Pediatric Dentistry
What is pediatric dentistry
For pediatric dentistry is known to the branch of dentistry responsible for dealing with children. The most usual dentist tasks are to detect possible anomalies in the position of the jaws or teeth to send to the orthodontist, a specialist in orthodontics, and restorative treatment do if needed.
The main difference between conventional dentistry and pediatric dentistry is the presence of primary teeth or milk in children which requires different treatment.
Calendar of Tooth Eruption
Development of temporal teeth:
| TEMPORAL TEETH | ERUPTION | LOSS |
| Superior central incisor | 8-12 months | 6-7 years |
| Superior lateral incisor | 9-13 months | 7-8 years |
| Superior canine tooth | 16-22 months | 10-12 years |
| First superior molar | 13-19 months | 9-11 years |
| Second superior molar | 25-33 months | 10-12 years |
| Lower central incisor | 6-10 months | 6-7 years |
| Lower lateral incisor | 10-16 months | 7-8 years |
| Inferior superior canine tooth | 17-23 months | 9-12 years |
| First lower molar | 10-16 months | 7-8 years |
| Second lower molar | 23-31 months | 10-12 years |
Development of permanent teeth
| PERMANENT TEETH | ERUPTION |
| Superior central incisor | 7-8 years |
| Superior lateral incisor | 8-9 years |
| Superior canine tooth | 10-12 years |
| First premolar | 10-11 years |
| Second premolar | 10-12 years |
| First molar | 6-7 years |
| Second molar | 12-13 years |
| Third molar | 17-21 years |
| Lower central incisor | 6-7 years |
| Lower lateral incisor | 7-8 years |
| Inferior superior canine tooth | 9-10 years |
| First lower molar | 6-7 years |
| Second lower molar | 11-13 years |
| Third lower molar | 17-21 years |
Trauma in temporal teeth
In temporal teeth we can not forget the realtionship between the apex of the temporal tooth and the germ of the permanent tooth that is erupting considering that it can cause malformations, disturbances in the eruption and food impaction in the adjacent teeth causing tooth decay or periodontal pockets. They are normally accompanied by soft tissues injuries like in lips and in the frenulum so it can lead to a heavy bleeding.
Instructions for the pacient or the parents: A good healing after an injury in the teeth or oral tissues depends on a correct oral hygiene. It is important that the parents understand the importance of a correct hygiene for a proper diagnosis.
Trauma in permanent teeth
Usually they are accompanied by soft tissue injuries like in lips and in the frenulum so it can lead to a hevay bleeding.
Instructions for the pacient or the parents: A correct oral hygiene is recommended for a proper healing and it is important that the kid and the parents understand the importance. In order to prevent the accumulation of plaque it is recommended to brush the teeth with a soft brush after each meal and rinse with chlorhexidine 0,1% twice a day for two weeks.
Decay
Tooth decay is a disease caused by oral bacteria, often due to poor oral hygiene and bad alimentary habits. It is influenced by factors such as saliva, maloclussion or abnormal tooth formation. If left untreated, decay can affect the formation of tooth permanent germs so that’s why it is important to prevent or treat them.
Dental sealant
Dental sealant is a coating applied to seal pits and fissures of teeth susceptible to develop caries, acting as a physical barrier to decay. The use of dental sealants is a prevetive measure for decay.
Fluoridation
Fluorids are organic and inorganic components containing fluor and that are present everywhere (earth, air, water, plants, animals).
Toothpastes for adults normally contain fluorids in concentrations of 1000 to 1500 ppm and in children’s toothpastes from 250 to 500 ppm. Mouthwashes marketed for daily home use contain between 230 and 500 ppm of fluor and those for weekly or biweekly use nomally contains 900 ppm of fluor.
¿What are the benefitial effects of fluoride for teeth?
The objectives of fluorides is to provide a maximum level of prevention of caries and a minimal level of dental fluorosis. It exists a vast variety of fluoride products: water, toothpaste, oral solutions, dental gels and enamels, salt, milk and other supplemets.
pulp treatments
The principal aim of pulp treatment in temporal teeth is to mantain the health of the oral tissues. Even if it is desirable to mantain the vitality of the pulp of the teeth affected by decay or trauma, a tooth may remain functional by removing the pulp partially or completly.
Vital pulp treatment in temporal teeth with normal pulp or reversible pulpitis:
- Indirect Pulp Capping: It is done when teeth are damaged with deep carious lessions close to the pulp but with no signs or symptoms of pulp affection. After the removal of the damaged dentin, a layer of a biocompatible material it’s applied over the desmineralised dentin layer still uninfected in order to avoid a pulp exposure and remineralise the injury through the formation of a reparative dentin.
- Direct Pulp Capping: Application of a material (calcium hydroxide) directly on the normal pulp of a permanent tooth when the pulp has been accidentally exposed during the filling or in cases of miminal traumatic exposures.
- Pulpotomy: In temporal teeth with pulp exposure (deep decay or trauma), the coronal pulp affected is removed while the radicular remnant tissue is mantianed vital. It is done to relieve pain, sensivity, swelling and the presence of root resorption.
No vital pulpar treatment in temporal teeth with irreversible pulpitis or pulp death:
- Pulpotomy: referred to teeth with chronic inflamation or death of the radicular pulp evidence sinde the root must mantain at least 2/3 of the normal lenght.
Apexification
Consists in cleaning necrotic root canals and introducing in them filling materials with the capacity to induce an apical closure. In permanent inmature teeth with irreverisble pulp lessions that leads to loss of vitality. (Usually consists of a necrosis of the superior incisors caused by the trauma).
Exodontia
They are done in order to extract a temporal tooth with caries linked to an infectious process or to a ortodoncic reason. The dental extraction must be specified by an specialist.
Space maintainer
An orthodontic appliance that maintains the space left by the premature loss of one or more teeth that will be filled by a tooth not yet erupted. Serves to maintain the space until the eruption of permanent, not to interfere with the development or eruption of the successor, or interfere with the development of the bony bases and preventing the extrusion of the antagonist. It also prevents the development of habits.
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