A Dentist's Views On Children's Dental Care

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This is an interview with Dr. Pooja Jagtiaani, about children's dental care and oral hygiene.

Introducing Pooja

Dr. Pooja Jagtiaani is a graduate of Padmashree Dr. D.Y.Patil Dental College and Hospital in Mumbai. After working at Dr. D.Y.Patil Dental Hospital and other dental clinics, she set up her practice in Suburban Mumbai, with a commitment to delivering the highest level of contemporary, comprehensive and compassionate dental care.

She has completed a Masters in Business Administration (MBA) specializing in Healthcare and Hospital Management and also has a Post - Graduate certificate in Cosmetic Dentistry from SUNY Buffalo, USA.

Dedicated to staying current and proficient with leading cutting edge dentistry, she incorporated some of the most advanced dental technology and techniques into her practice and participates regularly in continuing education and advanced training courses throughout the country.

Her practice is concerned with General and Family Dentistry with a special emphasis on Cosmetic Dentistry and Smile Designing.

The Interview

I want to thank Pooja, for taking the time out of her busy schedule to answer some questions about children's dental care. Her answers are clear and concise with useful details, that should address most concerns you have, about your child's dental health.

How long have you been a practicing dentist and how often do you work with kids?

I have been into private practice close to 15 years now and work closely with kids almost on a daily basis in the form of providing them dental treatment at my clinic and conducting dental camps and lectures at schools.

When should parents start cleaning their baby's teeth/gums and when should they start using toothpaste?

Ideally we need to clean the baby's gums and mouth soon after birth even before the first teeth erupt. Until the teeth emerge use a soft wet washcloth or gauze wrapped around the index finger to clean the mouth, tongue and gums. Once the first milk tooth erupts (on an average at 6 months) clean the teeth with a soft baby brush and a non fluoridated toothpaste. Once the child learns to spit out the paste (2 years and up) shift to a mildly fluoridated age appropriate toothpaste.

What is the difference between children’s and adult toothpaste?

The main difference is the amount of fluoride in the toothpaste. Children's toothpaste have a lesser amount of fluoride, they come in various flavors and are usually gel based as it is less abrasive on a child's sensitive enamel.

Does sucking fingers or using pacifiers affect the structure of teeth? Should such habits be stopped to avoid damage?

It is completely normal and healthy for your baby or young child to suck on a thumb, finger or pacifier.Sucking is a natural reflex and something he or she did in the womb. Children usually give up sucking habits on their own by the time they are 4 to 5 years old. If they stop the habit at this age, the shape of the jaw is usually not affected and the teeth grow in normally. However, some children find the sucking habit hard to break. Children who are still sucking when their permanent (adult) teeth start to come in are more likely to have bite problems.

Sucking can cause:

  • The top front teeth to slant out

  • The bottom front teeth to tilt in

  • The upper and lower jaws to be misaligned

  • The roof of the mouth to be narrowed

To help an older child break a sucking habit, explain clearly why the habit can be harmful, be supportive and encouraging and provide positive acknowledgment of efforts to end the habit. If the child sucks a finger or pacifier because of a stressful situation, it is important to address the source of the stress. When needed, dentists can provide appliances that correct distortions created by the sucking habit and help the child stop the habit.

Ways to stop the thumb sucking habit:

  • Use positive reinforcement.

  • Track progress by noting every successful day using a sticker or star on a chart.

  • Put an adhesive bandage (Band-Aid and other brands) on the finger as a reminder or have your child wear a mitten when sleeping.

  • Take the finger out of your child's mouth after he or she falls asleep.

  • If all fails, your dentist can fabricate a habit breaker for your child.

What is baby bottle tooth decay and how can it be avoided?

The first risk to a child’s primary teeth often comes in the form of baby bottle tooth decay (baby bottle syndrome or bottle mouth). This happens if a feeding bottle in a baby’s mouth for long periods of time while the baby sleeps. Sugar from milk or juices remains on the teeth for hours at a time begins to eat away at the enamel. The front teeth appear pocked, pitted or discolored due to the rapid decay of the child’s teeth.

Also if your child favors soft foods, complains or cries when eating cold, sweet, or hard foods, they should be checked for tooth decay. The teeth most likely to be affected are the upper front teeth as they are the first teeth to erupt and hence have the longest exposure time to the sugars in the bottle. The lower front teeth tend to be protected by the tongue. Sometimes, by the time tooth decay is noticed, it may be too late and pulp therapy, crowns or even extraction of the decayed teeth may be necessary until permanent teeth grow in.

As a result, your child may suffer from speech impediments, crooked or crowded teeth, and poor oral health. Parents should only allow a baby to have a bottle during meals, and to fill the bottle only with water if it is used at night. Clean your child’s teeth daily, never allow your child to fall asleep with a bottle filled with juice, milk, or formula (or when awake, sip on it for long periods of time as a pacifier), start bottle weaning, at least, by the time your child is one year old, give your child plain water for thirst, make sure your child gets the fluoride needed to prevent decay & have regular dental visits for your child.

When should one start flossing?

Once a child's teeth start to fit closely together, usually between the ages of two and six, parents should start to get their children in the habit of flossing daily. As they develop dexterity, you can help them learn to floss. Children usually develop the ability to floss on their own around the age of 10.

Do kids need regular dental check-ups? If so, when should they start and how often should they get a check up?

Yes, like adults kids need dental checkups every 6 months. We suggest that children start seeing the dentist at age one, or as soon as the first teeth erupt.

In your experience what are the most common dental problems in kids with milk teeth?

Although a child’s baby teeth eventually will be replaced by permanent teeth, it is important to care for these baby teeth. Newly erupted primary teeth should be off-white or ivory in color. Teeth that erupt with a black tint or another color, usually, indicate an underlying problem. Most often, this is the result of plaque growing on the teeth due to a build-up of bacteria in the child’s mouth. Liquid medications containing iron, some antibiotics and certain supplemental vitamins also can cause this effect. Some other causes of discoloration include chronic illness or recurrent fevers, excessive fluoride (causes white spots called flourish), tooth injuries (pink or grayish discoloration), jaundice in newborns (yellowish or green tint) and the use of antibiotic tetracycline by the mother during pregnancy.

Poor maintenance of primary teeth can result in early loss either naturally or by extraction due to extensive decay. This can cause a change in the eruption schedule of the permanent teeth, which may lead to space problems for proper eruption. The permanent teeth may erupt crooked and misaligned.

Primary teeth are prone to injuries that can cause them to chip, fracture or come loose. Usually, an injury causes baby teeth to loosen, rather than fracture. These injuries often occur as the result of falls, during play or accidents during athletics. If you child suffers an injury to the gums or a baby tooth that causes bleeding, run cold water over a piece of gauze and apply pressure gently to the injury site. Ice should be applied to the injured area to reduce swelling until the child can see a dentist. Baby teeth that are knocked out, do not require special care after they come loose, unlike permanent teeth, because they cannot be re-implanted. Re-implanting a baby tooth can damage developing permanent teeth and often results in death of the pulp. In some cases of primary tooth loss, a dentist may use a space maintainer to keep the area open until the permanent tooth erupts.

Primary teeth are also vulnerable to dental plaque, a clear film that sticks to teeth and attracts bacteria and sugar. As the bacteria feed on the sugar, they are broken down into acids that eat into the enamel of the teeth. This causes cavities in the teeth. Plaque also causes the gums to become red, swollen and sore leading to gingivitis (gum disease)

And of course we need to be careful about Baby Bottle Tooth Decay which we spoke about.

What are the most common dental problems in teens?

There are a number of common dental concerns that occur in teens. From oral hygiene issues to crooked and crowding teeth, from cavities to wisdom teeth pain, preventative care and early detection can make these common problems much easier to deal with and solutions faster for your teen.

What purpose do braces serve, besides making your teeth look nice?

Braces are used for a variety of purposes. For some, braces are implemented in order to straighten out crooked or overlapping teeth. People with gaps in their teeth may also benefit from having braces. In addition, braces can be a great way to correct malocclusion, which is a condition in which the two parts of the jaw do not line up correctly. Malocclusion can be either an overbite (when the upper jaw is bigger than the lower jaw) or an underbite (when the lower jaw is bigger than the upper jaw). Braces can even help to align the lips and teeth properly.

What is the ideal age to get braces? How long do braces need to be worn?

There's no set age for a child's first orthodontist visit — some kids go when they're 6, some kids go when they're 10, and some go while they're teens. Even adults can need orthodontic treatment. Many orthodontists say kids should see an orthodontist once their permanent teeth start coming in, around age 7. At this age, issues such as uneven bite and overcrowding will become apparent.

Starting the process early doesn't mean a child will get braces right away. It just means the orthodontist will be able to find problems and decide the best time to start treatment.

How long your child will need to wear braces depends on the problems the orthodontist is trying to fix, but the average is about 2 years. After that, your child might wear a specially molded retainer — a small, hard piece of plastic with metal wires or a thin piece of plastic shaped like a mouth-guard. Retainers keep the teeth from wandering back to their original places.

What are some important oral hygiene practices that are often overlooked?

Even if you make a point of brushing your teeth twice a day, you may be overlooking some of the most important aspects of good oral care. For many, oral hygiene becomes a redundant routine that can feel somewhat like a chore. However, when you start looking at cleaning your teeth as something you're obligated to do, it encourages bad habits that can end up causing problems such as halitosis, tooth decay and gingivitis in the long term. If lately you've just been going through the motions, consider these aspects of responsible oral care that may be missing from your regimen:

  • Brushing for 2 minutes followed by cleaning the tongue

  • Using mouthwash

  • Mastering your brushing technique

  • Flossing

  • Regular Dental Checkups

Are children particularly scared of dentists? If so, what can parents do to help them get over this fear?

Taking kids to the dentist is necessary to keep their teeth healthy and promote excellent oral hygiene habits. But from a child's point of view, a trip to the dentist can be a scary event -- lying on a chair in an unfamiliar room filled with unfamiliar noises and objects, all while a stranger is poking cold, metallic, and unusual instruments in his mouth.To help ease future visits for your child (and for the dentist!), follow these steps so that he will feel comfortable and more relaxed.

  • Start young - The earlier a child visits the dentist, the better. It's best that the first visit starts at age 1 or when the first tooth is visible.

  • Keep it simple - When preparing for a visit, especially the first time, try not to include too many details. Doing so will raise more questions, and adding more information about an extra treatment like a filling he might need may cause unnecessary anxiety. Keep a positive attitude when discussing an upcoming visit, but don't give your child false hope.

  • Watch your words - Don't use the injection, pain or hurt words with children. Let the staff introduce their own vocabulary to children to help them get through difficult situations.

  • Consider a pretend visit - Before the first dentist appointment, play pretend with your child to be the dentist and the patient, all you'll need is a toothbrush. Count your little one's teeth by starting with the number 1 or the letter A. Avoid making drilling noises or lining up other "instruments." You can even hold up a mirror and show her how the dentist might look at and check her teeth. Then let your child role-play by using a toothbrush to clean the teeth of a stuffed animal or doll. The key is getting her familiar with the routine so that she's more comfortable for the real visit.

  • Do not try to relate - Some parents take their children with them to their own dentist appointment, but experts say this is a mistake. Parents themselves might feel anxious about the visit without even realizing it, and their child might sense those fears. Telling "war stories" about extractions, root canals, or other negative experiences will also trigger anxiety, especially because your child may not even have those procedures.

  • Prepare for some fussing - It is normal and age-appropriate for a young child to cry, whine, wiggle, and not want to be examined by a stranger. Stay calm and remember that the dentist and the staff are used to working with children and have seen their share of tantrums. Let the dental care professionals guide you; they might ask you to stay at a distance or to hold your little one's hand, which will provide comfort and prevent him from grabbing any dental instruments.

  • Avoid bribery - Many experts do not recommend promising your child a special treat if she behaves well at the dentist. Doing so will only increase their apprehension. Promising a sugary treat also sends the wrong message after a dentist emphasizes having clean, healthy teeth by avoiding sweets that can cause cavities. Instead, after the visit is over, praise your child for her good behavior and bravery. Every once in a while, surprise her with a sticker or a small toy as an encouragement.

Is there anything else you would like to say to parents regarding dental care and hygiene?

Everyone understands that you should take care of your teeth to avoid toothaches, maintain your looks and keep dental bills at bay. Many people, however, don’t understand how crucial oral health is to our total health picture. Tooth problems can lead to diabetes, heart disease, systemic infections, an inability to eat or speak properly and other maladies – some life-threatening. Crooked or crowded teeth can contribute to gum disease that can eventually lead to tooth loss. Straight teeth are no longer just for looks. It is imperative to visit your dentist every six months and get your teeth professionally cleaned as advised by your dentist.

Tags: braces, teen, baby, health, parenting, kids, teeth, toddlers, hygiene