It is normal for the children to have to unhealthy oral habits. Some of such habits include thumb sucking, nail biting, tongue thrusting, mouth breathing etc. In order to control such routines, separate appliances are designed and manufactured. These appliances are known as habit breaking appliances. These appliances can either be of removable or fixed type.

The importance of these appliances can be estimated by the effect of the pernicious habits. If these habits are not controlled, they may lead to periodontal diseases, change in the shape of jaws & change in the teeth position.

The various ill habits of the children are as follows:

Thumb sucking: Thumb sucking is the phenomenon in which the children suck either thumb or other finger. Although this condition is common in children below 3 years, most of them discontinue after this age. On the other hand, this habit can lead to many dentofacial changes.

Some of the clinical features of this habit are as follows:

  • The maxillary and mandibular teeth suffers from lingual prolapsed & labial flaring.
  • During such a condition, the tongue is inferiorly placed. This condition can lead to conditions such as posterior cross bite.

The diagnosis of this condition is quite easy as the changes are very much noticeable. The associated thumb appears to be very much clean and reddened. The fingernails may also be short and chapped. The lips may also seem to be hyperactive.

The following devices can be employed to control this condition:

  • Blue grass appliances: These devices are mostly fabricated using Teflon. A modified six-sided roller constitutes these appliance. These devices are used for better control of the tongue, preventing the sucking process in a major way.
  • Fixed intra oral anti thumb sucking appliance: They are devices that are attached to the upper teeth. The fitting is done with the help of bands, that are usually fitted to the first permanent molar or primary second molar.
  • Quad helix: This appliance shall restrict the thumb from inserting. This can help in the correction of malocclusion.

Tongue thrusting: This condition is also known as immature swallow or reverse swallow. During such a condition, the tongue is place in a wrong position. The tongue can be placed either to the sides or too forward. A constant level of pressure is needed for swallowing. However, constant exposure to such a pressure can force the teeth to go out of alignment. This habit is involuntary and it is relatively difficult to rectify.

The causes for tongue thrusting are not much clear. However, many factors can cause such a condition. Some of them are as follows:

  • Difficulty in deglutition.
  • Other ill habits like thumb sucking, mouth breathing etc.
  • A large and lengthy tongue.
  • In some cases, the child may also have a tongue-tie.

There are several types of tongue thrust. The major types of tongue thrusting are anterior open bite, anterior thrust, unilateral thrust etc.

Mechanical therapy is prescribed for patients above 9 years of age. Some of the habit breaking appliances used in this context include:

  • Fixed habit breaking appliance: Examples of such appliances are bands & crowns. They are mostly fitted on to the permanent molar.
  • Removable appliances: A number of variants of Hawley's appliances are employed to treat it.
  • Nance palatal arch appliances: For guiding the tongue in the right position, an acrylic button is used.

Mouth breathing habits: Normal respiration occurs through the nose. However in some cases, respiration occurs through mouth. This condition is known as mouth breathing. Changes might be present in the face due to this habit. The face of the child having this issue is known as adenoid faces. The major characteristics of such a face are narrow nasal passage and nose, short upper lip etc.

Using habit breaking appliance is regarded as the most effective way to treat this condition. On such device is oral screen. The oral screen prevents the inhaled air to enter the oral cavity. The oral cavity can also be closed.

The oral screen is a very thin rubber membrane that is commonly fitted onto the buccal & labial teeth surfaces. The device can also be fitted onto the vestibule of the mouth. Initially, in order to have some passage of air, windows are also fitted onto the oral screen.

The human tooth is a carefully designed structure. It is designed precisely in such a manner that it is normally immune to external disturbances. However, an unhealthy tooth can have many abnormalities. The common abnormalities are the fissures and pits. Fissures are grooves present mostly in the back teeth and molars. Pits on the other hand, are depressions in the tooth surface. If left untreated, these deformities will worsen, creating more severe dental issues. A healthy tooth is therefore, is a structure that is properly sealed.

The tooth structure with defects like pits & fissures are very much vulnerable to the development of dental caries. Also known as dental cavities, these are infections that are mainly caused due to bacterial proliferation. Establishment of these cavities can lead to destruction and demineralization of the hard tooth layers. Therefore, it is very much necessary to prevent the formation of these structures. One effective way of doing this is by sealing the pits and fissures.

 

Comprehensive studies reveal that the potential of the dental cavities is directly related to the depth of the fissures and pits. In this case, the applications of sealants are very much effective in the aspect that they shall remain bond safe for a long period of time. These sealants are synthetic materials that are generally applied either to a single tooth or multiple teeth. They are usually applied to the chewing surfaces of the teeth, which happens to be portion which is the most vulnerable to bacterial attack. The application of these sealants shall prevent the trapping of food particles in these areas.

Dental sealants can therefore be defined as the materials that are introduced into the fissures & pits, forming a micromechanically bonded mechanical layer. This protective layer shall help in cutting off the bacterial attack. According to the American Dental Association, these are adhesive materials that function to isolate the tooth structure from the rest of the oral cavity.

Dental sealants were introduced in the year 1905 in the form of Sliver nitrate. The method was introduced by Miller. With technological advancements, these materials began to be applied by employing Ultra Violet rays. For initiating the setting reaction, UV rays of 365nm wavelength is normally used.

Pit and fissure sealants are categorized in several ways. Some of the criteria by which they are classified are as follows:

  • Chemical constitution: Based on the chemicals used for synthesizing them, they can be classified into Nuvaseal (Methyl methacrylate ), Kerr pit and fissure sealant (Triethylene glycol dimethacrylate) etc.
  • Generations: Pit and fissure sealants can also be classified on the basis of their evolution. The 1st generation (Nuvalite, Alphalite etc) sealants used UV light whereas the 2nd category (Delton, concise white sealant) was a self-cured one. This was followed by the 3rd generation (Stephen K W Strang) wherein blue visible light was employed. Finally, the 4th generation came and this era saw the introduction of the method called fluoride releasing. Examples of these sealants are Jack Toumba, Toma L.Morphis etc.
  • Filler content: Pit & Fissure sealants can be either filled or unfilled. Both the categories have their own pros & cons. Unfilled sealants have the advantages of more retention, better flow etc. The filled sealants on the other hand are more resistant to wear & tear. However, these materials need occlusal adjustments.
  • Color: Pit & fissure sealants can be of different colors. The colored sealants give an aesthetic feel, however it is very difficult to identify as time progresses. Another category of colored sealants is the white tinted/opaque sealants. These materials contain titanium dioxide, responsible for giving the color. Colored sealants are very easy to identify. Example of such sealant is helioseal.

Although the sealants play a pivotal role in oral hygiene, they do not remove the need for fluoride application. In fact, sealants and fluorides work together in the maintaining oral health. Application of sealants at the right time is much better than cavity filling. In this regard, they can efficiently save time, money and most importantly oral hygiene!

Pediatric dental treatment is very important. Childhood is the period during which the temporary teeth develop. Over time, the child looses these teeth and permanent tooth erupts. The eruption of the permanent tooth however should be in the proper place. A very early tooth loss can often lead to the misplacement of the erupted permanent teeth. This eruption in inappropriate places leads to the formation of spaces between the teeth. Consequently, there may not be sufficient places for some permanent teeth to erupt.

The deciduous or primary teeth shall loose early under the following situations:

  • Tooth loss due to injuries.
  • Tooth extraction becomes inevitable due to severe infection or decay.
  • Certain diseases and conditions can also lead to tooth loss.
  • Congenital factors.

Space maintainers become essential under the conditions where the eruption of the permanent teeth happens in inappropriate places. Space maintainers may be used under the following conditions:

  • A missing permanent tooth.
  • Loss of primary tooth prior to eruption of permanent tooth.

Space maintainers can be of different types. It can be either of fixed or removable. Fixed space maintainers are those maintainers that are fixed into the either side of teeth. Removable space maintainers on the other hand, resemble the dental retainers. Those spaces that need to remain open are filled either with artificial plastic blocks or artificial teeth. For older children, these appliances are advantageous.

Fixed space maintainers can be further subdivided into various sub-categories. A common example of such a space maintainer is the band-and-loop space maintainer. This device is made up of stainless steel. This space maintainer is placed with the help of a crown fitted onto the nearby teeth. In most cases, a loop of wire is also fitted into the crown. The benefit of such a space maintainer is that it prevents over-crowding in certain areas of teeth.

The dental health of children is an important aspect. Good and appropriate dental habits should be inculcated into their lifestyles, right from an early age. One such common dental habit is the application of toothpaste.

Most toothpaste contains fluoride compounds. Fluorides are natural minerals that are normally found in many food items. These minerals erode away from the tooth structure when the tooth is exposed to acids and other substances. These compounds have been included because these natural elements are very much safe, when used properly in children. Application of fluoridated toothpastes is believed not only to prevent tooth decay, but also to reverse the decaying effect in early cases. The below list mentions some of the other positive effects of fluoride application in children:

  • Increasing the strength of teeth.
  • Prevention against acid attack.
  • Facilitates the repair of unhealthy tooth.
  • Eradication of bacteria that causes infections.

2 main forms of fluoride exist in the market. They are systemic fluoride and topical fluoride. Topical fluorides can be either self-applied or can be applied by a dental professional. Application of toothpaste is the example of a self-applied topical fluoride. The American Dental Association has recommended the use of toothpastes from the age of 2. The other methods of applying topical fluorides are through the various mouth-rinses available commercially. Professionally applied topical fluorides on the other hand, occur in the form of a gel, rinse or foam. They are mostly applied during dental visits. The concentration of these fluorides is typically higher than the conventional fluorides used at home.

Systemic fluorides include the use of dietary fluoride supplements and community water fluoridation. These measures are very effective in fighting against tooth decay. Both systemic and topical protection is provided through these measures. Another distinctive feature between the 2 categories of fluorides is the level of action. Systemic fluorides work on the microscopic or cellular level.

As the child grows, adequate changes in the dental habits can be incorporated. One such measure is the introduction of droplets or tablets for including fluoride into the structure of tooth.

The most vital factor that is to be considered during fluoride application is the dosage of fluorides used.

If the dosage of the fluoride is very much less, then it might not be sufficient for protection, management & repair. The over-application of fluoride also has negative consequences. In this case, children can be affected with dental discoloration, fluorosis and even tooth damage. Fluorosis is a dental condition in which the enamel layer gets disturbed. Due to this reason, this disorder is also called mottling of enamel. The disorder can occur at any age, although this is seen to affect the younger ages more. The specs or the white streaks in the enamel layer and other features clearly indicate this disorder. The child's teeth will have a brownish or chalky white appearance when the tooth is on its way of destruction.

In many cases, children often apply more fluoride than that is necessary. Sometimes, the sources of fluoride can come from common items like fruit juices.

Some of the steps that can be employed to decrease the excessive application are as follows:

  • Employing a baby cleanser for age upto to 2. These apparatus are devices without fluoride.
  • Have a clear understanding of the amount of fluoride taken in. Carefully consider fluoride supplements and hidden sources like fruit juices. Consult the doctor if necessary.
  • Children in the age group of 2-4 may be unable to spit out the fluoride taken in. When this happens, the children might ingest the fluoride, which does have negative effects. Care has to be taken so that this is not practiced regularly.
  • Always maximize the use of water when fluorides are applied. It is reported that the application of fluoride is water drops the chances of developing dental cavities by about 30%. Therefore, apply water during fluoride application. For children under 3 years, bottled water may be used.

Pediatric dental care is a matter that needs immediate concern. It is a commonly known fact that the teeth of children are not fully developed. For the successful growth to happen, the teeth have to be kept away from the damages, both physical and mechanical. If at all damage occurs, it has to be immediately treated. Pediatric restorative dentistry is a branch that effectively helps in bringing back the oral health of the children.

 

The ever-increasing in the number of dental issues has necessitated the establishment of a special branch known as restorative dentistry. The branch deals with the management, treatment and prevention of teeth disorders to 'restore' their original structure. The replacement and repair of the damaged teeth is also performed under this branch.

Pulpectomy is the surgical procedure in which the root canals are accessed. In this process, the infectious or dead tissues are removed. After this procedure, the root canal is filled with an appropriate material to ensure that the tooth is safe from infection. Pulpectomy can either be complete or partial. In a partial pulpectomy, the diseased or normal pulp is removed with an incompletely formed root. However in the case of total/complete pulpectomy, the entire diseased pulp is extirpated.

 

All teeth have a layer of pulp in them. It is nothing but a soft tissue layer. An important component of pulp is dentin, which is a hard material makes up the tooth structure. Some of the main functions of the dental pulp are as follows:

  • Protective function: The pulp facilitates the formation of secondary dentin, known as odontoblasts.
  • Nutritive function: The pulp supplies nutrients & moisture to the organic components of mineralized tissues.
  • Formative function: The pulp tissues produce dentin, which protects & surrounds the pulpal tissue.
  • Sensory functions: This function is responsible for the sensation of pain in response to extreme pressure, temperature or

Any issues in the pulp may lead to various issues. In majority of cases, it may cause infection, a phenomenon that can spread to the other areas of the mouth, especially jaws. Infections can either be seen as an abscess or can be diagnosed using diagnostic tests like X-rays.

Procedure: At first, local anesthetic is administered. The pulp layer is then accessed by making a small hole into the tooth. All the unwanted material is then removed to eliminate any chances of infections. An inert substance is then filled into the tooth to minimize the chances of any future infections. An example of such substance is prophylactic antibiotics.

Pulpectomy is different from pulpotomy, which is the procedure in which only the pulp from the tooth crown is extirpated. The surgical procedure however poses the risk that infectious tissues might be avoided.

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