Pedodontics

PEDODONTICS

Rampant CariesWith pedodontics, cavities occurring in children are all taken care of. This also involves fluoride application for protection of teeth and prevention of dental caries.

Rampant caries is a lesion of acute onset involving many or all of the erupted teeth, rapidly destroying coronal tissue, often on surfaces normally immune to decay, and leading to early involvement of the dental pulp. In a recent study, subjects with active, rampant dental caries were defined as those who had five or more new carious surfaces per year. It is perhaps one of the most difficult and challenging conditions confronting the dental practitioner from both a preventive and management standpoint.

Clinical Appearance

The pattern of rampant caries in the primary dentition is usually related to the order of tooth eruption, with the exception of the mandibular primary incisor. The mandibular incisors are probably more resistant to caries because of their close proximity to the secretions of the submandibular salivary glands as well as the cleansing action of the tongue during the process of suckling the bottle.

Treatment

The type of treatment instituted for patients with rampant caries depends on the patient’s and parents’ motivation toward dental treatment, the extent of the decay, and the age and cooperation of the child. The initial therapy will help the dentist to determine the ultimate success or failure of the case. Caries stabilization and provisional restorations should be placed in symptom-free teeth with established dentinal caries to minimize the risk of pulpal exposure in the future and to improve function. However, in patients presenting with acute and severe signs and symptoms of gross caries, pain, abscess, sinus, or facial swelling, immediate treatment is indicated, Formocresol pulpotomy may be performed if the pulp is still vital, but pulpectomy followed by obturation with zinc oxide-eugenol cement is indicated if the pulp is non-vital.

Fluoride Therapy

Fluoride Therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay (dental caries) which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves fluoride supplementation using water, salt, tablets or drops which are swallowed. Tablets or drops are rarely used where public water supplies are fluoridated.

Toothpaste

Most toothpaste today contains between 0.22 percent (1000 ppm) and 0.312 percent (1450 ppm) fluoride, usually in the form of sodium fluoride or sodium monofluorophosphate (MFP); 100 g of toothpaste containing 0.76 g MFP equates to 0.1 g fluoride.

Mouth Rinses

The most common fluoride compound used in mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05% sodium fluoride (225 ppm fluoride) for daily rinsing are available for use. Fluoride at this concentration is not strong enough for people at high risk for cavities.

Gels/Foams

Gels and foams are used for individuals who are at high risk for caries, orthodontic patients, patients undergoing head and neck radiation, patients with decreased salivary flow, and children whose permanent molars should, but cannot, be sealed.

Varnish

Fluoride varnish has practical advantages over gels in ease of application, an unoffensive taste, and use of smaller amounts of fluoride than required for gel applications. Varnish is intended for the same group of patients as the gels and foams.

Slow-release Devices

Devices that slowly release fluoride can be implanted on the surface of a tooth, typically on the side of a molar where it is not visible and does not interfere with eating.

Dietary supplements

Dietary fluoride supplements in the form of tablets, lozenges, or liquids (including fluoride-vitamin preparations) are used primarily for children in areas without fluoridated drinking water.

Consult with our pedodentist before starting any treatment.

White spots.

Moderate to high risk patients for developing decay.

Active decay.

Orthodontic treatment.

Additional protection if necessary for children in areas without fluoridated drinking water.

To reduce tooth sensitivity.

Protect root surface.

Decreased salivary flow.

Institutionalized patients.

Root Caries

Root caries is a growing concern, especially as our population ages. Adult patients need to receive topical fluoride to effectively manage root caries. Demineralization of root surfaces can occur at a higher pH than coronal caries. Root lesion progression and mineral loss are 2.5 times greater for root surfaces than for enamel (without fluoride therapy). Fortunately, root surfaces have an even greater affinity for topical fluoride uptake than coronal enamel, probably due to relative porosity. Root surfaces are quite receptive to the formation of calcium fluoride. Unless these lesions progress too far, they may be reversed via aggressive topical fluoride therapy.

Why Your Child May Need a Space Maintainer?

Children may need space maintainers if they lose a tooth early or have a baby (primary) tooth extracted due to dental decay. If either is the case, it is important to know the benefits of using a space maintainer and how it can help support your child’s dental health. A space maintainer is an appliance that is custom-made by a dentist or orthodontist in acrylic or metal material. It can be either removable or cemented in a child’s mouth. Its purpose is to keep the space open to allow the permanent tooth to erupt and come into place. Baby teeth are important to the development of the teeth, jaw bones and muscles and help to guide permanent teeth into position when the baby teeth are lost. If a space is not maintained, then teeth can shift into the open space and orthodontic treatment may be required. Not every child who loses a baby tooth early or to dental decay requires a space maintainer; however, a professional consultation with your dentist or orthodontist should be conducted to determine if using a space maintainer is needed.

Types of Space Maintainers

There are two types of space maintainers for children, removable and fixed.

Removable ? removable space maintainers are similar to orthodontic appliances and are usually made of acrylic. In some cases, an artificial tooth may be used to fill a space that must remain open for the unerupted tooth.

Fixed ? there are four different kinds of fixed space maintainers: unilateral, crown and loop, distal shoe and lingual.

Wearing the Space Maintainer

Once the space maintainer is made by the dentist or orthodontist, it may take the child a few days to get accustomed to wearing the appliance whether it is removable or fixed. The dentist should review with the child and parent the proper ways to clean the space maintainer thoroughly in order to keep the gum tissue healthy and free of dental plaque. Proper instruction for tooth brushing and flossing should be considered for improved oral hygiene.

Making the Space Maintainer

Each space maintainer is custom-made by a dentist or orthodontist. For a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made. Impressions are made with a soft material that tastes like toothpaste. It sets into a gel around the teeth and is easily removed from the mouth. This allows the laboratory to make a copy of the teeth to use in making the space maintainer. The band is also removed and sent to the dental laboratory with the impressions. The lab creates the space maintainer and sends it back to your child’s dentist. He or she cements it into place at a second office visit. Sometimes, a space maintainer can be made in the office in a single visit without impressions. To make a removable space maintainer, the dentist first makes impressions. They are sent to a lab, which makes the appliance.

Follow-Up

Your child’s dentist will take X-rays regularly to follow the progress of the incoming permanent. When the tooth is ready to erupt, the space maintainer is removed. If a permanent tooth is missing, the space maintainer will be used until your child’s growth is completed (age 16 to 18). Then a dentist will place a bridge, implant or removable partial denture in the space.