Preventing early childhood caries (ECC) is important not only for the current generation of children but also for future generations. ECC is a severe form of tooth decay that can cause pain, infection, and even tooth loss in young children. If left untreated, ECC can have a significant impact on a child's oral health, speech development, and overall quality of life.
Fortunately, there are steps that parents and caregivers can take to prevent ECC and ensure that future generations of children have healthy teeth and gums. Here are some tips for preventing ECC and passing on good oral hygiene habits to future generations:
By following these simple steps, you can help prevent ECC and pass on good oral hygiene habits to future generations. Good oral hygiene is essential for maintaining healthy teeth.
Image credits: drrajeshbariker
Is Nitrous Oxide Safe for Children?
Yes, it is! In fact, our dentists typically prefer to administer nitrous oxide to children compared to other deeper levels of sedation. This is because it has an excellent safety profile.
Why Are Patients Given Oxygen After Nitrous Oxide?
It is common to administer 100% oxygen to patients once they are no longer breathing in nitrous oxide. The oxygen therapy eliminates any lingering nitrous oxide in the lungs, while helping patients become more alert. The oxygen therapy also prevents headaches, which can sometimes be caused by nitrous oxide.
Who Shouldn’t Receive Nitrous Oxide?
Although nitrous oxide is safe for most people, we are always sure to review your health history before proceeding with treatment under nitrous oxide. Typically, nitrous oxide is not recommended for women in their first trimester of pregnancy. Also, the use of nitrous oxide is generally contraindicated for patients who may have: COPD, methylenetetrahydrofolate reductase deficiency, cobalamin deficiency, or a history of substance abuse.
Should I Eat Before Receiving Nitrous Oxide?
If you know that you are going to be receiving nitrous oxide, you can feel free to have a light meal a few hours before treatment. However, some patients find they will become nauseous as a result of the nitrous oxide. In these cases, we advise to avoid eating too much food before treatment, so you don’t become sick. If you or your child has never had nitrous oxide before, refrain from eating prior to treatment until you know if it will make you feel nauseous.
We take great pleasure in announcing our much awaited center at Whitefield, Bengaluru in order to cater to the increasing requests of our patients. We promise to maintain the same quality of service and deliver everything that’s expected of us.
This new state-of the art center has been made possible by your immense support. We wish to be at the receiving end of the same even in the future.
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Abusive head trauma (AHT) often happens when a parent or caregiver becomes angry or frustrated because of a child's crying. This is because it is most often caused by shaking a small child or infant so hard that it has a whiplash effect. It can also be caused by jerking, throwing, or hitting the child. Abusive head trauma is a form of child abuse that can be deadly or leave a baby seriously injured for a lifetime. Most often, victims of this kind of abuse are less than 1 year old, but it can happen with children up to age 5.
How is abusive head trauma diagnosed?
You should go to the emergency room right away if you suspect your child is suffering from abusive head trauma. Some symptoms of abusive head trauma (for example, vomiting or irritability) are also common in other illnesses. So, it is important for the doctor to know if your child may have been shaken or hit in the head. The doctor will ask questions about what happened. Unfortunately, the person responsible for the abuse may not be honest about their actions.
Can abusive head trauma be prevented or avoided?
Because this happens due to a caregiver’s actions, it is absolutely possible to prevent abusive head trauma. It is important for everyone who takes care of your baby or young child to learn how to handle stressful situations (for example, when your baby cries for a long time).
One way to handle stress is taking several deep breaths, finding a safe place for your child (for example, the crib), and walking to another room for 10 to 15 minutes to calm yourself.
Soothing a crying baby is not easy. However, there are a number of things you can try to calm the baby, including Singing, Rocking, Swaddling, taking them for a ride or a walk, Breastfeeding, offering a bottle or pacifier, Laying the baby on their stomach across your lap, and gently rub or pat the baby’s back
Combining these strategies with “white noise” or rhythmic sounds (for example, music, a hairdryer, or a clothes dryer) can help. You also can try putting your child down for a nap on their left side to help with digestion, or on their back.
Mothers’ own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable or solely adequate. Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible, and is based on cow’s milk or soymilk. A number of alternatives to cow’s milk-based formula also exist. Most of us are well aware of these facts but ignorance or lack of awareness of oral hygience maintence leads to early childhood caries in children. The infographics here provide a co-relation and highlight the importance of mother's milk, cow's milk, formula milk and their ongoing relation with caries.
#kidsdentist #kidsdentisthsr #kidsdentistindirangar #kidsdentistharlur #india #bengaluru #pediatricdentistry #pediatrics #mothersmilk #cowmilk #formulamilk #infantformula #aapd #aap #amop
Evidently, mother-in-the-making implies all types of sacrifice. During this time, a mother-to-be can get so focused on making everything perfect for her little one that she can neglect her own health. But, a mother who cares for herself is also caring for her unborn child—its necessarily true when it comes to oral health.
Make sure you visit your dentist. It will allow him or her to analyse your current oral health and map out a dental plan for the remainder of your pregnancy. When you take care of your teeth and gums, it can potentially make a difference for your baby, both before and after birth. This is important.
Tooth decay in infants and very young children are often referred to as baby bottle tooth decay. Baby bottle tooth decay happens when sweetened liquids or those with natural sugars (like milk, formula, and fruit juice) cling to an infant's teeth for a long time. Bacteria in the mouth thrive on this sugar and make acids that attack the teeth.
Presenting a case of full coronal restoration of lower anterior teeth with strip crowns in a 2.4-year-old child with nursing bottle caries. The patient was treated chair-side without local anesthesia.
𝗜𝗠𝗣𝗢𝗥𝗧𝗔𝗡𝗧 𝗙𝗢𝗥 𝗣𝗔𝗥𝗘𝗡𝗧𝗦:
Gum pad cleaning with a soft gauze/muslin cloth for children under 6 months is a must.
Start brushing/cleaning with a finger brush as early as the first tooth eruption.
A pediatric dentist visit around the first tooth’s eruption time to specifically discuss breastfeeding, oral supplements, and oral hygiene maintenance is vital.
Remember, Prevention is always better than treatment.
Apgar index (AI) is used for postnatal, general, neural, and behavioral assessment of newborns. This index is an important marker for future enamel defects.
Enamel defects are serious challenges because of their unaesthetic appearance, dentinal sensitivity, and subsequent susceptibility to dental caries.
Lower Apgar index reciprocated more hypoplastic and hypocalcified teeth both qualitative and quantitatively
Apgar values below 6, has considerably increased vulnerability for the development of enamel defects, irrespective of the gender of the individual.
Remember, Lower AI scores reciprocate to higher chances of Enamel defects. Thus, those under higher risk need stringent preventive measures.
Schedule a visit to your nearest pediatric dentist for oral care counseling.
Further reading
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The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with the continuation of breastfeeding up to 1 year
While the IAPD Recommends
Oral care of infants from Day 1 starting from gum massage to wiping gums with a clean cloth after every feed.
It also recommends introduction of fluoride toothpaste as soon as the first tooth erupts.
Early childhood caries can be avoided EARLY.
Prolonged Breastfeeding as per recommendation and no/minimal oral care equals ECC.
The threat of Early Childhood caries is real in children as young as 12 months.
Remember,
Oral care of infants since day one is equally important as breastfeeding.
Teeth eruption is an ongoing physiological process, in which teeth move from their developmental position within the jaws to break the mucosa toward the oral cavity. Researchers consider a tooth as erupted when as any part of the tooth crown penetrates the gingival tissue and is visible in the oral cavity. Parents consider eruption of first primary teeth as an important developmental milestone that has to be achieved by the child and often seek pediatrician opinion if there is a delay. Studies have shown wide variations in the timing of primary teeth eruption.
Studies have shown wide variations in the timing of primary teeth eruption within a given geographic area as well. Numerous factors influence the timing of eruption. These include gender, ethnic origin, racial group, gestational age, systemic diseases, hereditary factors, and nutritional status. Dental age of children widely vary among children and depends on their dental developmental milestones, thus a delay is not necessarily a worry sign for parents. Dental age is also a key factor for implementation of caries prevention programs such as topical fluoride application.
Step 1: newborn oral care
Seek counseling for oral care of NEW-BORN, with emphasis on post-feeding care and infant gum care.
Step : when the first tooth erupts
Visit a pediatric dentist for counseling and education.
Step 3: brushing care
Which, How many times, Tongue cleaning?
Step 4: Oral care post supplements
Seek counseling on Oral care if supplements are included in the infant's diet.
Among the major objectives of pediatric dentistry is to guide the developing dentition to a state of normalcy in line with the stage of oral-facial growth and development. This period of mixed dentition offers the greatest opportunity for occlusal guidance and interception of malocclusion. If delayed to a later stage of maturity, treatment may become more complicated.
Anterior dental crossbite requires early and immediate treatment to prevent abnormal enamel abrasion, anterior teeth mobility and fracture, periodontal pathosis, and temporomandibular joint disturbance.
The main objective of the intervention is to tip the affected maxillary tooth or teeth outward to the point where a stable overbite relationship exists. Spot them early. Visit your nearest pediatric dentist for an evaluation.
#kidsdentist #kidsdentisthsr #kidsdentistharlur #kidsdentistindirangar #bengaluru #india #pediatricdentistry #childrendentistry #childrenphoto #today #nyud #ucla #childcare #oralhealth #orthodontics #pediatrics
Fluoride applications for children can help to prevent cavities by strengthening the outer enamel of the teeth and may also reverse any early signs of cavities that may have begun forming. Your child will not undergo any stress or anxiety during the application of fluoride as it is painless and quick. The dentist will paint a thin layer of fluoride varnish on the child’s teeth which often has a pleasant taste. The application is fast and dries quickly. Your child will be prohibited from eating or drinking anything for about 30 minutes after the treatment.
𝙃𝙤𝙬 𝙛𝙡𝙪𝙤𝙧𝙞𝙙𝙚 𝙥𝙧𝙚𝙫𝙚𝙣𝙩𝙨 𝙙𝙚𝙣𝙩𝙖𝙡 𝙘𝙖𝙧𝙞𝙚𝙨
Fluoride works to prevent dental caries through both topical and systemic mechanisms via 3 processes:
a) inhibiting tooth demineralization,
b) enhancing remineralization, and
c) inhibiting bacterial metabolism.
Newer studies also suggest that fluoride interferes with bacterial adherence to the teeth. The topical effect provides the majority of the benefit. Through systemic mechanisms, the lesser effect, fluoride is incorporated into the tooth structure during tooth development to harden the enamel and make more resistant to demineralization.
They are indeed
Simple
Fun
Always effective
It is always a delight to notice perikymata. These are signs of incremental growth that appear on the surface of tooth enamel as a series of linear grooves. In humans, each perikyma takes approximately 6–12 days to form. Thus, the number of perikymata can be used to assess how long a tooth crown took to form. They usually disappear as the enamel wears overtime after tooth eruption.
It on the other hand is disenchanting to notice enamel hypoplasia which by definition is a reduced quantity of enamel that results in irregularly shaped teeth, which may be pitted, thinner, or smaller in size. Whereas, reduced quality of the enamel is termed hypomineralisation. Localized hypoplastic defects can be caused by trauma or infection in the primary tooth. Generalized hypoplastic defects can also be due to systemic, environmental, and genetic factors. The most common cause of chronological hypoplasia seen in children is due to vitamin D deficiency.
We, pediatric dentists, continue to emphasize/ overemphasize the importance of early prevention strategies to avoid cavities in toddlers and children. Dental caries or cavities are primarily a result of a breakdown of the tooth enamel. This breakdown is the result of bacteria on teeth that dissolve foods and produce acid that destroys tooth enamel and leads to tooth decay.
Although dental caries is largely preventable, they remain the most common chronic disease of children. Tooth decay is bacterial infection and infants are not born with the bacteria that cause decay. Most children acquire these bacteria from their mothers and other caregivers before their third birthday. Parents and caregivers can potentially spread the bacteria as they share food, utensils and kiss their babies.
If you are an expectant mother with gum disease, recent studies suggest that your baby is seven times more likely to be underweight. It’s the inflammation from the gum disease coupled with the hormones from pregnancy that puts mothers at more risk.
While, gum disease can be difficult during pregnancy, tooth decay is not easy to cope with for newborns and infants. It is also the most unmet health need among children and is mainly owed to lack to oral hygiene maintenance awareness for the little ones.
Remember, a tooth plus sugar in any form equals decay. It actually takes around just 20 mins after you eat for a decay to start. We can co-relate when child is nursing on mothers’ milk and doses with some milk residue on teeth. Lactic acid, which is produced when bacteria in plaque eats the sugar is the actual culprit. The acid lowers the pH level in the oral cavity and dissolves minerals from enamel. Frequent snacking is like adding fuel on a fire. Children naturally cannot inculcate oral hygiene habits on their own and thus parents need to be the ones making sure healthy habits start at home. Stick to as basic as water rinsing and rinse after eating to keep children’s teeth clean.
Also, to remember, an unhealthy mouth affects other parts of the body and cavities causing germs can be passed to our children, so we should all begin by taking care of our own mouths first and passing on good oral hygiene habits, and not germs to our children. Its high time and schools being presently shut, now is a good time to make this resolution for better oral health practices all year long.
This detailed infographic explains in detail: a) perinatal management approaches for pregnant women to improve the outcomes in mothers and neonates. b) Summarizes the clinical presentation and management of neonatal SARS-CoV-2 infection c) Describe the neonatal multisystem inflammatory syndrome in children.
A) Understanding SARS-CoV-2
· Coronaviruses are positive sense–enveloped, single-stranded RNA viruses.
· Serotypes from the α and β coronavirus genera can cause human disease.
· The novel SARS-CoV-2 is a α-coronavirus
· 80% homology to SARS-CoV-1 (the agent causing severe acute respiratory syndrome, or SARS)
· Even greater homology to some bat coronaviruses, suggesting a zoonotic origin.
· Like other coronaviruses, SARS-CoV-2 has a “crown” appearance on electron microscopy caused by projections of the spike (S) glycoprotein from the envelope
B) HOW Transmissible
· SARS-CoV-2 is more transmissible than SARS-CoV-1,
· *Maybe due to stronger binding to the ACE-2 receptor and more effective transmission of virus from asymptomatic and presymptomatic hosts.
· Transmission primarily occurs via respiratory droplets, though airborne and contact transmission may occur to a lesser extent.
· Disease caused by SARS-CoV-2 tends to occur in a biphasic manner, with the
· 1)Initial illness: the result of direct viral infection
· 2)Subsequent phase: immune-mediated.
· In addition, SARS-CoV-2 infection is known to cause coagulopathy, which may contribute to organ dysfunction as well.
C) COVID-19 IMPACT ON PREGNANT WOMEN
In the United States, pregnant women with COVID-19 are significantly more likely to be admitted to an ICU and receive invasive ventilation and extracorporeal membrane oxygenation (ECMO) compared with nonpregnant women
Mortality is also higher among pregnant women infected with COVID-19.
These findings may be related to
a) physiologic changes of pregnancy, such as increased heart rate and oxygen consumption,
b) shift in cell-mediated immunity,
c) reduced lung capacity secondary to upward diaphragmatic shift, and
d) increased risk for thromboembolism.
Similar to nonpregnant women, pregnant women with COVID-19 present with
a) cough (50%)
b) fever (32%)
c) myalgia (37%)
d) and shortness of breath.
In addition to respiratory symptoms, the placenta may be affected in COVID-19.
D) Measures to prevent COVID-19 during pregnancy
a) wearing a proper mask,
b) frequent handwashing, and most importantly,
c) avoiding crowded areas and parties (including baby showers).
Vaccination during pregnancy is a controversial topic as to date, pregnant and lactating women have been excluded from vaccine studies.
However, the American College of Obstetricians and Gynaecologists and the Society of Maternal-Fetal Medicine have issued statements suggest
pregnant and lactating women should be given a choice to receive the vaccine after discussing individual risks (including the possibility of fever following vaccination)
E) AAP section Statement
Recommend shared decision-making regarding vaccination during pregnancy and lactation.
The risk of transmission of the vaccine (i.e., COVID-19 messenger RNA [mRNA]) across the placenta is unlikely but,
maternal immunoglobulin (Ig) G antibodies in response to the vaccine are likely to be transmitted.
Antibodies to COVID-19 are found in infants born to mothers with COVID-19 and in the breast milk of mothers with COVID-19.
Active immunization with other vaccines has been shown to increase specific IgA levels in breast milk.
G) DELIVERY OF A NEWBORN OF A MOTHER WITH COVID-19
Three potential mechanisms of maternal transfer of SARS CoV-2 to the infant
1. Intrauterine transmission through transplacental hematogenous spread or viral particles in amniotic fluid that are ingested or inhaled by the fetus. This mode appears less likely but there are anecdotal reports suggesting that this is possible.
2. Intrapartum transmission after exposure to maternal infected secretions or feces around the time of birth.
3. Postpartum transmission from an infected mother, family member, or health care worker (probably the most likely mode of prevaccine transmission).
Transmission from an infected mother is more likely from respiratory secretions and less likely from breast milk.
Pregnant women with suspected COVID-19 (symptomatic or recent positive household contact) must be prioritized for SARS-CoV-2 testing, while universal screening may be used in areas with high prevalence.
The timing and mode of delivery and anesthesia in pregnant women with suspected/confirmed SARS-CoV-2 infection is dependent on obstetrical indications.
A cesarean section rate of 24% to 41% has been reported in pregnant women infected with COVID-19 from hospitals in the United States.
Antenatal steroids may be administered to infected pregnant women at risk for preterm delivery (including 34–36 6/7 weeks) until more evidence is available because of the potential benefits of promoting fetal lung maturity and decreasing maternal mortality.
If a pregnant woman has significant COVID-19–related illness and requires invasive mechanical ventilation, delivery may need to be conducted in the intensive care unit setting.
Cesarean section has been reported in a pregnant woman with COVID-19 who was receiving ECMO.
H) BREASTFEEDING IN TERM INFANTS BORN TO MOTHERS WITH COVID-19
No current compelling evidence suggesting that SARS-CoV-2 can be transmitted from an infected mother to her neonate via breast milk; rather, breast milk may be beneficial by providing protective antibodies against SARS-CoV-2 infection.
The nutritional, immunologic, and developmental benefits of breastfeeding, if permitted by the mother’s health, outweigh the potential transmission risk, given that infants typically have mild illness.
Newborns are more likely to acquire infection via horizontal transmission from an infected mother or another care provider; thus, the importance of maintaining appropriate respiratory hygiene when an infected person is in contact with a newborn cannot be overemphasized.
An infected mother should wear a surgical mask, wash her hands and breasts with soap and water before feedings, and breastfeed the infant.
Alternatively, the infant can be fed expressed breast milk by a healthy care provider. Between feedings, the infant’s crib (or incubator) should be placed at least 6 feet from an infected mother’s bed, preferably behind a physical barrier (such as a curtain).
Both international and national societies, including the WHO and AAP, support protecting breastfeeding during this pandemic.
It is worth mentioning that although the passage of remdesivir (an antiviral medication used for the treatment of moderate to severe SARS-CoV-2 disease) to an infant via breast milk is unknown, no adverse events were reported in a newborn whose mother received remdesivir therapy for Ebola infection.
The Academy of Breastfeeding Medicine does not recommend cessation of breastfeeding when lactating mothers receive an mRNA-based liposomal vaccine.
I) CARE OF TERM AND PRETERM INFANTS BORN TO MOTHERS WITH COVID-19
Vertical transmission of SARS-CoV-2 appears to be uncommon because of lack of viremia and nonoverlapping expression of ACE-2 and transmembrane serine protease 2.
Neonatal infection was reported in 1% to 3% of births to US mothers with COVID-19, with lower chances of infection if the mother tested positive more than 14 days before delivery.
Preterm birth, low birth weight, cesarean section, and NICU admissions were frequently observed among COVID-19 deliveries.
Contrary to initial beliefs, the rate of neonatal infection was not increased with vaginal delivery, rooming-in, or breastfeeding.
J) SYMPTOMS IN INFANTS
Infants should be monitored closely for symptoms and signs of SARS-CoV-2 infection, which may include fever, cough, rhinorrhea, respiratory distress, poor feeding, lethargy, vomiting, diarrhea, rash, and edema.
Testing for SARS-CoV-2 RNA RT-PCR is recommended for all neonates born to mothers with suspected or confirmed COVID-19 at 24 and 48 hours after birth (or a single test at 24–48 h) using a nasopharyngeal, oropharyngeal, or nasal swab.
Asymptomatic SARS-CoV-2–positive neonates can be discharged from the hospital after ensuring close follow-up.
An infected mother who has been afebrile for 24 hours without antipyretics and is improving is not likely to be contagious 10 days after the onset of symptoms and can safely care for her infant.
K) NEONATES WITH SARS-CoV-2 INFECTION
The immature immune system, passive transfer of maternal IgG antibodies, and lower ACE-2 expression may result in less inflammation, milder illness, and hastened recovery in infants and children compared to adults.
Neonates, however, have been reported to have more severe illness compared to older children (3% of older children required intensive care unit care) in a systematic review.
SARS-CoV-2–positive neonates should be clinically monitored and isolated.
Early-onset neonatal COVID-19 (onset of illness between 2 and 7 days after birth) is likely caused by perinatal transmission.
Most infected neonates are either asymptomatic (20%) or have mild symptoms such as
a) rhinorrhea and cough (40%–50%) and
b) fever (15%–45%)
Moderate to severe symptoms such as
a) respiratory distress (12%–40%),
b) poor feeding,
c) lethargy,
d) vomiting and diarrhea (30%), and clinical evidence of multiorgan failure have been observed as well.
Laboratory evidence of COVID-19 infection in a neonate may include
a) leukocytosis,
b) lymphopenia,
c) thrombocytopenia, and
d) nonspecific findings of elevated inflammatory markers.
Management for symptomatic COVID-19–positive neonates is mostly supportive.
Appropriate respiratory support, such as CPAP, is recommended for respiratory distress.
Endotracheal intubation is more likely to be indicated if there is neonate-specific lung pathology.
L) LATE-ONSET NEONATAL COVID-19 INFECTION
The majority of symptomatic SARS-CoV-2 infections in neonates are diagnosed beyond 5 to 7 days after birth (late-onset neonatal COVID-19).
Postnatal transmission by neonatal exposure to maternal respiratory secretions or exposure to infected health care workers or household contacts probably plays a major role in late-onset neonatal COVID-19 infection.
For neonates with COVID-19, management remains supportive and includes
a) supplemental oxygen,
b) respiratory support,
c) fluid resuscitation and
d) temperature control.
Currently, evidence for the use of antiviral medications and steroids in neonatal COVID-19 is lacking.
Use of remdesivir has been reported in 2 new-borns: a 22-day old with severe late-onset COVID-19 who clinically improved and tolerated the treatment well and a 4-day old who continued to deteriorate and received dexamethasone and convalescent plasma, required invasive ventilation until 13 days of age and ultimately improved.
M) NEONATAL MIS-C
Multisystem inflammatory syndrome in children (MIS-C) is a novel condition following COVID-19 infection in children, and is characterized by fever, elevated inflammatory markers, and high levels of both pro- and anti-inflammatory cytokines.
Children with MIS-C frequently present with symptoms related to the
a) cardiovascular system
-shock, left ventricular dysfunction, elevated cardiac enzymes, coronary artery abnormalities.
b) gastrointestinal system (nausea, vomiting and diarrhea mimicking gastroenteritis, or inflammatory bowel disease), or with mucocutaneous symptoms resembling Kawasaki disease.
The median age of children with MIS-C has been reported to be 5 to 9 years, as opposed to Kawasaki disease which is typically seen between 6 months and 5 years of age.
MIS-C is infrequent in infants, with the Centers for Disease Control and Prevention reporting only 4% of MIS-C cases occurring in children younger than 1 year.
N) LONG-TERM IMPACT OF NEONATAL COVID-19
Practices such as
a) mother-infant separation
b) caesarean section
c)early cord clamping and
d)avoidance of breastfeeding to err on the side of caution, could alter
1)neonatal colonization with maternal microbiota, hamper mother-infant bonding and breastfeeding, and
2) predispose the infant to
a) iron-deficiency anemia and
b) increased frequency of respiratory and gastrointestinal infections in infancy.
Infected neonates with no or mild symptoms may possibly remain hypoxemic for a variable period before becoming overtly symptomatic similar to what has been observed in infected adults.
Indeed, neonates may be silent carriers of the virus in their airway epithelia with prolonged asymptomatic shedding of the virus.
We speculate that chronic airway inflammation could result in airway remodelling and thickening, predisposing neonates to childhood asthma.
Reference: Sankaran D, Nakra N, Cheema R, et al. Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update. NeoReviews. May 2021. 22(5). 10.1542/neo.22-5-e1001
Band and Loop Space maintainers continue to mesmerize. Premature loss of teeth in children leads to space loss and affects the integrity of the dental arch. The band and loop space maintainer is used in the majority of patients requiring single tooth space maintenance in both primary(up to 6 years) and mixed dentitions(6-10+ years). It preserves the dimensions of the area due to early loss of milk tooth and allows the permanent successor to erupt normally.
Delayed tooth emergence (DTE) is a clinical term used when exposure of a tooth or multiple teeth through the oral mucosa is overdue, according to population norms based on chronologic age. DTE is common in childhood and adolescence, yet it is often overlooked or dismissed in pediatric primary care. Timely screening and recognition of DTE by clinicians can minimize medical, developmental, functional, and esthetic problems resulting from untreated underlying local and systemic causes. If you notice an eruption bulge and the tooth doesn't appear/ erupt, do speak to your pediatric dentist for an evaluation.
Mammelons (also spelt mamelons) are bumps that usually appear on the top of newly erupted (this is when a tooth has broken out from its crypt & is visible in the mouth) permanent upper and lower, central and lateral incisors (the front teeth).
How are mammelons formed?
All teeth develop from lobes. A lobe is the primary anatomical division of a crown; i.e it is a division of the upper part of the tooth that is covered in enamel (the crown) & it grows to form a part of the tooth. Like other teeth, the lobes of the incisors grow together under the gingiva (the gum), however they have 3 lobes that grow to form the front of the tooth.
Are they abnormal?
Absolutely NO. These are natural characteristics and they will disappear as child grows. This is because, over time, as a child uses their permanent teeth continuously to chew their food, the mammelons gradually wear away. On the other hand, if an adult who still has mamelons, it may be because when you bite, your top front teeth don’t touch your bottom front teeth.
𝙒𝙝𝙮 𝙖𝙧𝙚 𝙩𝙝𝙚𝙨𝙚 𝙞𝙢𝙥𝙤𝙧𝙩𝙖𝙣𝙩?
Taking good care of your child’s milk can not only help in maintaining a great smile but also in children’s proper nutrition and general well-being. Establishing a good oral hygiene routine while they are still young can have a lifelong impact.
One of the most vital roles baby teeth have is preparing the space for proper alignment and growth of permanent teeth in time to come. The longer baby teeth are maintained, the easier for permanent teeth to emerge in proper alignment.
Thus, when primary teeth have to be removed for various reasons such as abscess, trauma or accident, pediatric dentists recommend space maintainers. These easy and comfortable devices hold the space for the permanent teeth’s future slot and keep the surrounding teeth from infringing on the area.
Space maintainers are not permanent and they are removed as soon as the permanent teeth erupt.
𝙒𝙝𝙖𝙩 𝙝𝙖𝙥𝙥𝙚𝙣𝙨 𝙬𝙝𝙚𝙣 𝙢𝙮 𝙘𝙝𝙞𝙡𝙙 𝙬𝙚𝙖𝙧𝙨 𝙨𝙥𝙖𝙘𝙚 𝙢𝙖𝙞𝙣𝙩𝙖𝙞𝙣𝙚𝙧𝙨?
Any appliance in the child’s mouth needs time to adjust and children need time to get used to their space maintainers. After having the space maintainers installed, it is best to ask the dentist for some care instructions for both the teeth and the appliance. These instructions usually differ depending on the type of space maintainer your child has received.
𝙃𝙤𝙬 𝙖𝙧𝙚 𝙨𝙥𝙖𝙘𝙚 𝙢𝙖𝙞𝙣𝙩𝙖𝙞𝙣𝙚𝙧𝙨 𝙢𝙖𝙞𝙣𝙩𝙖𝙞𝙣𝙚𝙙?
Oral hygiene maintenance is of paramount importance while any appliances are installed in the child’s mouth. Encourage your child to practice excellent oral hygiene on a routine basis. This will keep the space maintainer in its best shape while also preventing the possibility of tooth decay. Try to keep your child’s hands out of their mouth to preserve the space maintainer.
𝙒𝙝𝙖𝙩 𝙨𝙝𝙤𝙪𝙡𝙙 𝙢𝙮 𝙘𝙝𝙞𝙡d 𝙖𝙫𝙤𝙞𝙙 𝙬𝙝𝙚𝙣 𝙬𝙚𝙖𝙧𝙞𝙣𝙜 𝙨𝙥𝙖𝙘𝙚 𝙢𝙖𝙞𝙣𝙩𝙖𝙞𝙣𝙚𝙧𝙨?
If your child has space maintainers, they need to avoid hard or sticky foods such as caramel, hard candy, frozen chocolates and gum. There is a high chance that these types of food will get stuck to the oral appliance, which is more likely to cause decay. Remember to schedule regular appointments with your pediatric dentist for them to monitor any changes or discomfort in your child’s mouth.
The eruption date of the permanent incisors ranges from 6 to 9 years. Over-retained primary teeth refer to the condition where the primary tooth is still retained after the successor has erupted. Prolonged retention of a primary tooth, caused by atypical root resorption or failure of root resorption can redirect the eruption path of the permanent tooth. This frequently occurs in the mandibular anterior region, where the central incisors erupt lingual to their predecessors, resulting in two lines of teeth. An over-retained primary maxillary central incisor may result in ectopic palatal eruption of the permanent incisor and lead to a simple anterior cross bite.
#oralhealth #ectopiceruption #kidsdentist #kidsdentisthsr #kidsdentistind #kidsdentistharlur #overretained #Benglauru #milktteeth #toothpaste #Pediatrics #OralCareTips #oralcare #caries #parents #parentslife #parenting #parentinghacks #pediatricdentistry #dentalhealth #cavities #oralhealtheducation
Source:
Xia B, et al. Children stomatology outpatient treatment requirements analysis and countermeasures. Beijing Da Xue Xue Bao Yi Xue Ban. 2013;45:92–96.
They must be. Even before the teeth begin to erupt, you should always clean baby's mouth at least once a day with a clean gauze pad or soft cloth. This should become a regular habit. It can be as simple as placing a clean gauze pad or soft cloth over your finger and by dipping the gauze in water to make it damp, but not soaking wet. Wipe your child's teeth and gums gently.
Pediatric esthetic dentistry has always been in sync with functional dentistry. Esthetics although are not the major highlight of treatment in children, restoring function remains top priority. To ensure improvements in child's oral hygiene maintenance, follow ups play a very vital role. They do need those routine check-up and extra motivation from their pediatric dentist apart from parents( *dental home concept). This case presents Preformed Zirconia crowns upon one week and one year follow up. Not the usual pre and post images. Will be sharing the pre and post images in the post to follow.
Zrc crowns: Kids-E
#kidsdentist #kidsdentistindia #kidsdentisthsr #kidsdentistharlur #kidsdentistindiranagar #kidsdentistind #ZRC #pediatricdentists #PediatricEsthetics #esthetics #dentistry
Bacteria from your mouth can naturally be transmitted to your baby's mouth. So, part of taking care of your newborn's mouth is to CARE FOR YOUR OWN ORAL HEALTH. Brush your teeth twice a day, clean between your teeth, and get a dental check-up every 6 months. #oralhealthtips #childcare #newborn #newbornbaby #kidsdentist #kidsdentisthsr #kidsdentistind #kidsdentistharlur #mothers #fathers #parentinghacks #parenthood #oralhygiene #latest #healthcare #children #tooth #teeth
Should we clean the gums of a new born ?
They must be. Even before the teeth begin to erupt, you should always clean baby's mouth at least once a day with a clean gauze pad or soft cloth. This should become a regular habit. It can be as simple as placing a clean gauze pad or soft cloth over your finger and by dipping the gauze in water to make it damp, but not soaking wet. Wipe your child's teeth and gums gently.
#parenteducation #kidsdentist #kidsdentisthsr #kidsdentistharlur #kidsdentistindia #kidsdentistindiranagar #Bengaluru #childrensbooks #infantcare #newborn #newbornbaby #OralCare #OralCareTips #newborncare #newborncarespecialist #pediatricdentistry #pediatrics #awareness #nyudentistry #USCA
The challenge always remains when it come to protecting toddlers and young children.
Toddlers and young children like to explore, climb, walk, run, and dance. These activities put them at risk for falls and injuries. You can help prevent accidents in the following ways:
Keep thinking ahead for new falling hazards that your child may encounter, such as:
The majority of under five year olds whom I routinely come across during my consultations are challenged by a tooth decay typical of upper anterior teeth, which appeared to progress rapidly since their initiation as a white/brownish spot to full fledged involvement of most the visible tooth structure.
We clinically classify them as Early Childhood Caries (ECC), which in Lay definition —Tooth decay in pre‐school children which is common, mostly untreated and can have profound impacts on children's lives. Clinically, we define it as — the presence of one or more decayed (non‐cavitated or cavitated lesions), missing (due to caries), or filled surfaces, in any primary tooth of a child under age six. The common question often is which toothpaste to prevent cavities.
Prevention of ECC (the resultant complication here of improper cleaning in infants and toddlers) requires multiple approaches and can be structured in three phases
A) Primary prevention includes improving oral health literacy of parents/caregivers and healthcare workers, limiting children's consumption of free sugar in drinks and foods, and daily exposure to fluorides.
B) Secondary prevention consists of the effective control of initial lesions prior to cavitation that may include more frequent fluoride varnish applications and applying pit and fissure sealants to susceptible molars.
C) Tertiary prevention includes the arrest of cavitated lesions and tooth‐preserving operative care.
When do we start using toothpastes?
IAPD (International Association of Pediatric Dentistry) recommends daily tooth brushing with fluoridated toothpaste (at least 1000 ppm) in all children, using an age‐appropriate amount of paste. This has been detailed in my immediate previous post.
Also, as previously emphasized, the first visit to a pediatric dentist needs to happen as soon as the first tooth erupts or by the child’s first birthday. Do not delay this. This counseling session is extremely vital for parents and caregivers understand and improvise if necessary,the preventive measures to dodge cavities.
Now, to keep your child’s mouth as clean as possible, use a soft cloth to wipe his or her gums clean from the start. As soon as the first tooth erupts, begin brushing them with a soft, child-sized toothbrush and a fluoride toothpaste about the size of rice grain. This will help spread the fluoride onto teeth without your child swallowing too much, since he or she can’t really spit yet. Once your child becomes better at spitting (about age 3), use a pea-sized amount of toothpaste and have your child spit after brushing. Keep helping your child brush until at least age five or six.
Why the toothpaste with Fluoride matters?
There is a global consensus that regular use of fluoride (F) toothpaste constitutes a cornerstone in child dental health. In fact, a global survey revealed that most experts addressed F toothpaste as the main reason for the dramatic decline in caries during the last decade of the 20th century. Moreover, toothpaste is probably the most readily available form of F and tooth brushing is a convenient and approved habit in most cultures. Working groups within national Health Technology Agencies have independently and in parallel presented strong scientific evidence that daily tooth brushing with F toothpaste is the most cost-effective, self-applied method to prevent caries at practically all ages.
Do we need to worry if my child swallows toothpaste with fluoride?
Not if you are using the recommended amount of toothpaste for your child’s age and supervising their brushing to prevent unnecessary swallowing. Fluoride toothpaste is recommended for babies and toddlers by the IAPD, ISPPD, AAP, AAPD and ADA.
How much toothpaste ?
For children under age 3: Brush teeth with a smear of fluoridated toothpaste. With this minimum quantity, it is safe without spitting.
For children over age 3: Use a pea-size amount and encourage your child to spit it out after you brush.
When your child can hold a toothbrush, it’s time to start learning how to brush. Let your child watch you brush your own teeth. Children enjoy trying to do what their parents do. You might even want to let your child try brushing your teeth—or a favorite plush toy’s teeth.
Be sure to monitor your young child’s brushing. After your child practices brushing his or her own teeth, finish the job by brushing your child’s teeth. Children need help brushing until their dexterity improves i.e they are old enough to tie their own shoelaces or have an improved hand writing, which is usually around age 7 or 8.
Brushing should last for at least two minutes. You can make it a fun time together. For example, you may want to play a favorite song while brushing or tell jokes with your child before and after
you brush.
Which one to choose to prevent cavities?
We have discussed about the cavities and their initiation process of cavities and why cleaning a child’s teeth is important right from infancy in my previous posts. The majority of under five year olds whom I routinely come across during my consultations are challenged by a cavities with upper anterior teeth, which appeared to progress rapidly since their initiation.
These are typical signs of Early Childhood Caries (ECC), which in Layman's definition is Tooth decay in pre‐school children which is common, mostly untreated and can have profound impacts on children's lives. Clinically, we define it as the presence of one or more decayed (non‐cavitated or cavitated lesions), missing (due to caries), or filled surfaces, in any primary tooth of a child under age six. The common question often is which toothpaste to prevent cavities.
Prevention of ECC (the resultant complication here of improper cleaning in infants and toddlers) requires multiple approaches and can be structured in three phases
A) Primary prevention includes improving oral health literacy of parents/caregivers and healthcare workers, limiting children's consumption of free sugar in drinks and foods, and daily exposure to fluorides.
B) Secondary prevention consists of the effective control of initial lesions prior to cavitation that may include more frequent fluoride varnish applications and applying pit and fissure sealants to susceptible molars.
C) Tertiary prevention includes the arrest of cavitated lesions and tooth‐preserving operative care.
When do we start using toothpastes?
IAPD (International Association of Pediatric Dentistry) recommends daily tooth brushing with fluoridated toothpaste (at least 1000 ppm) in all children, using an age‐appropriate amount of paste. This has been detailed in my immediate previous post.
Also, as previously emphasized, the first visit to a pediatric dentist needs to happen as soon as the first tooth erupts or by the child’s first birthday. Do not delay this. This counseling session is extremely vital for parents and caregivers understand and improvise if necessary,the preventive measures to dodge cavities.
Now, to keep your child’s mouth as clean as possible, use a soft cloth to wipe his or her gums clean from the start. As soon as the first tooth erupts, begin brushing them with a soft, child-sized toothbrush and a fluoride toothpaste about the size of rice grain. This will help spread the fluoride onto teeth without your child swallowing too much, since he or she can’t really spit yet. Once your child becomes better at spitting (about age 3), use a pea-sized amount of toothpaste and have your child spit after brushing. Keep helping your child brush until at least age five or six.
Why the toothpaste with Fluoride matters?
There is a global consensus that regular use of fluoride (F) toothpaste constitutes a cornerstone in child dental health. In fact, a global survey revealed that most experts addressed F toothpaste as the main reason for the dramatic decline in caries during the last decade of the 20th century. Moreover, toothpaste is probably the most readily available form of F and tooth brushing is a convenient and approved habit in most cultures. Working groups within national Health Technology Agencies have independently and in parallel presented strong scientific evidence that daily tooth brushing with F toothpaste is the most cost-effective, self-applied method to prevent caries at practically all ages.
Do we need to worry if my child swallows toothpaste with fluoride?
Not if you are using the recommended amount of toothpaste for your child’s age and supervising their brushing to prevent unnecessary swallowing. Fluoride toothpaste is recommended for babies and toddlers by the IAPD, ISPPD, AAP, AAPD and ADA.
Note:
The toothpastes shown in the visuals are the ones available for sale in India. Toothpastes and their F concentration can vary across nations. This is an awareness post about child’s oral care and is evidence based upon the latest recommendations.
These recommendations regarding fluoride and non-fluoride pastes could vary from child to child depending upon feeding practices, preventive measures undertaken since infancy, more than three sugar containing snacks or beverages per day, going to bed with bottle and parents with active caries lesions. Speak to your nearest pediatric dentist for individualized assessment and recommendation.
Source:
A) Colak H, Dülgergil ÇT, Dalli M, Hamidi MM. Early childhood caries update: a review of causes, diagnoses, and treatments. J Nat Sci Biol Med. 2013;4(1):29–38. doi: 10.4103/0976-9668.107257.
https://onlinelibrary.wiley.com/doi/full/10.1111/ipd.12490.
B) Early Childhood Caries: IAPD Bangkok Declaration. Pediatr Dent. 2019 May 15;41(3):176-178.
Which one to use ?
Tooth brushing is a specific, demonstrable behaviour that should begin early and occur often. Programmes to help parents create a habit of brushing their young children’s teeth show it is a behaviour that is also amenable to change. With so many varieties of brushes available, we often wonder which one could work best for my child.
Effective tooth brushing requires something more than knowing, or being told, it is important. As little as one in-person instructional session in how to brush a young child’s teeth can reduce risk of tooth decay. Instruction, combined with the opportunity to tailor programme elements to specific barriers or parent characteristics, has the potential for even greater reach.
Twice daily tooth brushing is a low-cost strategy to reduce risk of childhood caries. Brushing frequency is an effective means to train and is not related to children’s age.
There are several reasons why tooth brushing is a worthwhile focus for health promotion intervention. Research states, the tooth brushing behaviour most strongly associated with children being caries free at four years of age was as a result of the onset of brushing by the parent before age two.
Lets discuss tooth brushes which are available in the market.
BEFORE ERUPTION
Finger brushes: Age: 0 until tooth erupts
Use a clean, damp washcloth, a gauze pad, or a finger brush to gently wipe clean the first teeth and the front of the tongue, after meals and at bedtime.
Silicone brush: Age: upto 9 months
Help understand the concept of tooth brushing and make the whole exercise playful. They are easy to hold and really gentle on sensitive, soft gums. They can be frozen to serve as a teether.
AFTER TEETH ERUPT
Manual brushes: EXTRA SOFT bristled: Age: 6-36 months
These have soft grips that are easy for small hands to hold. Extra soft bristles effectively clean while being gentle on kids' teeth. Small brush head designed for kids' mouths. Their Angled bristles help to reach back teeth and hard to reach places. Use age appropriate tooth paste. Read my tooth paste post for further details.
Manual brushes: SOFT bristled. Age: 3- 6 years
These are best in removing plaque and debris from your teeth and along the gum line. These can be used much earlier as well.
ELECTRIC tooth brushes
Not a must. But helps parent clean better and effectively. IF your child is super fussy to brush and does not allow to brush his/her teeth, you can consider an brushing your child's teeth with an electric toothbrush which can help you clean the stains or plaque better with minimum effort.
MIH is a condition that is considered to have grown to epidemic proportions in children. It does not appear to be a new phenomenon, but when caries prevalence was high, the developmental defect responsible for initiation of the cavity was probably not diagnosed.
Prevalence
The prevalence figures range from 3.6– 25% and seem to differ between countries and birth cohorts. Studies from different parts of the world* show a wide regional variation of 0.5 to 40.2 per cent in the prevalence of the disease.
How widespread is MIH and who does it affect?
Studies from different parts of the world* show a wide regional variation of 0.5 to 40.2 per cent in the prevalence of the disease. One example: The 5th German oral health study revealed a prevalence of 28.7 per cent in twelve-year-old children.
What causes MIH?
Unfortunately, the cause of MIH is still unknown. Prenatal, perinatal and postnatal influences are being evaluated. Furthermore, environmental conditions and a variety of diseases occurring in the first few years of a child’s life may have an influence.
Are they an easy fix?
Clinically, MIH molars can create serious problems for the dentist as well as for the child affected. For dentists, the problems are related to unexpectedly rapid caries development in the erupting first permanent molar, inability to anaesthetize the MIH molar when treatment is indicated, and unpredictable behaviour of apparently intact opacities. The child, on the other hand, will experience pain and sensitivity (even when the enamel is intact) creating, for instance, toothache during brushing. They may also complain about the appearance of their incisor teeth.
What’s the takeaway?
It seems advisable to consider children with a poor general health in the first four years after birth at risk for MIH. These children should be monitored more frequently during eruption of the first permanent molars. The same applies to children at low risk of caries when opacity is noticed at the eruption of one of the first permanent molars. Management of these teeth should consider their long-term prognosis, as well as management of the presenting features such as pain.
My name is Rajesh and I am a pediatric dentist. I co-founded KidsDentist, exclusive pediatric dental centers three years ago in Bengaluru,India. I started this page to share educate, raise awareness and answer parental queries about milk teeth and also share my work with budding dentists across the globe. I look forward to interacting and empowering parents with the knowledge to take care of their child’s oral health and provide parents with the resources to make their lives just a little easier. Feel free to ask me your queries.
Cavity free teeth are not a myth! AAPD recommends the first dental visit at time of the eruption of the first tooth and no later than 12 months of age as parents can be counseled about preventive care for newly erupted teeth. It is also important to monitor the developing teeth throughout eruption at regular clinical examinations. Evidence based prevention and early detection and management of caries/oral conditions can improve a child’s oral and general health, well-being, and school readiness. Look out for those white spots! Spots that look dry, chalky, and appear at the gumline warrant a visit to the dentist for a check-up and possible treatment. These early decay spots are caused by mineral loss from the enamel. Left unchecked, the spots will turn yellow or brown and require more extensive treatment. When seen by a dentist early, while spots are still white and just forming, it is often possible to treat the spots with professionally applied topical fluoride and careful removal of any plaque present. The fluoride replaces the missing minerals and strengthens the tooth enamel. Will they go away on their own ? Although, it depends somewhat on the cause of the spots, but if you do nothing, the spots are probably not leaving anytime soon. If you make no changes, the conditions that caused the white spots to develop still exist. Early Childhood Caries Caries among young children, or early childhood caries (ECC), is a particularly rapid form of tooth decay.ECC was once called baby bottle tooth decay, since a key cause of the disease is putting children to bed with a bottle of juice or milk. Due to the aggressive nature of ECC, cavities can develop quickly and, if untreated, can infect the tooth’s pulpal tissue. Such infections may result in a medical emergency that could require hospitalization and the extraction of the offending tooth. As mentioned earlier, children who are given pacifying bottles of juice, milk or formula to drink during the day or overnight are prone to developing ECC. This is a result of the sugar content in these beverages pooling around the upper front teeth and mixing with caries-producing bacteria, leading to rapidly progressing tooth destruction. Other factors that put children at risk for caries include enamel defects, frequent consumption of sugary drinks and snacks, lack of dental hygiene, lack of fluoridation, chronic illness, certain medications and mouth breathing or school performance. The longer ECC remains untreated, the worse the condition gets, making it more difficult to treat. These more complicated procedures are more expensive and performed by a smaller number of clinicians. In other words, as treatment is delayed, the problem becomes more serious and difficult to treat, and access and cost issues multiply.
#kidsdentisthsr #kidsdentist #kidsdentistharlur #kidsdentistind #kids #children #child #childcare #teeth #ECC #caries #cariesdental #today #NOW #dentistry #pediatrics #pediatrician #pediatricdentistry
