Kids 0-5 Years
Eruption of Primary Teeth
This eruption sequence is only a guideline; children may vary within ±6 months of the given months (see illustration below). Each child’s timing will be slightly different. You can monitor your child’s teething process by making use of this guideline:
– Right and left will correlate within a six-month period.
– Lower teeth erupt ±2-6 months before the correlating upper teeth.
– Within ±29 months all primary teeth should be present.
If primary teeth are carious, discoloured or missing, it does not necessarily mean that the permanent teeth will also show the abnormality. Signs of teething include drooling, facial rash due to drooling, swelling of gums, bright red cheeks, irritability, refusing food, diarrhoea, biting tendency, sleep problems and low fever (±38°C).
Prevention of Dental Problems
Take your child to the dentist from age two and-a-half for routine check-ups. This will ensure that he/she gets used to the environment without the trauma of major procedures. Gentle treatments such as cleaning will most likely be given. Most children with fear of dentists had treatment done on the first day.
It is very important to protect the primary teeth, seeing that they keep spaces for the permanent teeth. Early loss due to caries or an abcess may lead to crowding and other complications when permanent teeth erupt. Prevent decay and early loss by following this advice.
There are wonderful products on the market to make oral hygiene easy for parent and child.
Use the appropriate products as shown in PRODUCTS to assist in good oral hygiene. Up till the age of about one-and-a-half years, give the toothbrush to the child to chew on every morning after dressing and evening after bathing to start with the routine.
TIPS FOR TEETHING
Wipe drool with a soft cloth (Refrain from rubbing too much) and spread petroleum jelly on the skin to prevent drying and irritation. Buy teething toys to not only give them something to bite, but also take their minds off the discomfort of teething. Toys that can be put in a freezer or a wet cloth that was frozen brings great relief when chewed on. Rubbing or massaging gums brings relief to some, but others might not allow this.
Topical gels are generally safe to use on gums, but don’t overdo it because swallowing too much of the gel can numb the back of the throat and decrease the gag reflex. If your child develops a rash or swelling, stop using the gel, for in rare cases it might be an allergic reaction. Consult your doctor or pharmacist if this happens.
Smooth food like cold yogurt and applesauce
or rigid foods like biltong and apple slices, are a healthy and good option. Cool the baby’s drinks for relief. If pain is unbearable, medication such as acetaminophen can be provided by a doctor or pharmacist.
Do not give your child any medication without first discussing it with a doctor or pharmacist. If fever rises too high, make sure that there is no underlying medical condition and consult a doctor.
Give your child more love and have a little more patience than usual, seeing that he/she is not feeling well and is in pain. An herbal option is chamomile that helps significantly with physical and behavioural problems associated with teething.
In the beginning children struggle with the co-ordination and may need some help from parents. TELL them how to brush and why we all do. SHOW them how you brush and how they should brush, and then let them DO it. Refrain from telling them they are not doing it right or from getting angry; it may discourage them to try again. Avoid putting too much toothpaste on. The flavour may discourage the child and cause nausea. A pea-size amount will do! Use appropriate toothpaste for children.
Diet and habits
Avoid giving your child juice, milk or fizzy drinks in a bottle to carry around all day or to go to bed with. The constant sugar exposure to the teeth will lead to caries. If you give the above, let your child drink it and then a little water afterwards to rinse away the sugar. Baby bottle caries is a common problem with children but can be easily prevented by avoiding constant exposure of the teeth to high sugar levels.
Thumb sucking: A child should never continue with thumb sucking past the age of two years. It is even better if the habit can be avoided completely.
The pressure from the tongue on the thumb during thumb sucking can lead to deformation of the anterior palate which can lead to fanning anterior teeth. If the deformations are small and the habit has stopped, it will restore normally without intervention by a dentist. However, if continued beyond two years, dental intervention will be necessary.
Depending on the severity of the deformities, the dentist will make an appliance or refer you to an orthodontist. The same two-year limit goes for dummies, but the effect of a dummy is much less than that of thumb sucking.
Different methods are successful for different personalities. Remind the child not to suck the thumb by putting a plaster or ribbon on the thumb. Replace thumb sucking with sucking a sugar free sweet. Try offering a pacifier, as it has less effect than thumbsucking. Reward the child for efforts to stop the habit, also when he/she succeeds.
Mouth breathing: Some children tend to breathe mostly through the mouth and not the nose. This may lead to changes in oral bones position, muscles tone and position of teeth. It is important to deal with the cause of mouth breathing. It is usually caused by sinus or nasal problems, which make breathing through the nose difficult.
See a medical doctor for sinus problems. If the habit is stopped at an early age, all deformations will correct without intervention. However, if left to an older age, treatment will be needed to correct defects. Depending on severity the dentist will make an appliance or refer to an orthodontist.
“Fluoride administered in the correct dosage can decrease fissure depths, desensitise, re-mineralise and increase the strength of teeth.”
How to make a child comfortable and cooperative at the dentist.
Prepare your child verbally referring to the video provided. Avoid mentioning fear, pain, injections, stress etc. Children are very quick to read between the lines and see your fear!
Use phrases like: View the provided video with your child, and then prepare them verbally, referring to the video. Avoid mentioning fear, pain, injections, stress etc. Children are very quick to read between the lines and pick up on your anxiety! Use phrases such as: “The friendly doctor is going to look at your teeth.” “The dentist helps us keep our teeth clean and healthy.”
Should there be a hole, prepare the child by saying: “The doctor will make the tooth sleep, clean it and put a little star in the hole.” If the child needs an extraction, you could say: “The dentist will make the tooth sleep and take it out so you can give it to the tooth fairy.”
The injection can be explained as making the tooth ‘sleep’, saying that it feels like when you sit on your foot and it goes to sleep. This way they expect a slight burning tingling sensation, if any. Role-play before going to the dentist. You can look into each other’s mouths, lying flat on your backs, and pretend to be the patient or the dentist.
At the dentist, let the doctor take control of the situation. Reassure your child of your presence, and that she/he can trust the dentist and should listen to what he/she says. Some dentists and mothers prefer the mother to wait outside, and for some children this arrangement works best.
If your child is already traumatised or uncooperative, there are many ways to give dental treatment without making matters worse. The following options can be discussed with your dentist:
Behavioural management: Methods such as Tell-Show-Do, Reward, Distraction, Desensitisation, etc.
Dormicum: The dentist may prescribe a pill, in the correct dosage for your child’s weight, which can be taken 45 minutes before treatment. This should make the child sleepy and calm so that treatment can take place. Dormicum also causes short-term amnesia so the child won’t remember much about the appointment. Children’s reaction to Dormicum differs; some sleep but some don’t even get drowsy, in which case a different method may be better. Possible side-effects are sleeping for the rest of the day, nausea, and falling due to loss of co-ordination.
Homeopathic option: Avena stiva, passiflora, humulus lupulus or valerian drops given in a little juice or water two hours before a dental visit and on arrival will help with nerves. Get this from your local homeopath.
Nitrous oxide: The dentist will place a small mask over the nose through which oxygen and nitrous oxide will flow. By increasing the nitrous oxide, the child will relax and fall asleep. The nitrous can be reduced or increased easily and when the flow is stopped, the child will wake up fully. Side-effects may include feelings of claustrophobia, which may cause some children to not co-operate.
Intravenous sedation: A qualified doctor or anaesthesiologist would place a drip through which medication is administered till the child is completely asleep and doesn’t feel any pain, but still breathes on his/her own. The doctor will monitor the vitals and administer drugs as needed. When treatment is finished, the anaesthesiologist will administer the correct drugs so the child wakes up. Side-effects may include sleeping for the rest of the day, nausea and vomiting, crying and disorientation.
General anaesthesia: If lots of work needs to be done, the dentist will advise general anaesthesia. This will be done in a theatre where complete anaesthesia will be administered. Side effects: sleeping for the rest of the day, nausea and vomiting, crying and disorientation.
Dental terms and procedures?
Scale and polish refer to cleaning of the teeth with a vibrating instrument and water, followed by a polishing cup or brush. This can be done regularly during visits when the dentist will clean the teeth from plaque, calculus and staining. If no calculus is present, the teeth will only get polished. Calculus is hard deposits on teeth that can’t be removed by normal brushing and can be white or discoloured.
Fluoride administered in the correct dosage can decrease fissure depths, desensitise, re-mineralise and increase the strength of teeth, thus decreasing chances of caries. In-chair fluoride treatment is safe, seeing that it does not have any systemic effects. Additional fluoride in the form of tablets and drops can be discussed with dentist. The correct dosage should be determined by taking into consideration the amount of fluoride the child is already exposed to in water and his/her diet. Incorrect fluoride levels can lead to fluorosis or staining, and some systemic effects.
Fissure sealants: Fissures are the small groves on the teeth that vary in depth from person to person. This is usually the place where caries starts. Fissure sealants are small fillings that seal the grooves on permanent molars to prevent caries from starting there.
No anaesthesia is needed, and this is ideally done as soon as permanent molars are fully erupted (6-7yrs). This is a great way to help prevent decay in your child’s teeth!
Fillings: Depending on the size and depth of the filling, the dentist may or may not need to give an injection. The caries (rotten part of tooth) will be drilled out and then the filling will be placed. Amalgam (silver) fillings or composite (white) fillings can be placed, but composite fillings are considered to be safer, as there is no risk of mercury poisoning.
Pulpotomy and pulpectomy: If the hole is so deep that it affects the nerve the dentist will need to remove the nerve partially (pulpotomy) and then place a filling. Or the dentist will remove the whole nerve (pulpectomy), fill the nerve canals and then place a filling.
Stainless steel crowns can be placed on primary molars when teeth have large fillings or had pulpotomy or pulpectomy. These crowns prevent teeth from breaking in the future.
Extraction is the removal of a tooth after an injection. This is considered when a large part of the tooth is broken or carious, the shedding time is near or child co-operation for pulpectomy is not sufficient. If a primary tooth is extracted long before the permanent tooth will erupt, the dentist will make a space maintainer to keep the space for the permanent tooth.
Antibiotics may be prescribed in some cases and are usually safe in the correct dosages. If your child has any allergies or medical conditions, be sure to tell your dentist.
What to look out for?
Looking inside your child’s mouth. Note changes in the colour of the teeth. Look for dark brown areas, holes and bad breath. If there is swelling of the gum next to a rotten tooth or draining of a yellow substance, take your child to the dentist to check for an abcess. If an abcess (even if it is not painful) is not treated by a pulpectomy or extraction, it can affect the permanent tooth, leaving white stains called enamel hypoplasia.
Pain. If your child complains about pain when eating cold or sweet stuff, make an appointment with the dentist. This is usually the first signs of decay and a filling will probably resolve the problem. If pain reaches a level where it begins spontaneously, keeps the child up at night and is accompanied by fever, more extensive treatment such as antibiotics, pulpectomy or extraction will probably be needed. That is why regular check-ups are so important – to stop a problem while it is small!