Treatments Pediatric Treatment

It is a good idea to consult the dentist by six months of age when the first Milk teeth are expected to emerge into the oral cavity. Regular visits to the dentist every 6 months will help in giving adequate preventive care to the child that will aid in preventing dental decay. If there are any cavities it is good to undertake the treatment at an early stage. These regular visits are advised even if you think the baby teeth are healthy. These regular visits also help the child get used to the idea of visiting the dentist before he needs any treatment to be administered.

Humans have two sets of teeth. The teeth that appear first are called the Milk teeth or deciduous dentition or the primary teeth. These teeth are later shed off and are replaced by permanent set of teeth called the Permanent dentition.

Milk teeth are called so due to their white color which resembles the color of Milk. The Milk teeth are whiter than the permanent teeth which replace them. The refractive index of Milk teeth is similar to that of Milk and hence they are called so.

The Milk teeth start appearing at 6 months of age. It is quite normal for them to erupt a few months earlier or later. The first Milk teeth to appear is the lower front tooth called the lower central incisor. However the order of eruption of different teeth may vary in some children. The diagram on the left gives the usual order of appearance of the Milk teeth. However the order may differ in some children.

It is quite normal for the teeth to erupt 3-6 months later than the expected time. However delay beyond 6 months may be an indication that you should consult your dentist. The dentist would try and determine the cause of the delay.

Very rarely we come across babies who are born with one or more teeth. Teeth that are seen at birth are called natal teeth while teeth that appear within a month of birth are called neonatal teeth. These teeth are retained unless they are very mobile or pose major problems in nursing.

All the Milk teeth erupt by 3 years of age. The Milk teeth are shed from 6 years onwards till about 10 years of age. The permanent teeth appear by 6 years of age. Between the ages of 6 - 9 years the child has some Milk teeth as well as some permanent teeth This period is called the mixed dentition period. By about 12 years all the Milk teeth should be shed off and replaced by the permanent teeth.

As the permanent teeth start emerging they wear off the roots of the Milk teeth. Thus the Milk teeth loose their support in the bone and become mobile. The Milk teeth are ultimately shed off and are replaced by the permanent teeth.

It is normal to find the Milk teeth in children to be spaced. These spaces between the teeth help later in accommodating the bigger permanent teeth. Thus absence of spaces between the Milk teeth in children may be a fore warning that the child may not have adequate space to accommodate the bigger permanent teeth which may erupt in a crowded arrangement.

The permanent teeth start erupting by about 6 years of age. Most of the permanent teeth erupt by 12 years of age except the third molars or the wisdom teeth, which erupt any time between 18 -25 years of age.

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Ugly Duckling stage is a transient phase during childhood when we find a very large space or diastema in the middle between the two upper incisors, which can also be flaring. This occurs due to pressures from adjacent erupting teeth. This stage corrects on its own and does not require any orthodontic intervention. Click for Animation (Use Animation Titled Ugly Duckling)

This is a rampant form of dental caries involving several teeth in the mouth and affects those teeth which are generally considered resistant to dental decay. Nursing bottle caries or rampant caries is usually associated with prolonged bottle feeding of sugar containing drinks such as Milk and juices. They may occur due to bottle-feeding at bedtime or during sleep and lack of cleansing of the teeth thereafter. Nursing caries can also occur due to prolonged on demand breast feeding at night due to lactose sugar present in the Milk. This form of dental decay affects many teeth and may be seen as marked discoloration of the teeth. In later stages the teeth may fracture. The child often experiences pain on brushing and eating cold or hot food substances.

In some children, the grinding surface of the teeth tends to have very deep pits and grooves which predispose to stagnation of food and microbes. For such teeth the dentist may use appropriate sealants to reduce their depth. These are called pit and fissure sealants.

Deep inside the tooth is the dental pulp or the vital tissue comprising of nerves, blood vessels and other tissues. This tissue is protected by the outer covering of dentin and enamel. When the cavity becomes large and deep the caries may reach the inner vital tissue of the pulp. Thus the area of pulp adjacent to the dental decay may get infected and inflamed. Pulpotomy is the procedure where the superficial part of the infected pulp adjacent to the area of dental decay is removed leaving behind the pulp present deeper inside. The procedure involves clearing all the decayed tissue and removing a part of the pulp tissue followed by treatment by some medications which would promote healing of the rest of the pulp

Sometimes a Milk tooth may have to be extracted (due to dental decay or some other cause) much before the permanent tooth is ready to replace it. In such cases the early extraction of the Milk tooth may cause the neighboring teeth to move into the space and thus prevent the underlying permanent tooth from erupting into its correct position. To avoid this, the dentist may give the child a device called space maintainer that maintains the space till the permanent teeth that replaces the Milk teeth are ready to erupt.

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