Pediatric Dentistry

PEDODONTICS - (PEDIATRIC DENTISTRY)

Pedodontics – (Pediatric Dentistry)

 

Pedodontics is the branch of dentistry that performs all types of treatment and preventive procedures for children. The dentists who have received special training in this field are called pedodontists (pediatric dentists).

Who is a Pedodontist / Pediatric Dentistry Specialist? A Pedodontist / Pediatric Dentistry Specialist is a specialist dentist who, after completing a 5-year dental education, has embarked on an academic career in the Pedodontics (Pediatric Dentistry) departments of dental faculties. They have successfully completed doctoral and specialty training, receiving education in subjects such as dental development, diagnosis and treatment of potential problems, child psychology from infancy to young adulthood, and behavior management.

The treatment approaches of pedodontists, in line with their training, are aimed at preventing the development of “dental fear” in children by turning treatments into fun games. In our clinic, after a comprehensive examination of your children, parents are informed about their nutritional habits, their risk status for cavities, and preventive measures against these risks. Additionally, our expert team successfully performs the diagnosis and treatment of cavities in primary and permanent teeth, preventive orthodontic procedures to prevent potential crowding from early primary tooth loss, and general anesthesia and sedation applications for highly anxious and worried children.

When should the first dental examination be done? The American Academy of Pediatric Dentistry (AAPD) and the World Health Organization (WHO) recommend that the first dental examination be performed after the first primary tooth erupts (usually between 6 months and 1 year of age).

Since pedodontists are specialists trained in child psychology and behavior management, it is very important that this first examination is conducted by a pediatric dentist. During this examination, parents are taught how to clean their baby’s teeth. Furthermore, providing early information to parents about Early Childhood Caries, also known as “Baby Bottle Tooth Decay,” which can arise from poor feeding habits, is highly effective in preventing future problems.

It is in your hands, as parents, to turn your child’s first introduction to the dentist into a pleasant and fun visit, rather than a session that could be painful and difficult.

Our expectations from parents before the first examination: Please make an appointment for your child to meet a pedodontist after their teeth begin to erupt, before any problems like pain or abscesses occur. The positive communication your child establishes with the dentist during this first appointment will enable any future problems to be resolved more easily and smoothly.

Fears that children acquire from birth often stem from the impressions and verbal communications created by parents. Therefore, please do not use sentences like “don’t be scared,” “it won’t hurt,” “you won’t get a needle,” or “your tooth won’t be pulled” before this first appointment. Please do not mention your own past experiences. Motivate your child with positive affirmations.

Are primary (milk) teeth important? Primary teeth, present in the mouth from infancy to childhood, have many functions, including nutrition, speech, and aesthetics. The decay and subsequent loss of primary teeth during this period due to poor nutrition, inadequate oral hygiene, etc., can lead to nutritional problems for children.

Initially, pain that manifests after eating when cavities are not yet advanced can later turn into continuous, severe pain that wakes the child from sleep at night. Consequently, children may not want to eat, leading to inadequate nutrition. Disrupted nighttime sleep and the inability of children to sleep regularly will negatively affect their development, just like poor nutrition.

Furthermore, while initial cavities can be resolved with simple treatments like fillings, when they become severe enough to cause night-waking pain, they require more advanced treatments (root canal, extraction). This can increase the time your child spends in the dental chair and lead to potential cooperation problems.

Phonation problems can be encountered with the early loss of primary teeth, which play an important role in speech and the correct pronunciation of words.

Primary and permanent teeth are designed in a magnificent balance, and primary teeth serve as an important guide for permanent teeth. They preserve the necessary space for the permanent teeth to erupt and ensure the healthy development of the jaw and muscles. If preventive treatments like space maintainers are not used after the loss of a primary tooth, the adjacent teeth can drift into the empty space, causing crowding in the permanent teeth and leading to the need for orthodontic treatment in the future.

Additionally, self-esteem problems can develop in children who cannot smile due to cavities in early childhood and tend to keep their mouths closed. It is in your hands as parents to ensure your child can smile with confidence…

What is baby bottle tooth decay? Early Childhood Caries, or “baby bottle tooth decay” as it is commonly known, is a type of cavity that typically starts as matte, chalky-white discolorations on the upper front incisors as a result of poor feeding habits. It progresses very rapidly and can lead to the loss of the teeth. The actual culprit is not the bottle itself, but the milk/liquid inside it. Both breast milk and cow’s milk naturally contain sugar. Molasses, sugar, and other sweeteners added to milk worsen this situation. Feeding babies with a bottle before bed or during sleep allows milk to remain in the mouth, creating a favorable environment for bacteria to multiply. Combined with the reduced saliva flow during sleep, this leads to the formation of cavities. Therefore, it is crucial to clean the teeth, especially after nighttime feeding.

What can be done to prevent baby bottle tooth decay?

  • To help your baby acquire proper feeding habits early on, for preventive measures to be taken, and for risk assessment, be sure to consult a pedodontist/pediatric dentist as soon as your child’s first teeth erupt.

  • Do not allow your baby to fall asleep while breastfeeding or with a bottle. If you cannot prevent these habits, make sure they drink water after feeding.

  • As soon as the teeth start to erupt, clean them after feeding using finger brushes or a clean gauze pad.

  • Do not add molasses, sugar, or other sweeteners to the bottle, and do not dip the pacifier in these substances to give to your child.

What is preventive dentistry? Preventive dentistry begins with the eruption of the first baby teeth and lasts a lifetime. In principle, it adopts the approach of preventing problems before they arise by determining the child’s specific risk status and then creating a personalized treatment plan.

Preventive practices in pediatric dentistry include:

  • Regular dental check-ups

  • Monitoring tooth eruption times to ensure healthy development

  • Oral hygiene education and follow-up

  • Informing parents about proper nutritional habits

  • Determining the caries risk status and creating a personalized preventive program

  • Fluoride applications

  • Fissure sealant applications

  • Stopping harmful habits like thumb sucking, nail-biting, and teeth grinding, and resolving the problems they cause

  • Preventive orthodontic treatments such as space maintainers.

What should be done if primary teeth are extracted early? In addition to nutrition, speech, and aesthetics, primary teeth also have the function of guiding the permanent teeth that will come in beneath them. It is thought that permanent teeth, positioned just under the primary teeth, push them as they erupt to reach their correct position in the mouth. If a primary tooth is lost early due to problems (decay, trauma, etc.), failure to preserve the space maintained by that tooth can cause adjacent teeth to drift into the gap. This prevents the permanent tooth from erupting correctly when its time comes, leading to crowding. This, in turn, creates the need for long-term orthodontic treatment in the future. Therefore, after the early extraction of a primary tooth, protecting the extraction space with simple preventive appliances called space maintainers will both ensure the correct positioning of your child’s teeth and protect your child from long-term orthodontic treatments by preventing future crowding.

What should be done in cases of injuries to teeth and surrounding tissues in children? It is very common for children’s teeth to be fractured, displaced, or knocked out due to blows to the mouth area from accidents like falling or impacts. In such situations, it is necessary to consult a pedodontist as quickly as possible for emergency intervention. Even if parents think the situation is not serious, an intraoral evaluation by a pedodontist, and if necessary, a radiographic assessment, is very important to prevent potential future problems.

If a tooth is knocked out due to an impact, the most appropriate action before consulting a pedodontist is to rinse the tooth under running water without touching the root and reinsert it into its socket as soon as possible. If parents cannot do this, they should place the tooth in milk and consult a pedodontist immediately.

What is a fluoride application? Fluoride application is the most effective and simple method known for controlling initial cavities, protecting tooth enamel from harmful acids, and preventing new cavities from forming. In the USA and other developed countries, regular fluoride applications are stated to be the most effective method for preventing the increase in cavities (The American Academy of Pediatric Dentistry – Guideline on Fluoride Therapy). Gel or varnish forms applied to the tooth surface combine with the calcium in the tooth, making the teeth more resistant to harmful acids. After an examination, your doctor will inform you, the parents, about the fluoride application method and frequency according to your child’s needs.


 

FISSURE SEALANTS

 

The small pits and grooves on the surfaces of molar teeth are called “fissures.” These pits create areas that are difficult to clean with a toothbrush. On molar teeth, where chewing is most effective, rapidly progressing cavities starting in these areas are very common, especially in children who have not yet developed a regular brushing habit. The main purpose of fissure sealant applications is to fill these pits with a filling-like material without harming the tooth, thereby creating areas that are easier to clean with brushing and preventing potential cavities. As is known, “The most rational treatment is preventive treatment before the disease occurs.”

 

TOPICAL FLUORIDE APPLICATIONS

 

Preventive treatments are procedures that prevent the occurrence of tooth decay and gum diseases. Fluoride applications, which are preventive procedures, are used through systemic (taken orally) or topical (acting on the teeth) methods. Systemic fluoride can be obtained from water or prescribed by a physician in tablet form. The fluoride dose in the tablets is adjusted according to your child’s needs and age. Therefore, follow your physician’s usage recommendations. Keep fluoride tablets out of the reach of children. Overdosing can lead to a poisoning scenario characterized by sweating, nausea, vomiting, and muscle contractions. In such a case, you should go to the nearest health institution without delay. Topical fluorides are products that can be used at home or applied in the clinic. Home-use products include fluoride-containing toothpaste, mouthwashes, gums, and dental floss. Follow your physician’s advice on the use of such products. Clinic-applied products are in gel or varnish form and are applied to the teeth by the physician every 3-6 months. Before the application of fluoride, it may be necessary to remove the plaque and tartar that accumulate on the teeth and cause gum disease with appropriate instruments, followed by a polishing procedure with suitable pastes. After the fluoride application, it is necessary to comply with the eating/drinking restrictions specified by the physician.

 

SPACE MAINTAINER

 

This is a type of prosthesis made to replace primary teeth that are extracted before their natural time of exfoliation or permanent teeth lost at an early age. Their purpose is to prevent crowding and malocclusions by stopping adjacent teeth from drifting into the space of the lost teeth, and to correct aesthetic, chewing, and speech functions. The treatment of malocclusions is a more difficult, lengthy, and expensive form of treatment. However, malocclusion may still develop despite a space maintainer. In this case, space maintainers will ensure that any developing malocclusion is less severe. To make a space maintainer, an impression is first taken of the child’s mouth with appropriate trays and impression materials (For a fixed space maintainer, a band or crown is first placed on the tooth). Nausea and vomiting may occur in children during the impression process. The space maintainer is fitted into the mouth at the appointment given to you according to the laboratory’s completion schedule. If you do not come to the given appointment date, the space maintainer may not fit the mouth. Use of Space Maintainers: You need to be careful with the use of space maintainers. Removable space maintainers should remain in the mouth while eating. After meals, removable space maintainers should be taken out of the mouth, and after brushing the teeth, the space maintainers should also be brushed with a toothbrush with paste on it. After being cleaned similarly before sleep, it is stored in a clean glass of water. It should be put back in the mouth upon waking in the morning. If it is removed from the mouth and left dry for a long time, the space maintainer will not fit the mouth. If the space maintainer does not fit the child’s mouth at home after being fitted by the physician or causes discomfort, the physician should be notified immediately, and it should be kept in water during this time. Do not try to adjust the clasps used to hold the space maintainer in the mouth with any tool. This will damage the space maintainer and it will need to be remade. Removable or fixed space maintainers are used until the permanent teeth erupt. Space maintainers do not hinder your child’s jaw development. However, as the child’s jaws are constantly growing and developing, they will need to be replaced at certain intervals. You are responsible for the full financial liability of the new space maintainer. You must come for a check-up every 2 months for space maintainers. Failure to come for check-ups on time will cause the space maintainers not to fit the mouth. Remakes may be necessary if the space maintainers are broken, lost, not used, or if the usage recommendations are not followed. In this case, all financial responsibility is yours. After removable space maintainers are fitted, speech problems, difficulty eating, nausea, and increased salivation may occur. All of these conditions are temporary. Reading a book aloud or singing will make it easier to get used to the space maintainer.

 

PULPOTOMY (AMPUTATION)

 

In cases of deep decay in primary and young permanent teeth, the pulp tissue (the tissue inside the tooth containing nerves and blood vessels) can also be negatively affected. A pulpotomy is a form of treatment that aims to remove the pulp tissue with special instruments, allowing the rest of the tooth to remain healthy. The materials used are developed to cause minimal harm to the tooth and surrounding tissues. However, like any medication, side effects can occur. As with all dental treatments, success cannot always be expected in this treatment. In pulpotomy treatment, the child’s history and the physiological characteristics of the tooth affect success. After a pulpotomy, a decision for a root canal or extraction of the tooth may be made. Since the decision for a pulpotomy is often made during the treatment of a decayed tooth, you may not be informed at the first examination. However, you will be informed during the application. If a decision is made to extract the tooth after a pulpotomy, the initial treatment plan may change. Your physician is not responsible for the resulting financial liability in this case.

Is it possible to perform dental treatments under sedation or general anesthesia? For children who cannot overcome their dental fear, refuse treatment in the dental chair despite all efforts, and have a very high level of anxiety, sedation or general anesthesia applications are preferred for performing dental treatments. Forcing treatment on children who do not want it during childhood can both prevent the treatments from being performed as planned and with the desired quality, and can also result in the development of a dental phobia in the future and in adulthood. Therefore, if success is not achieved after a necessary number of treatment attempts in the dental chair without forcing the child, sedation or general anesthesia should be preferred. This makes it possible to solve all problems in the mouth in a single session and allows children to regain their health without having bad experiences.

These applications must be performed in fully equipped hospital conditions, in collaboration with an experienced anesthesiologist and pedodontist, as a team effort. Before the procedure, an examination by the anesthesiologist must be conducted to determine if there are any conditions that would prevent the procedures.