Though not much different than normal dentistry in principle, children dentistry is completely a different branch for the reasons of infantile fear and anxiety toward dentists and dentistry processes and different techniques of children communication. The crucial point is to accustom children to dental clinics and to dentists and to prevent fear and anxiety for future processes rather than eliminating infantile complaints. For this reason, more different séances should be arranged with shorter periods of treatment, and processes should be conducted in children dentistry unit and simultaneously with other children, if possible. Besides eliminating complaints of children, it is Pedodontics specialist’s duty to endear and accustom oral and dental care.
Extractions are needed in advanced decay and loss of deciduous teeth or dangling deciduous teeth. Extractions can be made under topical spray anesthesia or local anesthesia in accordance with the dangling level of tooth. After extraction, while it is sufficient to follow dentition of permanent teeth in case there is a short period of time for dentition, space maintaining applications are required in case there is long period of time for dentition of permanent teeth.
Extraction is needed if early period advanced decay and loss occurred on permanent teeth and exceeded the limit for saving. After extraction, either the current space should be protected with space maintainers for future prosthesis and implant applications, or the space should be covered by providing the dentition of adjacent teeth toward the extraction area.
Decay and loss on deciduous and permanent teeth should be restored with filling materials similar to the applications applied on adults. Filling treatment should not be avoided thinking that deciduous tooth will be replaced in the end and treatment should be conducted in order not to let an infection to occur, not to let the following permanent tooth to be affected negatively or not to let premature loss of deciduous teeth.
In case the decay level on deciduous teeth exceeded the limit of restoration through filling materials and reached to vital part of teeth, the vital part should be cleaned, disinfected and restored similar to root canal treatment. This process is called “Amputation”. Amputation process and the number of séances can show changes in accordance with whether deciduous teeth nerves are vital or necrosis.
In case of advanced teeth in the early period deciduous teeth, deciduous root canal treatment is preferred instead of amputation if decay reached to vital parts. In deciduous root canal treatments, it should be considered that the following permanent teeth can dissolve deciduous teeth roots and that, for this reason, the root canal filling material should also be dissolved compatibly with roots and suitable root canal treatment applications should be applied.
Differently from adult patients, in case root development of permanent teeth is not completed, root canal treatments on permanent teeth should be applied in a way to accomplish healthy root development. For this reason, root canal treatment duration and number of séances can show changes in order to follow root development.
Tartars can also be seen in early ages around deciduous and permanent teeth. Similar to adults, these should not be disregarded and should be cleaned in order not to cause gingival diseases in early ages. During this process, falling deciduous teeth or growing permanent teeth should be approached sensitively.
In case premature loss of deciduous teeth takes place for any reason, current space should be protected with space maintaining applications in order to provide proper dentition for following permanent teeth. Space maintaining can concern a single tooth or all jaw and future need for orthodontic treatment can be eliminated though providing proper dentition for following permanent teeth.
In cases of crowded teeth or jaw stenosis, in order to eliminate the need for future orthodontic treatment or at least to decrease the severity of required orthodontic treatment, dentition of following permanent teeth can planned, their timing can be adjusted and extraction of deciduous teeth can be conducted in a particular order and arrangement. This process is called dentition guidance.
If there is loss of tooth which cannot be restored with filling in deciduous teeth, pedodontic prefabric crowns are used similar to porcelain crowns applied to adults.
Since the prevalence of decay on following permanent teeth is more common in children whose deciduous teeth decay number and level is high, topical fluor applications are suggested in order to reinforce enamels of permanent teeth. Since the fluor is applied as gel and only on teeth enamels, it does not have any systemic adverse effect.
Tooth decays generally occur as a result of food residue and microorganism contamination in dentations and indentations which are anatomically found on teeth. In children whose deciduous teeth decay number and level are high, indentations on teeth are covered with fluidal fillings which are called as fissure sealant in order to prevent decay formation on permanent teeth. In this way, food residue and microorganism contamination in indentations is prevented and decay risk is minimized.
Oral and dental care habit is gained in childhood. For this reason, it is crucial to suggest children to have them their teeth brushed. As a first step, parents should brush their children’s teeth using toothbrushes for children and toothpastes with adjusted fluor amount. After a period of time, when the children come to an age to brush their teeth themselves, they should brush their teeth under the guidance of parents and even they should be encouraged to use dental floss.
Each day and at the same time every day, teeth should be brushed altogether. Thus, setting an example to children, parents can help them to gain the habit of teeth brushing. Toothbrushes and toothpastes for children should be obtained in accordance with the suggestions by doctors.