MILK TEETH AND DENTAL EXCHANGE
Children’s dentistry or pediatric dentistry is a specialization in general dentistry that deals with the care and rehabilitation of dental elements in children.
The young patient is more subject to cariogenic risk *, due to the child’s lack of ability in home oral hygiene * and the frequent intake of food rich in sugar creating the optimal condition for the formation of caries *.
Therefore, it is very important to monitor the child through professional oral hygiene sessions * and periodic checks, in order to intercept the carious process early and cure it. Deciduous (milk) dental elements become affected by caries * much more easily than permanent elements and, moreover, the carious process * progresses very quickly reaching in a short time, if not prevented, the dental pulp. *
DIFFERENCES BETWEEN DECIDUOUS TEETH AND PERMANENT TEETH
Milk teeth are numerically fewer than permanent teeth (they are only 20) but, they perform very important functions within the child’s oral cavity. In fact, they help chewing and the digestion of food and maintain the space necessary to accommodate future permanent elements. Therefore it is essential that they remain inside the oral cavity for as long as possible and that they are not lost prematurely due, for example, to caries * or trauma *.
Furthermore, the deciduous elements differ from the permanent ones also in their anatomical composition.
In fact, unlike permanent teeth, milk teeth have a thinner layer of dental enamel, an equally thin layer of dentine which in turn flows into a very large pulp chamber. For this reason, it is very important to prevent and monitor carious process * in children in order to prevent nerve contamination with resulting devitalization and/or extraction.
The first dentition of “milk” or “temporary” teeth comprises 20 teeth, arranged in a number of 5 for each hemi-arch:
- central incisor
- lateral incisor
- first molar
- second molar.
The second dentition, that of the “permanent” teeth, instead comprises 32 teeth and consists of 8 teeth for each hemi-arch:
- central incisor
- lateral incisor
- first premolar
- second premolar
- first, second, third molar (or “wisdom tooth”)
The exchange takes place following a fairly predictable chronology:
- at 6 years -> first upper molars
- at 7 years -> central incisors (lower and then upper) and lower first molars
- at 8 years -> upper and then lower lateral incisors
- between 9 and 12 years old -> canines, first and second premolars
- at 12 years old -> second molars
- between 18 and 21/30 years -> third molars
At about the age of 12, a child has already formed, within the jaw bones, almost all the definitive teeth, with the exclusion of wisdom teeth. These can appear up to the age of 30 or they may never appear.
CONSERVATIVE THERAPY IN PEDODONTICS
Milk teeth are numerically fewer than permanent teeth (they are only 20) but they perform very important functions within the oral cavity and for the general development of the child. In fact, they help chewing and the digestion of food and maintain the spaces necessary to accommodate future permanent elements. Therefore it is essential that they remain inside the oral cavity for as long as possible and that they are not lost prematurely due, for example, to caries * or trauma. *
The control of caries * passes through an individualized prevention plan, thanks to checks and sessions with the dental hygienist, which limit the presence of cariogenic reactions.
Nutrition plays an essential role, since the habit of consuming sugar or sugary substances predisposes the presence of caries.
Deciduous elements differ from permanent ones because their anatomical composition has a much thinner layer of dental enamel, an equally thin layer of dentine which in turn flows into a very large pulp chamber. This condition involves a progressive and rapid development of caries towards the nerve part of the tooth. For this reason, it is very important to prevent and monitor carious processes in young patients, in order to prevent contamination of the nerve with subsequent devitalization and / or extraction of the deciduous element.
Decayed milk teeth must be treated! In particular, if tooth decay should occur prior to exchange. Failure to carry out treatment results in important consequences ranging from pulpitic pain, to the formation of an abscess, early loss of dental elements with consequent disruption of the correct eruption of the permanent teeth, and even an incorrect nutrition due to the impossibility of chewing food correctly.
The therapy involves the removal of caries and the reconstruction of the dental element.
Depending on the size of the caries, the appropriate therapy is structured. In more complex cases, the removal of caries is performed under local anaesthesia and if this affects the nerve of the tooth, the removal of the central part of the nerve called pulpotomy is performed. Pulpotomy is very frequent in cases of medium-sized caries on milk teeth, precisely because of the anatomical conformation of the dental layers described above.
At our centre, thanks to the experience of our specialized clinicians, collaboration with young patients is practiced, fostering a relationship of trust so as to carry out the appropriate therapies in serenity. This, together with the use of appropriate protocols and advanced technology, allows anaesthesia to be administered and completely pain-free therapies to be performed, thanks also to the use of electronic devices.
DENTAL TRAUMAS IN PEDIATRIC AGE
Dental trauma is a very frequent event that can affect both pre-school children in their “milk” teething stage, and children of school age in mixed or definitive dentition.
The most frequently affected dental elements are the upper central incisors (50% of cases) and the upper lateral ones (30% of cases). Falls are the most frequent causes of facial trauma.
In the growth phase, a dental trauma can lead to serious consequences. Therefore, Omniadent specialists pay a lot of attention to preventive measures which we do through correct information that involves dentists, dental hygienists *, parents, school teachers and athletes, all in close collaboration with pediatricians. In fact, they all follow children in early childhood, when they start walking, with and without a walker. This is the most frequent time for the occurrence of dental trauma due to the high tendency to fall and to hit furniture.
Among the most frequent causes of dental trauma is the increase of the overjet (distance between upper and lower incisors). Consequently the central upper teeth are much more protruding than normal. This can be due to genetic factors or the habit of sucking the thumb or pacifier. Our preventive work is aimed at divulging suitable and correct information on alimentation and intercepting and correcting any dental protrusion early.
We can divide trauma in two categories:
- Trauma to the hard tissues of the tooth (enamel-dentin-cement)
- Trauma to the supporting tissues of the tooth (t. Bone-ligament-gum)
They can occur individually or concurrently and must be treated appropriately.
A clear distinction must also be made between dental AVULSION (complete tooth loss) and CORONAL OR RADICULAR FRACTURE of the tooth.
If a dental trauma occurs, it is important that the parent, teacher or adult present calms the child down and, once the damage is ascertained, go to a dental specialist as quickly as possible.
In the event of AVULSIONof a permanent tooth, it is essential to recover the lost element and replant it as quickly as possible, no longer than 2-3 hours.
The tooth is necessary only for the crown (the largest and whitest portion of the tooth), not for the root (the thinnest and yellow portion of the tooth). It should not be cleaned, in order not to alter the periodontal fibers but should be kept in a liquid environment ((physiological solution, milk or saliva).
Once repositioned in the mouth, it must be temporarily splinted to the other teeth for about 2-4 weeks and periodically checked to rule out the onset of complications. For the next 10-14 days, rinses are advised or the use of chlorhexidine gel (1%) and a soft diet is recommended.
In the event of CORONAL FRACTURE of the tooth, it is very important to recover the fractured fragment. If possible, also keep it in physiological solution, milk or saliva and go to a specialist as quickly as possible.
It is the opinion of our dental team, in fact, to encourage schools and sports centres to add vials of sterile physiological solution to their first aid kits.
The adhesion of the dental fragment to the remaining part of the tooth is the most conservative and effective therapy.
In case of dental trauma it is very important to carry out a careful clinical and radiographic examination to exclude the presence of root fractures, evaluate the degree of tooth formation, the degree of dislocation of the tooth in the alveolus and, in the case of avulsion, without finding the tooth, in order to make differential diagnosis with intrusive dislocation (complete recovery of the tooth in the alveolus).
Our centre pays close attention to these traumatic events, not only in view of an aesthetic recovery of the dental element involved, but also to intercept possible complications to the not yet erupted permanent dental elements. If the tooth in question is a milk tooth with a view to maintaining correct functionality of the mouth in general and of the muscular and skeletal structures connected to it.
It is in fact, important to underline that a traumatic event can involve not only the teeth, but also the bone, joint and muscle structures of the face that must be properly evaluated to avoid future functional and postural complications.