One of the issues that parents are most curious about in babies and children is the eruption of milk teeth, oral care and how to treat decaying milk teeth. In this article, information about the structure of the mouth and teeth in infants and children and how oral health should be maintained are discussed. The digestive system has vital importance and is of primary importance for our health. Our mouth and teeth form the first part of this system and care should be taken starting from infancy. In this article, the points that parents should pay attention to in terms of oral and dental health in children and information about solving common problems will be discussed. Tooth eruption In 90% of babies, the first teeth erupt at 6 months. There are 20 milk teeth in total and they are very important in terms of feeding children and guiding permanent teeth. The timing of tooth eruption depends on genetic factors. Early or late eruptions may be encountered, and there are also cases of babies born with teeth, albeit a little. It is considered normal for the first teeth to erupt until the age of 1-1.5 years. Longer delays should be checked with radiography. In a normal child, the eruption of milk teeth is completed between the ages of 3-3.5.
With the appearance of teeth in the mouth, there is an increase in the number of microorganisms in the mouth and an increase in their species. This brings the risk of tooth decay. Therefore, as we will talk about shortly, the need for cleaning of baby teeth begins. Increase in salivary flow, loss of appetite, fever, weight loss, digestive and nervous disorders, which are frequently encountered during tooth eruption, are temporary and should be treated for the cause. Adding sweeteners such as honey and molasses to the milk in the bottle, putting the babies to sleep with a bottle at night and giving breast milk for more than one year cause “bottle caries” in infants. Due to the young age of children, their treatment is also very difficult. Cleaning the teeth especially after night feedings or drinking water after a bottle are simple precautions to be taken. Oral Care for Babies Daily oral care practices in the form of tooth brushing and gum massage in babies should be started with the eruption of the first teeth. It is a very difficult practice to use a toothbrush in this period. It will be sufficient to clean the teeth with a clean damp cheesecloth or gauze after morning and night feedings instead of a toothbrush.
Parents have the opinion that dental cleaning is difficult and unnecessary at this age. However, microorganisms that cause dental caries settle in the oral cavity with the eruption of the first teeth. After the incisors are completed around 1-1.5 years of age, brushing should be done with a soft, small-headed toothbrush. Pasteless brushing should be done until the age of three. Babies swallow fluoride-containing pastes, which leads to excess fluoride accumulation in the body. A child around the age of two wants to use his own toothbrush and brush. It should be known that a child at this age does not develop enough motor functions to brush consciously, and after brushing, the parent should brush himself. If widespread cavities have occurred on the teeth during this period, fluoride toothpaste can be recommended starting from the age of 1-1.5, provided that the amount is small (as much as lentils). It is recommended that parents brush their teeth together and keep the brushing time as long as possible to set an example for their children. Brushing teeth immediately after taking sugary foods is effective in preventing caries formation. Toothbrushes should be replaced with new ones every 3-4 months for hygiene reasons and due to the deformation of the bristles. In case of indiscriminate use of fluoride tablets, discoloration is seen in the permanent teeth. For this reason, the fluoride tablets given by the dentist should be used regularly and at the recommended doses when deemed necessary. There are also common opinions that fluorine tablets are not very effective and their use is not mandatory. However, it has been proven that caries formation can be prevented by applying a superficial fluoride gel in the mouth and covering the tooth recesses prone to decay with a fluoride-containing material. It is more appropriate to do this type of protective application when the child is 6 years old and after the first permanent molars erupt. The caries in milk teeth may be ignored due to the idea that ‘they will change anyway’. However, this belief is not true. Especially as a result of the decay of the milk molars, the child does not want to eat because it hurts during chewing, so there may be delays in development as a result of malnutrition. Extremely decayed primary teeth can cause febrile and painful gingival abscesses. Milk molars are expected to function in the mouth until the age of 10-12.
Early loss of milk teeth can lead to impacted permanent teeth or crowding in the teeth. In order to avoid such undesirable results, the habit of brushing teeth should be established in children and children should undergo regular dental check-ups. Even if babies do not have any complaints, taking them to the dentist regularly at least twice a year starting from the age of 1 will help prevent the formation of “dentist fear” in them. Dental Health in Childhood Milk teeth, which are completed around the age of three, leave their place to permanent teeth from the age of six to seven. The first permanent tooth to appear in the mouth is the first molars, which last at the age of 6 years. At the same age, the milk teeth begin to shake and leave their place to permanent teeth.
First, it is expected that the milk teeth in the lower and upper anterior region will change. During the change of milk teeth, the permanent teeth coming from the bottom of the tongue or lips start to come in a crooked way, and in the meantime, the fact that the milk teeth have not fallen out yet may worry parents. However, this appearance is normal for this period called “mixed dentition” and continues until the age of 10-12 until all the milk teeth are replaced and the permanent teeth are placed in their places. It is very important to keep the milk teeth healthy in the mouth until the permanent teeth erupt. Because prematurely extracted milk teeth cause speech, nutrition, aesthetic problems and crowding in the teeth in children. In children who get used to different tastes in childhood, the habit of eating snacks between meals develops. In terms of tooth decay, it is recommended to consume sweet sticky foods immediately after meals. In between meals, instead of chocolate, wafers, biscuits, candies, and cola drinks, you can give milk, yogurt, cheese, buttermilk, eggs, or fruit that can be eaten by biting, such as apples, carrots, without peeling the skin. It is up to you to prevent your child from indulging in sugar and sweetened foods. It is necessary to limit the consumption of sugar used to sweeten food and drinks as much as possible. You can make your child meet his sugar needs naturally (for example, from fruits). One of the most common problems in school-age children is dental trauma. Impacts to the teeth due to impact or accident cause tooth fractures or infections.
Immediate intervention in treatment is the most important factor affecting success. Therefore, it is necessary to consult a dentist as soon as possible. Dental Care for Children Children aged 3-6 can brush their own teeth depending on the development of their motor functions. However, parental control and assistance is essential until school age. Since complicated tooth brushing methods will not be suitable for children, it is sufficient to brush the teeth in a rubbing style at the beginning by holding the brush horizontally. As the child grows, he can use the methods that adults brush. At the age of six, the first permanent molars erupt behind the primary teeth. These teeth are lower than the adjacent teeth. For this reason, it is necessary to brush by keeping the toothbrush inclined in this area. The use of dental floss, which is not necessary until this age, should be started after the age of six. In addition to dental care at home, fluoride treatments to be applied by the dentist at these ages, or the process of covering the surfaces of the teeth that are prone to caries with special filling materials, called fissure sealants, and six-month dentist checks are offered as simple but effective solutions for the prevention of dental caries. In addition to all this, remember that your child imitates you! You should brush your own teeth regularly (after breakfast and before going to bed at night!) at least twice a day. If possible, you should have your child watch you while you brush your teeth, and you should introduce him to brushing. The main treatments applied in children Caries treatment: 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 damaged 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 and going to the dentist. Front tooth/s displaced by impact: Put the tooth between a clean gauze and wet it with saliva and go to your dentist immediately. 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 the front teeth is broken after the impact: 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 can’t find the pieces: 1. 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 their eating habits and oral hygiene. 2. 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. It is not correct to apply porcelain laminate veneers in children younger than 17 years of age, since the development of teeth and jaws is not completed. Again, composite laminates that cover the entire front surface of the tooth and the fractured part are made. But there are problems caused by the material, they may need to be renewed after a while as they will become colored. 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 and x-ray, periapical x-rays are taken at regular intervals and compared with old films. 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. Tooth extraction: In some cases, the caries progresses to the living (nerve-pulp) part of the tooth. An inflammatory condition occurs that reaches the jawbone from the roots of the tooth. The child’s face swells, there is severe pain, 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 does not have any drawbacks. If the eruption time of the permanent tooth is not close, a space-holding appliance 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. Teeth 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.
Preventive Dentistry in Children Today, preventive medicine, which we can call stopping the problem before it occurs, has gained importance in dentistry, as in every field of medicine. 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. Hygiene education: Complete oral and dental care is only possible with complete information. Hygiene education, which includes teaching tooth brushing and 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. 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 areas with high fluoride content in their waters have encountered less tooth decay since ancient times, and 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 considered and applied in some regions, then 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 for the child’s first encounter with the dentist and for a check-up every 6 months. After this process, which takes a few minutes, the fluoride stored on the surface of your child’s teeth will make the teeth much healthier and stronger. Fissure protector: The chewing surfaces of the teeth are indented. These pits and mounds are called pits and fissures. These areas are very narrow and are often where cavities begin due to the inability to get trapped and cleared. A special fluid filling material is used in order to prevent the accumulation of food and microorganisms in these areas and accordingly caries. First of all, this area is completely cleaned and the fluid filler, which we call fissure protector, is applied to this area. It is hardened by light and polished by correcting the excess.
Thanks to this process, it is possible to be protected from chewing surface caries, which constitutes approximately 70% of all caries. Although it can be used for many years under normal conditions, it is useful 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 permanent teeth done shortly after they start 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 the fissure protector instead. Although it can be applied to adults without caries, its use in children is more beneficial and important. Placeholder: Deciduous tooth is lost early due to various reasons (cavities or accident). In such cases, until the permanent tooth from below is ready and erupts, the adjacent teeth may bend and turn, covering the area that the lost primary tooth should protect 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 room for the next permanent tooth. Thus, the permanent tooth will either not grow at all or will develop out of its normal place. Problems caused by losing even a single primary tooth prematurely: -the teeth will be displaced, so crowding will occur, these areas will not be cleaned easily and the tendency to decay will increase; – chewing will become difficult; -More serious orthodontic problems will arise. As a result, the first task of milk teeth is to ensure the proper nutrition of the child. In addition, the proper development of speech also depends on the presence of milk teeth. Milk teeth protect the area they cover for the permanent tooth that will replace them and guide it while the permanent tooth is erupting.
When the primary tooth is pulled out early, this natural place-holding function disappears. Problems in milk teeth are the source of many future problems. A prematurely lost milk tooth causes a number of problems. The resulting bruises create foci of infection in the child, and also make feeding difficult.
1- Babies should never be put to sleep with a bottle.
2- The use of pacifiers should be stopped around the age of one.
3- The child should meet the dentist between the first and second years of age.
4- Meeting the dentist early and when there is no problem yet creates a positive image in the child.
5- As soon as the teeth come out, they should be brushed.
6- Children of the 21st century eat sugar 3 times their needs. Proper nutrition is also an essential element of dental health.
7- Today, the most important task of dentists is to guide children towards a caries-free future with preventive treatments.
8- Fluor and Sealant are the strongest preventatives against caries accepted all over the world.
9- Children should be examined in terms of orthodontics at the age of 7-9 years.
10- The place of a milk tooth that was removed before its time must be protected until the permanent tooth comes.
