Pedodontics (Pediatric Dentistry) is a branch of dentistry that deals with the oral and dental health of newborns, children or adolescents. Pedodontist (Pediatric Dentist) follow-up the primary and permanent teeth and maxilofacial development of newborns, children or adolescents, implement preventative treatments for these individuals and treat them when health problems arise.
The first primary tooth in infants erupts usually around 6 months of age with the eruption of two lower anterior central incisors. The eruption of the lower anterior central incisors is usually followed by the 2 upper anterior central incisors and then respectively lateral incisors, first primary molars, primary canine teeth and primary second molar. The completion of eruption of twenty primary teeth in the mouth takes place approximately between the months of 24 and 36.
Restlessness, increase in saliva production, fever, loss of appetite and weight loss due to infections that may occur resulting from the desire to bite certain objects and scratch gums with it, slight swelling and red-purplish discoloration in the area of erupting teeth may occur during the period of eruption of primary teeth in infants.
In some cases, there may be a natal tooth in the mouth during childbirth, or a neonatal tooth that has erupted in the mouth immediately after birth. In these cases, the pedodontist determines whether the tooth is the baby's own primary tooth or an extra tooth, and checks whether the tooth is loose. In the presence of a loose tooth, a decision can be made to remove the tooth, since the tooth may be swallowed by the baby, and the baby's nutrition may also be affected.
In addition to the fact that primary teeth provide nutrition for infants and children, they also serve as a guide for permanent teeth that will erupt after them, and also contribute to maintaining space, speech and aesthetics. Primary teeth differ structurally and anatomically from permanent teeth. Therefore, primary teeth are more susceptible to the development of caries and abrasions.
As a result of the occurance of cavities in primary teeth, feeding and nutrition of infants or children can be adversely affected due to the pain, and malnutrition is observed. As a result of losing teeth due to the caries, space for the following permanent teeth can not be maintained and children, who go to school, have difficulty in concentrating in classes due to pain and anxiety, they experience sleep disorders, while children with rampant caries may become shy and avoid talking and laughing because of their appearance. Therefore, it is of foremost importance that children are examined with the eruption of the first tooth of the baby (6 months) by a dentist no later than 12 months before cavities occurs.
The eruption of permanent teeth usually begins with the eruption of the first permanent large molar around the age of six. Both primary teeth and permanent teeth are present in the mouth during the period of permanent tooth eruption, approximately between the ages of 6 and 13. Caries lesions, which may develop in one or more primary teeth, can affect the adjacent permanent teeth. Therefore, visiting a dentist regularly starting from the eruption period of the first primary teeth, is important to maintain the oral health of the babies and infants in the future.
Early childhood caries is defined as multiple caries lesions, tooth loss due to caries or the presence of a filled tooth surface in any temporary tooth in children aged 71 months and younger. Early childhood caries, one of the most common diseases in children, is a chronic and multifactorial infectious disease. Breast milk is the most important food source for the baby after birth. Breast milk is crucial in terms of contribution to the growth, development and immune system of the baby. However, breast milk contains 7% lactose compared to the 4% lactose content of cow's milk. If baby's mouth is cleaned with water after baby consumes cow's milk or breast milk, it poses no problem. However, it is reported that babies sleeping with a bottle of milk, especially during the night, or breastfeeding frequently throughout the night may be associated with the formation of caries. The saliva flow decreases significantly, especially during night sleep, and saliva can not properly cleanse the mouth. Therefore, when temporary teeth are in contact with milk, which is high in sugar, during the night for long periods, microorganisms in the environment produce acids using the sugar in the milk, and since saliva in small quantity can not neutralize the acids, it results in the formation of caries. Upper front teeth are affected initially since they are one of the regions most affected by the reduction in the amount of saliva at night, and due to the position of the bottle during feeding. However, if diet is not changed or the necessary measures are not taken, other teeth in addition to the upper front teeth, can also be affected by caries lesions. A similar effect is observed when a baby sleeps with a bottle containing a sugary drink or a pacifier soaked in honey and jam, and these high-sugar foods come into contact with the teeth during sleep. Caries lesions, which are initially chalky white in color, may not be easily noticed by families. When unnoticed, initial carious lesions can progress rapidly to deeper carious lesions as the same eating pattern is often followed, and substance losses may occur in the teeth. Caries lesions, which are initially chalky white, turn to a yellowy-brown colour as they progress. As a result of caries affecting deeper tissues, extensive tooth loss of substances, pain and swelling may occur. The pain and swelling can negatively affect the child's daily life, causing a decrease in the quality of life. In untreated cases, temporary teeth may need to be removed prematurely, which leads to misalignment of the teeth and may require additional treatment in the future.
One of the first measures to be taken is to prevent bacterial transmission that can cause caries from mother to child. For this reason, mothers should be contacted before and immediately after birth, and it is necessary to inform the mother and family that their oral health can directly affect the baby's oral health. Before labour, it is crucial for the mother to take the necessary precautions and improve her oral hygiene. After labour, mother /caregiver and families should avoid the common use of dinner plates and spoons or cleaning bottles and pacifiers with their own saliva. • First examination of the baby should be scheduled no later than the 12th month at the latest and oral and dental health should be maintained with routine examinations. • From the moment the first tooth erupts, families should always ensure that their baby's teeth are cleaned with a clean brush of the appropriate size or when it is not possible to clean them with a brush, with a clean cloth. From the moment the first tooth erupts, it is recommended to brush a baby's teeth twice a day with a toothpaste containing fluoride up to the size of rice until the age of two, pea-sized between the ages of 2 and 6, and close to the size of a brush after the age of six. It is also reported that parents should guide and supervise the child during brushing until he/she is at least 7 years old. • Due to the decrease in saliva production and flow rate at night and the inability to perform oral cleaning, long night feeding after 1 year of age poses a risk for children.
The pits and grooves that can be found on the surfaces of both the temporary and permanent molars are called fissures. Fissures are prone to caries formation due to the difficulty of cleaning the posterior teeth during brushing, and as saliva can not wash and clean these areas properly in the mouth. Fissures located on the occlusal surfaces of molars can be of different morphologies, and some types can cause caries, even when effectively brushed. For this reason, the process of covering the surfaces of the fissures with a liquid filling as a preventive measure before the formation of caries on these surfaces of the teeth in individuals prone to caries, is called the application of a fissure sealant. It is a preventive treatment against the development of caries. With this application, it is aimed to make the areas, where food residues accumulate and are difficult to clean, into flat, smooth surfaces that will not cause food accumulation and can be easily cleaned.
Fluorine is an element that can be found naturally in nature in the form of compounds. Numerous studies conducted to date have proven that fluorine is effective in protecting teeth from caries. Fluorine can form a structure that is more resistant to dissolution due to acid attacks and can fight against microorganisms that cause caries. Since fluorine is a naturally occurring element, we can take fluorine, albeit in low amounts, in our daily lives. Since there are no applications such as adding fluoride to drinking water, milk or salt in our country, it is only possible to take advantage of the beneficial effects of fluoride with oral hygiene products applications at home and with professional fluoride applications performed by a pediatric dentist. Patients can benefit from fluorine by using fluoride-containing toothpaste and mouthwash and flossing at home, and with professional fluoride varnish or fluoride gel applications. • The European Academy of Paediatric Dentistry (EAPD) recommends that the fluoride content of toothpastes according to age and the amount that should be used as follows: I. From the eruption of the first tooth to the age of 2: The use of toothpaste containing 1000 ppm fluoride in the size of a grain of rice twice a day. II. 2-6 years old: The use of toothpaste containing 1000 ppm fluoride in the size of a pea twice a day. III. Over 6 years old: Use of toothpaste containing 1450 ppm fluoride in a brush size according to age. • The use of fluoride-containing mouthwash is not recommended under the age of six due to the risk of ingestion. Whether fluoride varnish and fluoride gel applications, which are professional applications, are necessary is determined according to the individual caries risk analysis of the child. It is recommended that professional fluoride treatment be performed once in every 3 or 6 months in children with moderate and high risk of caries. Fluoride treatment, which is a preventive treatment method, should be supported with the individual's diet and oral hygiene practices performed individually at home.