Paediatric dentistry is a much neglected area of medicine. DR. ARUNA MOHAN makes out a case for treating it seriously.
TOOTH decay in children is neglected because of the misconception that milk teeth are not important since "they will fall out anyway". Dental caries or tooth decay remains the single most common disease of childhood that is neither self-limiting nor amenable to short term medical treatment and yet is preventable. Therefore an early start in regular dental care is important.
People usually think of an newborn as having no teeth. But the 20 milk teeth that will come up in the next two and a half years are present at birth in the baby's jawbone. In fact, at birth the crowns of the milk teeth are almost complete and the chewing surfaces of the permanent molars have begun to form. Milk teeth serve important functions such as allowing good pronunciation and speech, allowing good nutrition and building self-esteem in children. In addition, they hold the space in the jaws for the permanent teeth. Both the milk teeth and the permanent teeth give the face its shape and form.
Surveys of dental caries between 1941 and 1982 have shown a gradual rise in the rate of decay. Reported to be as low as 33.7 per cent in 1947, it has now risen to 95 per cent. Incidence of dental decay in children of both urban and rural areas is as high as 80 per cent. In India, the increased availability of a variety of chocolates, snacks and fizzy beverages (which contain high amounts of sugar in the form of high fructose corn syrup) has led to an increase in the number of children with dental decay, notably in the age group of two to eight.
Baby Bottle Tooth Decay (BBTD) or Nursing Caries is a serious form of decay in young children. This is tooth decay in toddlers who are not yet weaned by the age of one year or who are allowed to sleep with a bottle of milk or sweetened liquids. In clinical practice, it can be seen typically in a two-year-old with four upper front teeth (maxillary incisors) that "came in decayed" or "broke on eating". Careful questioning will usually identify a particular feeding pattern. If not treated and if unrestricted feeding patterns continue, total destruction of the front teeth occurs, followed by progression of decay in the back teeth or molars.
Untreated decay of the milk teeth can, in addition, lead to infections that affect the underlying developing permanent teeth. Decayed teeth can prove to be sensitive and painful and thereby a child's eating and sleeping patterns, possibly resulting in inadequate nutrition during a critical growth period. Prematurely lost milk teeth result in drifting of the adjacent teeth and "blocking out" of the erupting permanent teeth, resulting in malocclusion or "crooked teeth".
Many parents do not, however, realise the importance of restoring the milk teeth. They expect these teeth to be extracted because there won't be any further "teeth trouble". Unfortunately, this attitude has been fostered by the over willingness to resort to such practices thus engendering a lifelong poor attitude to dental health.
By making all efforts to restore and preserve the milk teeth, the psychological message imparted is that "teeth are important". The importance of this cannot be overemphasised. The character of dental practice has to change to include new emphasis on preventive dentistry. Preventive measures should be initiated at an early age.
From the point of both the child and the dentist, the prevention of pain is more desirable and easier to handle than its relief. Also when lesions are diagnosed early, dentistry is less extensive, easier to do and less time consuming.
Pre-natal programmes, which counsel and educate parents on the importance of their own dental health and that of their child, need to be put into practice. Early post-natal visits will allow screening for dental decay or other developmental problems. Parents should also check the children's teeth periodically for possible signs of decay including discolouration of teeth and holes in which case the child may complain of food being stuck in the teeth.
Pre-school years are the best to help a child establish good eating habits, with emphasis on minimal intake of sweetened foods and fizzy beverages. It would also help to start the child on an oral hygiene regimen with supervisory guidance from the parents. The right brushing technique can go a long way in helping prevent tooth decay. Brushing teeth should start preferably as soon as the first tooth comes out. Helping the child brush his/her teeth until the age of six by which time he/she should develop good brushing techniques is advisable.
Fluoride: The role of fluoride in the prevention of dental decay has been well documented. However, fluoride supplementation in India remains controversial due to excess natural fluoride in the water in certain pockets of the country.
Paediatric dentistry in India is an evolving field, which will help provide comprehensive oral health care to a growing child. This starts with improving awareness among parents and children. Like the baby clinics that form the core of overall paediatric health, paediatric dental check-ups should be encouraged.
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