinc oxide paste as a bandage. After that, a liner and a definite filling are placed.

Treatment of permanent teeth

The first permanent molars erupt at the age of five to six, most often in the mandible, and those are FIRST MOLARS. Eruption of the first permanent molar is not preceded by falling out or extracting a deciduous molar, and the process of eruption of that tooth is not accompanied by any significant subjective difficulties for a child. First molars are exceptionally prone to cavity because of deeper canals on the chewing surface, so it is necessary to seal and thus protect them. However, in case cavity in a child develops into an inflammatory process, namely if the process is not treated while localised in enamel and dentin of tooth crown, the pathological process advances and infects pulp and periodontal tissues due to wide dentin canals and highly voluminous pulp of children’s permanent teeth. Such cases require endodontic therapy – canal therapy of permanent teeth canals. Indications for endodontic therapy of permanent teeth in children are established individually for each patient and depend on disease diagnosis, rate of root development, namely whether the development is completed or not, space in a jaw for all permanent teeth, i.e. possibility and need for orthodontic therapy, phase of adjacent teeth eruption and motivation of a child and parents.

Treatment of periodontitis (juvenile periodontitis)

Many factors may lead to periodontitis in children. Anaerobic microorganisms (those with effect without the presence of oxygen) from plaque produce certain toxins (poisons), which lead to destruction of the tooth support apparatus and thus create conditions for tooth loosening or loss. Furthermore, some other diseases such as blood disease, diabetes, vitamin deficiency (especially vitamin C) may lead to this disease. One of the causes is the genetic factor, when it appears in several family members. “Juvenile periodontitis” is an extremely aggressive disease that quickly leads to a tooth loss. It usually appears between 11 and 13 years of age, three times more often among girls than among boys. This form of periodontitis is one of the gravest periodontal diseases, because it is very difficult to control it and prevent tooth loss, with patients losing teeth even before the age of 20. The first form refers to affecting individual teeth only, and any group of teeth may be threatened. Most often, only first molars and incisors are affected, with symmetrical changes. There may be no visible changes on gums. This form may emerge even before puberty and it may affect deciduous teeth as well. Initially, there may be no visible changes on gums, but vast destruction occurs in the bone. Later on, the disease is additionally complicated by gum inflammation and, ultimately, tooth loss. The second form is generalised, meaning that is affects the support apparatus of all teeth. This is the most severe form because destruction is highly intense and no treatment can slow it down. Regarding a treatment approach, it does not differ much from treating periodontitis in adults: removal of dental plaque and tartar and treatment of periodontal pockets are also applied, with administration of antibiotics as an important and efficient form of therapy. Nevertheless, poor results are achieved in treating juvenile periodontitis because the disease progresses rapidly, with few or no initial symptoms before reaching a severe phase. Therefore, its early detection is very important through regular dental controls, because it is the only way to react promptly and prevent early teeth loss in these patients.

Teeth injuries

Teeth injuries are common in children, most often referring to deciduous or permanent incisors. In addition to a tooth, surrounding tissue is injured and swelled, so everything looks much more complicated and difficult. However, in case of any tooth pain, swelling, wiggling and loss, a dentist should be contacted immediately. For children active in sports, it is recommended to use protectors for teeth and soft tissues. Also, for children with protruding teeth, orthodontic therapy should be taken into consideration. Classification of injuries There are different classifications of injuries of deciduous and permanent teeth. The most frequent ones include:

1.Injury of support tissues (periodontal tissues)

- Enamel fracture

- Tooth fracture

2.Injuries of hard dental tissues and pulp

- Luxation: concussion, partial tooth loosening, etc.

- Trauma avulsion

Most teeth injuries are treated successfully. Some procedures also include medications, in case of injury of pulp – live part of a tooth, others are solved by composite fillings exclusively, while some injuries require prosthetic and surgical and orthodontic procedures.

Teeth extraction

In the period when permanent teeth start replacing deciduous ones, the first teeth start loosening between the age of 5 and 7, with all 20 deciduous teeth replaced by the age of 14. Loosening of a deciduous tooth is supported by protrusion of a permanent one. Loss, namely extraction of a deciduous tooth is less unpleasant for a child than the process of permanent tooth eruption. Dentists recommend that children help tooth loosening with their tongue. Dentists advise not to extract insufficiently loosened teeth at home, in order to avoid unnecessary pain, remaining tooth parts, uncontrolled bleeding or potential infections. If loose teeth do not fall out naturally, it is advisable to extract deciduous teeth at dental practice, in controlled and clean conditions.

TIPS FOR PARENTS

In regard to care for children’s teeth, here are some helpful tips:

– Nursing is a healthier mechanism for developing the chewing apparatus in children than bottle feeding
– Children should start chewing food as soon as they start getting first teeth
– Oral hygiene in children should start with eruption of first teeth
– Children should learn how to properly brush teeth
– Teeth brushing should be a regular habit in the evening, and later on in the morning and in the evening
– Toothbrush should be gentle and soft; it should be replaced once it wears out
– Toothbrush should be rinsed at kept at clean place
– First visit to a dentist should be organised when the first teeth start erupting
– Child should have confidence in their dentist
– Child should feel comfortable when visiting a dentist
– Child should understand all dental procedures applied on them
– Child should bite and chew food much more than consume soft and mashed food
– Child should attend regular dental controls once in six months
– Child should extract loose teeth at dental practice or wait for them to fall out naturally
– Child should ask all questions that interest them
– Child should apply all tips received from a dentist

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