Tend the Tender

Paedodontics ||  From  Breaking Nasty Oral Habits To Making Beautiful Smiles

– By Gunjan Sharma

With his mouth wide open, eight –year-old Rahul was racing bikes with his friend Saksham on a play station fixed to his chair in a dental clinic. So excited was Rahul that he didn’t even realize that his dentist was drilling his tooth for a root canal procedure, which is other-wise painful.

It took the dentist 30 minutes to complete the procedure and Rahul cooperated without any sign of discomfort. “It is quite difficult to perform dental procedures on children, especially during elaborate treatments,” says Dr Shalini Pradhan, a Mumbai-based Paediatric Dentist.

Paediatric Dentistry or Paedodontics is a specialized branch, which deals with children and caters to their requirements from the eruption of deciduous teeth at six months to the formation of permanent dentition at 14.

In most cases, paedodontics go for relatively painless options such as laser drilling for children. “These procedures reduce pain by 70 to 80 per cent and cost hardly 25 to 30 per cent more than normal treatment,” she adds.

A paedodontist generally looks after caries and cavity that are common in children, crowding of teeth that occurs at the age of about seven, malocclusions (imperfect positioning of teeth) and unwanted habits that deform jaws.

“Of late, parents have become more conscious of their overall personality. And during childhood, the procedures are simpler,” says Dr Mahesh Verma, principal, Maulana Azad Institute of Dental sciences, Delhi.

Three year old Ananya sucks her thumb when she feels hungry or insecure. Her habit not only affects her appetite and makes her susceptible to various infections, but also has deformed her teeth. Her two upper incisors protrude, deforming her lips.

“I tried hard to stem the habit with the help of bitter substances such as neem oil, but nothing helped,” says Ananya’s mother, Nitu. “Recently, I heard about habit-breaking procedures, and met a paedodontist. I don’t know if it will help.”

Her dentist, however, has no doubts. “it hardly takes three months for a child to give up habits such as thumb sucking, nail biting and oral breathing. Even a stubborn child does not take more than six months,” says Dr Gyanendra Kumar, Assistant Professor, Paediatric dentistry, Maulana Azad Institute of Dental sciences.

Children with habits such as tongue thrusting, nail biting and bruxism (grinding of teeth during sleep), generally suffer from mal-occlusion, which affects the shape of their jaw, oral environment and teething. These habits usually start at an early age (till about 3) and doctors say it is easiest to get children to give them up when they are about four.

Parents should help by praising children for not doing it rather than scolding them. If a habit is not given up at this age, it will persist till adulthood.

Take the case of Aroonima, 11, who still can’t sleep without sucking her thumb. Her friends dubbed her ‘lollypop’. “Though I am embarrassed of this habit, I cant give it up..I have tried, but failed,” says the adolescent, who is now set for a habit-breaking procedure.

After the permanent teeth erupt, doctors generally have to resort to orthodontics (branch that deals with irregularities in alignment of teeth) for correction. “Recently, I had a 35-year-old patient with protruding maxilla, who said he still sucks his thumb when alone and stressed,” says Dr Suchetan Pradhan, head of dentistry, Hinduja Hospital, Mumbai. “We had to do an orthodontic surgery to realign his dentition.”

This first step towards developing healthy teeth is oral hygiene. A child needs oral care from the first day of his life. From the first few months, one should wipe their gums and tongue  with soft, clean, cotton cloth at least twice every day. Actual care starts when teething begins. “Right from the eruption of first tooth, one should start brushing with an ultra-soft brush and toothpaste for babies,” says Suchetan Pradhan. “Start the practice at the earliest to cultivate the habit. Moreover, most babies enjoy it, as brushing massages and soothes their irritating gums.”

The first dental check-up should be done at the age of two, when most deciduous teeth have erupted. Thereon, a child should be taken for regular dental check-ups. Says Kumar: “The period is crucial as caries, cavities or displacement of deciduous teeth affect permanent teeth.”

The Problems

Nail biting, thumb sucking and tongue thrusting:

Generally children, who feel insecure, do them more. These habits can be broken by appliances (costs Rs 500 onwards), which are easy to use and readily available.

Teething stage: It is around 6-7 years, when deciduous teeth delay their fall and permanent teeth begin to erupt. At the stage, a serial extraction of deciduous teeth may be required.

Bruxism: It is a condition where a child grinds his teeth in an unconscious state, generally while sleeping. It is important to find out the reasons – it should be stress, infection or premature contact – and treat it accordingly.

Broken tooth: It is a common problem with children. They may break their teeth while playing. If a tooth falls, one should conserve it in milk and contact a dentist. A chipped tooth can be fixed with filling material and a fallen tooth can be replaced with holders. In case of deciduous teeth, space maintainers are fixed so as to restore the space for permanent teeth.

Milk bottle caries: It is common in children who are given milk bottle at bedtime. The sugar in the milk invites bacteria to grow on teeth. Avoid the practice.

(Source: THE WEEK, HEALTH, AUGUST 31, 2008.)