Agewise oral health problems

0-1 year:

  • Natal teeth
  • Epstein pearls
  • Candidiasis
  • Teething
  • Delayed eruption
  • Trauma

0-2 year:

  • Trauma
  • Early childhood caries
  • Trauma
  • Thumbsucking habit

3-6 year:

  • Caries
  • Trauma
  • Malocclusion
  • Tongue tie
  • Mucocele
  • Primary herpetic gingivostomatitis

6-12 year:

  • Erupting permanent teeth
  • Calculus plaque
  • Habits
  • Trauma
  • Malocclusion
  • Caries
  • Enamel hypoplasia

 

0-1 year :

1.Natal Teeth :

Normal age eruption of first milk tooth 6 months or above even till 1 year. But in some babies when they are born or for some within 30 days of birth front teeth are present which are called natal teeth.  They are usually the lower front teeth rarely upper front teeth. these teeth might be loose and poses the risk of swallowing during feeding, they are very sharp such that during breast feeding hurting both mother and the child.

Advise: if natal teeth are firm, then mild grinding of the sharp edges making them smooth is enough. When the natal teeth are loose then removal of these teeth are advised, and removing before the baby is 10 days older needs Vit K supplementation.

2.Pearls in mouth :

A newborn baby can sometimes have bluish/whitish pearl like  thickening in the mouth where teeth are to erupt. They are scientifically called Epstein pearls.

Advise:  Do not worry these thickening will disappear by themselves. No need any special treatment for these  pearls.

  1. Tear of lip and gums
  2. Fall of erupted front teeth
  3. Broken teeth
  4. Displaced and mobile teeth
  5. Serious injuries can lead to fracture of jaw bones.
3.Candidiasis /white plaque/white patches :

The white patches on tongue and gums in infants can mainly be due to improper oral hygiene measures. Other reasons are children with low immunity (leukemia, haemophilia etc.). if your child is not having any other significant medical problems it is the lack of your proper hygiene care.

Precautions: after each feeding, the infants mouth is to be cleaned and wiped with a clean white soft cotton cloth dipped in warm water.  Candid mouth paint is the topical ointment for application for 1 week if prescribed by the Dentist after proper examination. Once the removable white patch is wiped off you can see reddish appearance . the child may have burning sensation or pain due to this. So avoid hot spicy diet and take proper care of your child.

4.Teething :

Normal age for the first milk tooth to erupt is 6- 14 months of age. The lower front teeth are mostly to erupt first . you can feel a prominent bulge in the region with a bluish or whitish tint of the mucosa covering the bulge. You can find your child very irritated, biting all things that are reachable to their hands and also excessive salivation. They are all normal teeth symptoms. Some people associate diarrhoea and fever with teething. This is not true, as your child has started moving by now and can reach any objects and take it to mouth, these objects which are not clean cause diarrhoea and fever.

Advice:

  1. All teething toys to be washed and kept clean. Teething toys that can be washed in boiling water are available. So look out for them and use them.
  2. Rusks, carrots can be given adding to the nutritional value.
  3. If diarrhoea and fever persists do consult your paediatrician for expert opinion.
5.Delayed eruption :

Many parents are worried once their little ones do not have any single tooth for their first birthday. The worry becomes greater when neighbour’s kid of same age has 8 teeth.

Advice:

  1. Check for the normal milestones of your child- whether the baby turned position,sitting , standing and walking all happened at the right time or it was delayed . if these milestones were delayed then eruption of teeth is also likely to be delayed upto one and half years of age.
  2. Good news is that the later the teeth erupts, lesser the chance for tooth decay and also escapes from bites of sharp teeth!
  3. Sometimes if your child had natal teeth and if they were removed then your child is likely to have no lower front teeth.
  4. If you cannot defer any appropriate rteasons for delayed eruption consult the pedodontist for expert opinion.
6.Trauma :

Below one year of age , the various reasons for trauma could be fall during play, while using walker, placing electric cords, fall from bed, any RTA(Road traffic accident).

The most common oral and facial injuries for this age group could be:

  1. Tear of lip and gums
  2. Fall of erupted front teeth
  3. Broken teeth
  4. Displaced and mobile teeth
  5. Serious injuries can lead to fracture of jaw bones.
Injury to lips and gums :
  1. Press sterile cotton or gauze in bleeding area
  2. Apply local anaesthetic gel (eg. mucopain) to relieve discomfort for child until you reach dentist.
  3. If mild abrasions no stitches will be needed otherwise pedodontist will suggest you for stitches if needed.
  4. Avoid hot spicy food intake
  5. Keep ice pack over lips if swelling present over lips. Sometimes swelling does not appear on the same day of trauma, it occurs the following day. If swelling does not reduce with ice pack report  to pedodontist immediately.
  6. Follow strictly to the instructions given by the pedodontist.
Mobile milk tooth :
  1. If the milk tooth has become mobile, do not disturb the position of teeth with your fingers. It may cause severe pain and sometimes injure the deep lying permanent tooth bud.
  2. The child might be asked to undergo radiographic investigation (X ray) for assessing the position of mobile milk tooth in relation to permanent tooth bud.
  3. Based on the results of the investigation, either the tooth will be repositioned or left in same position.
  4. If excessive mobility present then the pedodontist may request you to go for removal of the mobile teeth.
Broken milk tooth :
  1. There can be small chipping or loss of more than half of tooth structure.
  2. The treatment plan will be based upon your radiographic investigation.
  3. If minor fracture of tooth then just a small filling will be sufficient.
  4. If fracture is deep then invasive procedures like cleaning and filling the root canal will be needed.
  5. If tooth is broken below the gums then removal of the remaining tooth fragments will be advised.
Fallen milk tooth :
  1. If the milk teeth has fallen during trauma better not to replace it in posiyion as it might have severe adverse effects on permanent tooth bud and treatment outcome is also very poor. But in case of fall of permanent teeth it is replaced back into position and tried maximium to be retained in position.
  2. Artificial replacement with acrylic teeth generally recommended.
Serious injuries :
  1. Head injuries and fracture of jaws expertise advice is recommended.
  2. Do not flex the neck of the child.
  3. Beware if more than one episode of vomiting, any loss of consciousness,any continuous bleeding from ears, nose and throat
  4. Deep cuts in tongue may need sutures always.

1-3 YEARS

1.Early childhood caries/cavities:

Reasons:

  1. Poor oral hygiene
  2. Frequent night feeding
  3. Frequent consumption of sweets
Oral hygiene:

It is the time for your child to start brushing twice a day. If you want her to do it then you should practise it., “preach what you practice”. Children easily follow regular habits.

So make it a habit of 3B- Brush, Book, Bed (Brush at night, book to read bed time stories, going to bed to sleep). Might be the first one week they may show temper tantrums. If handled carefully children do develop this habit easily.

Choose flavours and colour of paste and toothbrush that are attractive to them.

Brushing at night is more important as salivation decreases during night and increases chances of cavity formation.

Develop the habit of gargling after each meal and snack time.

Feeding habits:

Breast feeding is nutritious –nobody denies it. But prolonged breast feeding especially after 1 year of age is of non nutritive value. Of course cultural practices and ethnic values make breastfeeding make breast feeding mandatory till 2 years of age. For those parents who are not under such influence, please stop breast feeding by 1 year of age. The first 150 days after the child is born it is mandatory for exclusive breastfeeding, later you can start weaning and after 1 year of age please stop it. It is very hard to see your little one crying and fussing, but make up your mind that you are doing it for the good of your child. Better shift to cup rather than feeding bottle. Even you can use SANGU/SANGADA.

For those parents whose cultural practices do not permit to stop breast feeding below 2 years of age, then strictly follow oral hygiene practices at night. Stop frequent night feeding, before the child goes to sleep feed the child , then wipe the entire mouth with clean whit soft cotton cloth dipped in luke warm water and then allow the child to sleep.

Frequent consumption of sweets:

Snacks or any kind of food with refined sugar makes the teeth more prone to develop cavities.  So restrict these types of food to one particular time of the day, say evening 5 o’ clock and strictly avoid them other time. (For eg. You give your child 3 toffees a day- 1 in morning, 1 in afternoon and 1 in evening- it is more harmful than giving all three together only in the evening.) after consumption of sweets, make a habit of gargling with water.

Any other medical issues:

Children with decreased salivation due to any salivary gland disease or under chemotherapy in case of leukemic children they are more prone to develop generalised cavities in all teeth.

Consult your pedodontist and get supplements to substitute saliva and for other precautions like topical fluoride application and use of some remineralising paste.

Treatment of cavities:
Preventive measures:
Under your control:
  1. Proper oral hygiene
  2. Brush twice
  3. Stop night breast /bottle feeding habits.
Under professionals control:
  1. Sealants
  2. Topical fluoride application.
Treatment of developed cavities:
  1. Mild cavities treated with tooth colored fillings. (silver fillings not recommended nowadays due to mercury content)
  2. Severe cavities with infection extending into the roots of teeth will need root canal cleansing and filling .
  3. Very badly damaged teeth needs removal followed by space maintainer.
2. Trauma:

refer 0-1 yrs age group.
Cap splint: mobile teeth if repositioned are stabilised by an acrylic plate for 1-2 weeks.

3.Thumbsucking habit:

If your toddler has the habit of thumbsucking try for some anti-thumbsucking solutions only after 3 years. So just wait for your toddler to complete 3 years. Do not criticise your child for this habit. Once the child continues the habit above 3 years of age then you can consult your pedodontist and handle effectively.

4.Pain and swelling due to cavities

It is a nightmare to see your little one wake up with a bizarre swelling on face. Your toddler would have told you sometime before that he/ she has tooth ache which might have been ignored leading to this emergency situation.

Report to the nearby dental hospital as soon as possible. You will be given a dose of antibiotics and analgesics for swelling to reduce. After 3 days, a radiographic investigation can tell you whether tooth is to be saved or removed.

3-6 YEARS

1.Cavities: read the above 2-3 years section :
2.Trauma: refer 0-1 years, 1-3 years section :

Tooth brushing, pencil chewing, lip biting can cause injuries to the soft tissue.

These injuries can cause pain, bleeding, ulcers and sometimes even swelling. Management of these lesions are to relieve pain and prevent infection by topical application of anaesthetic and antiseptic gel. Anyway consultation with pedodontist for expertise opinion is advised.

Mucocele: lip biting /cheek biting can cause trauma to the tiny salivary glands which causes a transparent bulge. If biting habit is stopped sometimes swelling regresses in size other times it needs professional intervention by minor surgical procedure. Even after surgical removal there is greater chance for it to recur if lip biting habit persists.

3.Tongue tie:

(Ankyloglossia) this is when a small band of tissue tightly attached to tongue and the underlying surface which limits the movements of tongue thus making pronunciation of certain alphabets like ‘s’, ‘t’, ‘f’ difficult. This again needs professional intervention by minor surgical procedure followed by speech therapy if needed.

4.Thumbsucking habit:

if this habit persists above 4 years it is of concern. This habit might have developed due to a psychological feel of insecurity or as a result of either prolonged breast feeding or insufficient feeding.
Counselling: initial ways of management is by professional counselling. Punishment/ criticism regarding this habit can cause psychological trauma.
Anti thumbsucking solutions: if counselling does not seem to work try some anti thumbsucking solutions like neem oil, Femite* (to be used with prescription of pedodontist).
Remainder therapy: long sleeve dresses, acrylic cap over thumb, a pouch stitched in shirt to place the hand during sleep.
Appliance therapy: pedodontist may advise for fixed or removable intra oral appliances to be used regularly.

Whatever be the mode of approach success depends entirely on the motivation and cooperation of the child.

6-12 YEARS

1.Problems associated with erupting permanent teeth:
  1. Eruption gingivitis and pericoronitis:  when permanent teeth erupt there is reddish area around the erupting teeth called eruption gingivitis. Hot and spicy food can cause burning sensation and pain. So avoid them. Topical application of anaesthetic gel and warm saline gargle can give some relief. The problem is severe in case of erupting first permanent molar at 6-8 years of age behind the last milk tooth. No teeth falls for it to come. So many mistake it to be a milk tooth. When this big molar tooth erupts it can cause severe pain and swelling of gums around it called pericoronitis. If there is no relief with anaesthetic gel and warm saline gargle professional intervention might be needed to remove the junk of swollen gums.
  2. Ugly duckling stage: when the upper front teeth erupts, they usually have a space between them, the two teeth may be slightly tilted with a wide gap between them. It is very common in 6-10 year age group kids, so need not worry about it as the correction occurs on own with eruption of other teeth. if similar condition persists even after 12 years then intervention might be needed.
  3. Saw edged teeth(mammelons): the newly popped out front teeth have saw edged appearance called mammelons. These curved edges become straight with biting force given by the child. In those children with too forwardly placed teeth the curved edges disappear.
  4. Criss cross teeth: most of the children lower front teeth appear criss crossed . these irregularly arranged teeth appear to be a problem , but they correct their position  by themselves gradually most of the times with tongue pressure and jaw growth. Anyway get expert opinion from pedodontists as in severly criss crossed teeth there might be a need for removal of some teeth to give space for normal arrangement of other teeth.
2.Trauma:

6-12 years age there is popping out of permanent teeth with shedding of milk teeth. Any injury to permanent teeth should be taken care off properly. It is usually the front teeth which are more susceptible for trauma due to fall during play, accidents etc.

Broken permanent teeth:

i.      If you can find the broken piece try to take it to pedodontist who may be in a better situation to analyse whether the broken fragment can be reattached. If you cannot find the broken piece no worries as there are tooth coloured fabrications to bring back the shape of tooth with good colour match and shape.

ii.      If tooth is broken such that there is damage to blood vessels and nerves in the tooth pulp then you may be suggested for root canal treatment.

iii.      If the tooth is severely fractured involving the root, then removal of mobile root segments or sometimes with bad luck tooth as a whole may be suggested. If tooth is removed as a  whole then artificial tooth with removable type plate may be fabricated as fixed replacement is advised only after 17 years of age2

Loose teeth:

i.      If the hit on tooth has made it mobile, based on the degree of mobility and condition of adjacent teeth treatment planning will be done with the aid of radiographic investigation.

ii.      Very mild mobility- you may be asked to only avoid hard food and advised regular follow up.

iii.      Mild mobility: some wiring or plating will be done with adjacent teeth and advised regular follow up.

iv.      Excessive mobility: there are poor chances for it to remain  in place after treatment , anyway attempts will be made to secure the tooth in its original position and wiring or plating will be done with nearby teeth.

v.      Strict instructions to be followed:

  1. Avoid hard food
  2. Avoid hot and spicy food
  3. Good oral hygiene
  4. Use of antiseptic mouthwashes after brushing
  5. Do not touch and see the mobile teeth or the wiring done to check whether they are in position.
Fallen teeth:

i.      If the tooth as a whole is fallen, then collect it and report to nearby dental clinic within 20 minutes.

ii.      Within these 20 minutes, if the child is mature enough to place the fallen teeth in mouth itself beneath the tongue till reaching the hospital as saliva is the best medium to preserve the vitality of tooth. If the child is not mature enough then you can place the tooth in any one following solutions: tender coconut extract, milk, normal saline(available in any medical store), Hanks Balanced Salt Solution

iii.      Do not scrub the tooth in water to remove dust or dirt as it might affect the vitality of tooth.

iv.      The pedodontist after thorough examination will replace the tooth in position and stabilize it using wire or plate.

v.      Root canal treatment will be suggested.

vi.       Strict instructions to be followed:

  1. Avoid hard food
  2. Avoid hot and spicy food
  3. Good oral hygiene
  4. Use of antiseptic mouthwashes after brushing
  5. Do not touch and see the mobile teeth or the wiring done to check whether they are in position.