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1. How do I prepare my child for his/her first dental visit?
Make your child’s first visit to the dentist a pleasurable one and going for subsequent visits will be a breeze. Most importantly, a child’s first dental visit should never be a traumatic experience. Prepare your child for the visit by reading with him or her story books like the "Dora Series Show Me Your Smile - A Visit To The Dentist" or role playing with toys such as the “Play-doh Dr Drill and Fill Play Set”. Drop frequent fun, positive, and exciting reminders about the upcoming event and remember to steer your child clear of words with negative associations like “pain, injections, needles, and hurt”, especially from other children and siblings.
2. What will I expect at my child’s first dental visit?
This really depends on how comfortable your child is at his or her first visit. For an anxious child, we would get him or her familiar and comfortable with the dental room by letting your child ride the dental chair up and down, play with the mouth mirror, and make balloons out of gloves. At the next visit, we will do a simple polishing and then later, more extensive treatments. However, if your child is comfortable with the environment, we will scale and polish, and address simple issues at the first visit.
3. What are the common problems with children’s teeth?
Most problems we encounter are preventable. One of them is nursing caries or milk bottle decay, which we see several a week. This pattern of decay is caused by routine and prolonged on demand feeding usually from the bottle left in an infant’s mouth to pacify them to sleep. Milk or feeding formula contains sugar which feeds the oral bacteria precipitating the onset of dental decay. Replace the formula with water or dilute the milk or formula. Teeth should also be cleaned after the feed. Traumatic injuries are another frequently seen problem. Those that occur from participation in sports (school age children) are minimised by the usage of a mouth guard. Over the counter mouth guards can be used but custom fitted ones made by a dentist offer better support but they will need to be adjusted annually as your child’s teeth grow. Mouthguards are HIGHLY recommended for all contact sports.
4. How do you clean a toddler’s teeth?
Children’s teeth usually start to erupt around 5 months. At this early stage, clean your baby’s teeth with a clean piece of gauze or a soft-bristled baby toothbrush after each meal and most importantly before bed time.
The use of adult toothpaste containing fluoride should be restricted till a time when your child can successfully spit it all out without swallowing, as excessive ingestion will cause discoloration to the developing teeth called fluorosis and an acute excessive amount can cause illness. Children’s toothpaste contains a lower concentration of fluoride than adult’s toothpaste and this limits the occurrence of fluorosis. Generally speaking, floss should also be used as soon as the teeth are in close contact. Your dentist can advise you on the correct method.
5. How do baby teeth develop?
The eruption of teeth into their baby’s mouth may seem to occur haphazardly to most parents, but there are often variations in both timing and sequence for each child. The general pattern of tooth eruption is described as follows. Beginning around the fifth month the top two and bottom two central incisors should erupt. Subsequently, new teeth will continue to emerge till about the age of 20-24 months by which time your child’s first dentition will be fully established. If there are large variations it would be best to see a dentist for further investigations. When the teeth erupt, it is common for your child to experience some discomfort, and possibly red and swollen gums overlying the location of the emerging teeth. This discomfort can be partially relieved by applying something cool to the area.
Soft teething rings cooled in the fridge for about 15-20 minutes prior to use or an equivalent soft chewable material like a cool damp clean cloth are recommended. Please make sure that whatever is used is not so small that it might potentially be breathed in or swallowed. Occasionally, a slight fever may develop at the same time as when teething occurs. This should not last more than a day and should not exceed 37.5 degrees Celsius as taken from the ear. Anything contrary to this may indicate a medical issue and you should seek an opinion from your child’s doctor.
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1. Why treat cavities in baby teeth when they will be replaced by new ones?
Although all baby teeth are replaced by permanent teeth, this must happen at the right age. If a baby tooth is lost much earlier than the scheduled time of eruption of its successor, it is possible that the space created by the loss of the baby tooth will reduce or even close due to drifting of nearby teeth. This may result in poorly aligned permanent teeth. Also unchecked dental decay can result in abscess formation under the affected tooth which is not good for the health of the child.
2. What are fissure sealants?
The top surfaces of the teeth are not smooth and flat but crossed with tiny hills and valleys called 'pits' and 'fissures'. These are places where, typically, a toothbrush cannot reach and so plaque is allowed to form and accumulate. One method of preventing cavities from developing in these pits and fissures is to seal them off with a pit and fissure sealant.
The procedure is as follows: First the tooth is cleaned, then the surface of the tooth to be treated is 'etched' with a special solution which helps the sealant to stick. Once the tooth is clean and dried, the sealant is applied and a light is used to cure the sealant hard. It is difficult to predict how long a sealant should last; 3-5 years would be considered a success but any period of time in which the tooth remains protected is beneficial.
3. At what age do the permanent teeth erupt?
The first permanent teeth to erupt are usually the lower incisors and back molars. Parents are often surprised to be told that the first permanent molar is indeed an adult tooth as these teeth do not replace baby teeth but simply erupt unannounced at the back of the mouth. The first molar is a very important tooth. The remaining primary (baby or 'milk') teeth are lost between the ages of 7-12 years; all the permanent teeth should have erupted by the age of 14 years with the exception of the wisdom teeth, which normally erupt between 18-25 years. The period in which both milk teeth and permanent teeth are present is termed the 'mixed dentition' stage.
4. What are the early symptoms of orthodontic problems?
Determining treatment need is not easy but there are some signs that may help in prompting you to seek professional advice. Look at your child's teeth. Are there overlapping teeth- or large spaces? Ask your child to bite down. Do the top teeth protrude? Do the top teeth cover more than 50% of the bottom teeth. These may be indicators for treatment. Look at the alignment of the jaws. Does the jaw shift to one side? These are just some of the signs that MAY indicate a need for orthodontic assessment but professional advice should always be sought.
5. At what age should an orthodontist be seen?
There is no 'best' or specific time when such an opinion should be sought. Your dentist will be continually monitoring your child's orthodontic development and will know the optimum time to refer for a specialist orthodontic evaluation if necessary. It is not always easy for the 'lay' person to determine if treatment is necessary because orthodontic problems can occur even though the front teeth look straight. Also, there are some perfectly normal developmental features that look out of place - for example, spacing - but which will resolve on their own.
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1. Should a fractured baby tooth be root canal treated or extracted?
Generally, a root canal treatment is recommended for a fractured baby (primary) tooth if one or more of the following conditions exist:
- The fracture has resulted in the exposure of the pulp cavity (part of the tooth housing the nerves and blood vessels).
- The tooth is discoloured.
- The tooth is not scheduled to shed yet and keeping this fractured tooth is needed for the maintenance of space prior to the eruption of its successor.
- There is an abscess (gum boil) related to the fractured tooth.
If a child is cooperative, a root canal treatment can be easily done under local anaesthesia. However, if he or she is fearful and uncooperative, then treatment done under general anaesthesia or relative anaesthesia would be a preferred choice.
2. Would the eruption of an adult tooth be affected after a traumatic impact on the related baby tooth?
It all depends on how great the impact is. A light impact is unlikely to affect the eruption of the adult tooth. If the impact is great, especially resulting in an intrusion (a condition which the tooth pushed into the gum) of the baby tooth, then the development of its successor may be affected. It may erupt later than expected or it may not erupt at all. Sometimes, it may end up with a bent root or a discoloured tooth surface.
Orthodontic treatment can help to hasten eruption of the adult tooth and move it into position. Nothing much can be done about the bent root. The discoloured tooth surface can be corrected with either a composite (white-coloured) restoration or a veneer (“porcelain shell”).
3. Is it normal for the baby teeth to be widely - spaced?
Baby teeth are generally smaller in size compared to the adult teeth. Moreover, as a child grows, the jaws will increase in size too. In fact, there is less tendendancy for the adult teeth to be crowded if there are spaces amongst the baby teeth. This is because the spaces will accommodate the larger erupting adult teeth.
4. If there is a missing baby tooth, does it mean that the related adult tooth is absent as well?
Absence of a baby tooth does not necessarily mean absence of the related adult tooth and vise versa. If the adult tooth is not erupted at the scheduled time, an X-ray will help to tell its presence or absence. When a diastema (gap) is developed as a result of a missing tooth ,it can be easily closed with orthodontic treatment.
5. I’m worried for my child’s teeth development because he doesn’t like to drink milk. What can I do to encourage him to drink more milk?
Calcium in milk is good for the development of healthy teeth and bones. Thankfully, we don’t have to depend on milk alone for an adequate intake of calcium. Hence, you don’t have to force milk down your child’s throat if he finds it unpalatable. Milo, soyamilk and yoghurt drinks are good replacement for milk. It is important to supplement your child with calcium-rich food too. Cheese, nuts, green vegetables, toufu and fish are some of such food on the list.
The absorption of calcium is lowered with a high sugar intake, so remember to keep the sugary food to the minimum. To increase the absorption of calcium, make sure your child has a sufficient intake of zinc, Vitamin C and Vitamin D . Zinc can be found in chicken, butter, mushrooms and pineapples. Vitamin C can be found in most fruits and vegetables. Vitamin D can be found in fish, eggs and cheese. Vitamin D can also be produced in the body when our skin is exposed to the ultra-violet light from the sun, so have some fun with your kid outdoor!
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