Why do we need to fix primary-teeth (baby teeth/milk teeth)?
The primary dentition is made up of twenty primary teeth, ten in the upper jaw and ten in the lower jaw. Their eruption usually commences around the age of 6 months and continues until the of 2.5 or 3 years. Usually, the first teeth seen in the mouth are the two front teeth in the lower jaw, and the last ones are the secondary molars in the upper jaw.
Picture 2: A 5 year old boy with all his baby teeth
HOW DO DENTAL CARIES FORM (DENTAL DECAY)?
Dental caries is defined as the deterioration of teeth due to bacterial activity in the mouth. The bacteria use sugars from food and drink to produce acid, which destroys the tooth enamel and the tooth substance underneath, dentin. The bacteria live in a thin layer on the surface of the teeth, known as dental plaque. If dental plaque builds up around the teeth, and if the bacteria in the dental plaque have access to sugars from food and drink (mainly sucrose), dental caries may develop.
„EARLY CHILDHOOD CARIES“
The occurrence of dental caries before the age of three years is called early childhood caries (ECC). ECC is a common condition and is most often associated with bottle-feeding. Sugary drinks, for example juices, soft drinks and milk (also breast milk), combined with poor oral hygiene, are the main risk factors for ECC. The caries lesions usually develop on the front teeth in the upper jaw, and on the chewing surfaces of the first primary molars in both jaws.
A 3 year old girl who slept with a bottle of prune juice. The parents did not realize that natural prune juice can cause sever dental caries.
PREVENTION AGAINST DENTAL CARIES
As soon as the first tooth appears, it is time to begin tooth brushing with fluoride toothpaste in order to prevent the development of dental caries. The older the child gets, the more crowded the teeth become (less space between them) and the development of dental caries between the primary/baby molars (the two inner most baby teeth) becomes more common. This is the time to add flossing, in order to clean the space between the teeth and thereby prevent the development of dental caries on those surfaces.
In addition to maintaining appropriate oral hygiene it is of utmost importance to ensure favorable food habits. It is important to limit the consumption of sweet and sticky food as much as possible and stick to regular meal times (avoid snacking between meals). Children should never be put to bed with a bottle filled with sugary drinks or milk, or any type of food. The same applies to drinking and eating during the night. If the child needs the bottle before or during the night, the bottle should only contain pure water. If the child uses a pacifier, it should never be dipped into sugary fluids or food, for the same reasons as stated above.
THE EFFECTS OF DENTAL CARIES ON DAILY LIFE AND GENERAL HEALTH
The development of dental caries in children can have a serious impact on the child’s health and wellbeing, as well as on the permanent teeth (adult teeth) which are developing inside the jaw bones. If left untreated caries lesions will grow in size and ultimately reach to the dental pulp (the dental nerve) inside the tooth. Big caries lesions, both those that reach into the pulp and those that don´t, can cause immense pain (toothache) in and around the offending tooth. Such pain can disturb the child´s daily routines, such as sleep, kindergarten- or school attendance, as well as studying. Furthermore, toothache can hinder the child from eating and drinking normally and research has revealed that untreated dental caries can lead to malnourishment and decrease height- and growth development.
If caries lesions reach into the dental pulp and no treatment is given, an infection will eventually develop, with an abscess in the bone around the tip of the root. A longstanding infection from a primary tooth, can cause developmental defects in the respective permanent tooth, a so called Turner tooth. A Turner tooth can be in such a bad condition that it needs extraction later on. In addition, the infection can spread from the tooth and to other tissues, included the brain and blood, where it can cause brain-and blood infection. This can become fatal.
The treatment of dental caries in baby teeth is just as important as the treatment of dental caries in permanent teeth. If the caries lesions are not too big it is usually possible to treat them with tooth colored plastic fillers. In bigger lesions stainless steel crowns could be a more durable treatment and less likely to require replacement. In more severe cases, the teeth might need to be extracted, usually because they have become infected or have decayed so extensively that they cannot be restored. In every case the pediatric dentist tries to restore the primary teeth instead of extracting them, if possible, and the sooner the caries lesions are discovered the better the chance to keep the teeth.
TREATMENT UNDER GENERAL ANESTHESIA
When treatment is needed for very young children, children who suffer from anxiety or intense fear, or if and extensive treatment is needed it may be preferable for the child (and the parents) that the treatment be conducted under general anesthesia. Young children usually lack the physical and cognitive ability to be able to cooperate during conventional dental treatment in the dentist chair. In addition, some dental treatments are long and tiresome, which increases stress and makes it even more difficult for the child, should they not be conducted under general anesthesia.
Serious complication frequency in connection with dental treatment under general anesthesia is very low, when performed in a hospital setting. General anesthesia is probably safer than heavy sedation, which is used in a normal dental setting, and should therefore be the treatment of choice when it is assumed to be better for the child. Various research shows that just one negative experience at a dental clinic is enough to cause dental anxiety or phobia, which can in turn cause serious problems later in the child’s life. It is, therefore, necessary, to prevent such unfortunate experiences.
THE IMPORTANCE OF REGULAR DENTIST VISITS
Primary/baby teeth are important in many ways. One of their roles is to preserve room for the permanent teeth. If the primary teeth are lost too soon, the space for the permanent teeth can become too small, which can create a need for extensive orthodontic treatment later on. The loss of teeth can also effect the child’s ability to speak properly and impede chewing. Therefore, it is of utmost importance to try to keep the primary teeth as healthy as possible until they fall out themselves. It is therefore important that all children have regular dentist visits, at least once a year, from the age of three, in order to discover any dental problems (should they exist) as early as possible as well as to provide appropriate treatment.
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