Published in "Panorama"
Caring for the milk teeth
Dental problems can arise in babies right from day one of birth! Yes, in some rare but not infrequent cases, babies are born with small teeth, called neo-natal or natal teeth, says Dr.Sushant Shetty, General Dentist, Zulekha Hospital, Sharjah. As in every aspect of modern health care, the thrust of dental care is on prevention rather than offering remedial measures when the damage is done. And this is best achieved right from a child’s first year of birth, more appropriately from the time its dentition begins.
Having said that, there are instances where some children are born with teeth. “These are usually present in the lower anterior segment, either in the lower or upper jaw, but usually in the front,” explains Dr.Sushant. “The reason for this is genetic, coupled with the environmental influences when the child is in the mother’s womb. Such babies will not suckle and also the suckling will be very difficult for the mother. In these situations we normally extract the tooth if it is quite mobile; else we leave it untouched.”
What are the other common causes of dental decay in infants and small children? One of the commonest reasons, particularly in this part of the world, says Dr.Sushant, results from a pooling of milk in the baby’s mouth when it falls asleep while suckling from a milk bottle. “This is the time when the decay usually starts. While lactose, the sugar present in milk itself can lead to the decay, the risk is greater if the baby is fed sugar-added milk. This nursing bottle decay presents as a rampant decay, usually involving the upper teeth. By the time the baby is a year and a half, there are no upper teeth left and this is quite a common phenomenon in this region. The milk pools in the upper area; the lower area still gets more cleaning because of the tongue which is constantly moving even when the baby is sleeping. The excess salivation doesn’t allow any milk to pool at the lower anterior teeth. The upper teeth are not so cleansable since the tongue cannot move so much, upwards. So this sets the enamel erosion process in motion and the consequent tooth decay.”
The problem is compounded since enthusiastic parents start their infants on juices as early as when they are six months old. Juice itself if basically acidic and it can erode the enamel, particularly if sugar is also added to it, opines Dr.Sushant.
The symptoms of dental decay in these infants may initially show up as white spots on the teeth, later turning black followed by erosion of the enamel and consequent crumbling. However, this process will not hamper the development of the permanent teeth. When the decay progresses, only part of the tooth may be there and where it is not possible to do any treatment, removal of the tooth may be the only solution. “A missing tooth may psychologically affect the child as he grows up and he may fight shy of meeting people, talking and even smiling,” says Dr.Sushant.
The problem of decay takes on a different dimension in pre and primary school children since by now they start indulging in eating sweets, chips, chocolates and fizzy drinks and snacking between meals. Preschoolers face the risk of injury and consequent damage to their milk teeth since they are physically very active at this age, tending to climb little heights and jumping from them. Similarly, there is the possibility that when the milk teeth give way to permanent teeth between the ages of 6 and 12, the front teeth are not aligned properly. If any corrective treatment is needed at this stage, it should be immediately done.
Plaque build-up is another common problem during the period when the milk teeth start shedding and give way to the permanent teeth. Explaining the condition, Dr.Sushant elaborates, “Hard calcium deposits may buildup and get integrated into the plaque. If these deposits are allowed to form, they can lead to gum irritation and bleeding, disabling the child from regular and proper brushing of teeth, thus promoting the accumulation of food particles along the area and the consequent pain from the whole process.”
Dispelling the commonly believed notion that mal-aligned or double teeth are a result of constant meddling with the milk teeth when they become loose and are about to fall, Dr.Sushant clarifies, “It is not a thumb rule that the permanent tooth will follow the path of eruption along the same inclination as that of the milk tooth. The path of eruption is fixed genetically and bears no relation to the child meddling with the loose milk tooth. Sometimes the path of eruption will vary – outwards or inwards to the original alignment area. This is the time when the children will have double teeth. This calls for orthodontic intervention and removal of the tooth.”
Further explaining the possible conditions, he reveals, “At times when there is decay is on the pulp and the tooth is not salvageable, if the milk tooth is taken out the front and back or the upper teeth, start blocking the area of that empty space. The permanent tooth therefore may not erupt in that path and might instead move inwards or it might not come out at all. In such situations we normally give space maintainers and block that area, make it clear so that new permanent tooth will follow in that space.”
Thumb sucking, tongue-thrusting and prolonged bottle sucking, can push the front teeth forward. Interceptive measures will have to be taken to handle these problems and prevent the teeth jutting forward, opines the surgeon.
Dental Tips for babies and toddlers:
1. If teething is taking place, use a teething ring so that the baby doesn’t feel the pain of dentition.
2. If baby cries from pain, apply local antiseptic creams upon the area of irritation. These are available in the pharmacies and dispensed by the dentists.
3. Don’t give any sweetened drinks to the baby from the bottle.
4. Establish regular bottle feeds. When baby needs drinks between feeds, use boiled and cooled water.
5. To wean babies off the bottle, dilute the milk to very low concentrations by adding water. This will ensure lesser amounts of milk going into the mouth and pooling when the child falls asleep.
6. After feeding, wipe the baby’s teeth with moist cloth or cotton.
7. It is better to cultivate the habit of drinking from a cup once the baby is 8 months old. This will definitely reduce the decay producing process.
8. Start brushing the baby’s teeth as early as when the teeth appear. Small nylon filaments are available for the purpose.
9. Do not brush with fluoride toothpaste; there are special brands of fluoride-free toothpaste available for small children.
10. By one year to eighteen months, start taking the child to the dentist to acclimatize him to the dental environment and rid him of the fear of doctors.
Dental tips for Pre-schoolers.
1. Teach the toddlers how to brush. This is usually done by the parents visiting a dental clinic to see a demo of the right brushing technique.
2. Use a very soft paediatric brush with pea sized, fluoride-free toothpaste.
3. See that the kids don’t junk between meals, especially sweets and sticky foods.
4. If you spot signs of tooth decay, don’t delay consulting a dentist. In this way you will avoid decay spreading into the pulp.
Dental tips for Primary Schoolers
1. We normally advice them to start brushing with fluoride paste under supervision by the parents.
2. Maintain good oral hygiene and habits, especially by avoiding snacking between meals and eating junk foods.
3. Get a pit and fissure sealant done if you see signs of decay in the pits and grooves of the teeth.
4. Get a fluoride application done where necessary since this helps the enamel to become strong.
5. If any corrective treatment is needed at this stage, have it done at the earliest.
6. Rinse your teeth even if you don’t brush after every bout of eating. As far as possible, keep on gargling your teeth since this reduces the amount of food particles which are in the mouth and reduces the amount of tartar formed around the area.
7. Brushing is a must if you eat sticky foods.