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What is Pedodontics?
Pedodontics has to do with prevention, dental restoration of baby and permanent teeth and all oral surgery treatments in children.
The service is carried out by Doctor Pamela Parolin who pays much attention to the psychological aspect of the child, thus enabling him/her to build a good relationship with the dentist and the orthodontic environment. A positive orthodontic experience as a child is fundamental for a future relationship with the dentist.
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What is used in conscious sedation?
We use nitrous oxide which is administered through a small mask. Its goal is to reduce anxiety, stress and vomit feeling, making orthodontic cares more acceptable, particularly in younger and more anxious children.Nitrous oxide is a non-toxic acid and its effect immediately runs out once the mask is removed.
If you want to learn more about the use of nitrous, read here
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For the care of dental cavities, besides using traditional techniques, we offer advanced techniques such as:
- Ozone therapy
It is periodically applied on decayed teeth by using small rubber cups. It “stops” cavities and facilitates the tooth remineralisation. It is a fast, safe and painless technique.
- Nitrous oxide
It is administered through a small mask. Its goal is to reduce anxiety, stress and vomit feeling, making orthodontic cares more acceptable, particularly in smaller and more anxious children. Nitrous oxide is a non-toxic acid and its effect immediately runs out once the mask is removed.
- Saliva testings and prevention
The real aim of pedodontics is cavities prevention which we try to achieve with a new system, based on an exhaustive study on hygienical and food habits, as well as saliva testings. Specific saliva testings are able to analyse the ability to destroy acids in the mouth and determine the amount of bacteria which is normally present in the saliva and which is the cause of dental cavities. Based on these results, the teeth examination and the analysis of hygienical and food habits, each child is then inserted in a personalized record of oral hygiene recalls, regular check-ups, fluorine and antibacterial sprays which all decrease cavities.
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Is fluorine prophylaxis important?
Yes, it is. It prevents dental cavities by applying fluorine on formed teeth.
Fluorine is a mineral which facilitates the formation of a more resistant enamel to acid attack of bacterial plaque.
Fluorine should be applied in an accurate way, in order to avoid an overdose which then causes fluorosis, spots and stripes on the tooth surface, or can even collect at skeletal level.
Since fluorine is also present in water and foods like spinach and apples, it is important to verify the amounts taken so that we do not exceed once we decide to take it in drops or tablets.
Tooth remineralisation can be improved by using fluorine toothpastes or mouthwashes to be checked when used by youngest children, thus avoiding ingestion or fluorine excess which can cause opacity of the dental surface.
Ingestion must vary according to age:
- before the age of 6, it is recommended to use a tooth paste with a low fluorine concentration (>600 ppb), or medium concentration (1000 bbp.) in cases at the risk of cavities.
- After the age of 6, anterior teeth are less exposed to the risk of opacification and it is therefore possible to use toothpastes with a high fluorine concentration (1500 ppb).
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When to start with dental checks?
The first check-up should be done at the age of 1 and then every 6 or 12 months in order to monitor the oral hygiene, diet and mouth development.
To make your child feel at ease, it would be useful to first take him/her to the clinic just to meet the dentist and become familiar with the orthodontic environment. The second time would be for the real check-up, so that he/she has time to build a faith relationship with the pediatric dentist.
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When do baby teeth erupt and how?
The first baby tooth usually erupts after 6 months and in rare cases earlier (natal teeth if present when the baby is born or neonatal ones if they erupt within the first month) or a few months later.
If the baby is one and the first tooth has not yet erupted, a dental check-up is necessary to verify the development of the baby´s mouth.
Read more about the dental growth in babies
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How to take care of baby teeth (or deciduous teeth)
Taking care of baby teeth is extremely important since their preservation allows to create the right spaces to host permanent teeth and avoid orthodontic problems.
Baby teeth are important not only to chew correctly, but also because they are involved in the jaw and lower jaw growth, in the future and correct eruption of permanent teeth and they allow the child to correctly develop speech and phonology.
Cavities of baby teeth should not be ignored because they can cause infections not only inside the mouth, but in the whole body.
Cavities are mainly caused by wrong food habits such as sweet drinks taken through baby bottles or pacifiers dipped in sweet substances, used to calm down children.
Cavities appear like small demineralisations close to the gum of upper incisors, which can then cause small cavities and develop into bigger wounds and damage baby molars.
The care of a baby tooth is similar to the one of a permanent one, but we should keep in mind that a younger patient needs more attention and a more relaxed environment that make him/her feel at ease.
Why to treat deciduous teeth? Read more
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Can hypersalivation and pain caused from baby teeth eruption be kept under contro
Increase in salivation during baby teeth eruption is absolutely normal and can only be limited with a regular mouth cleansing and tamponade.
During this time gums might be swollen and hypertrophic. To placate the pain caused by the eruption, we can use some games which should be put in the freezer to refresh the liquid they have inside and, once in contact with the mouth, they act as pain relievers.
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How and when gums and teeth should be brushed
When the child is just a few weeks old, it is important to clean the gums and tongue with a humid gauze at least twice a day.
Once the first baby tooth has erupted, it should be brushed with a small toothbrush with soft bristles. From this moment on, teeth will start to erupt and our child´s mouth is exposed to the risk of cavities. We will therefore have to pay much attention to his/her oral hygiene and avoid giving him/her baby bottles containing sweet drinks or pacifiers dipped in sweet substances when put to sleep. This is a good way to avoid cavities, especially those on upper incisors and molars.
At the age of 4, the space for permanent teeth is formed and maxillary bones start their development and increase.
At the age of 6-7, the first baby teeth fall out and make room for permanent ones.
The two central-lower incisors will fall out, followed by the two lower incisors and, almost simultaneously, the first upper and lower molars.
When our child is changing teeth, he/she can present deciduous and permanent teeth at the same time.
Request the guide on dental hygiene for 0-3 years
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Can dentition correct on its own during growth?
No, it will not correct on its own because the room available for anterior teeth does not usually increase much with growth and sometimes, when molars erupt, there is not much room left for other teeth.
Moreover, forces exercised on the teeth by the tongue and the lips, can influence their position, which has to be evaluated by the orthodontist and also by a speech therapist. The child, indeed, may present possible swallowing impediments or problems linked to the position of the tongue at rest and/or during diction.
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What are dental sealants?
The surface of molar teeth presents deep cracks where food and bacterial plaque collect and cause cavities.
Dental sealants are made of a special white-transparent resin which releases fluorine ions and close natural cracks, protecting teeth in a rapid and painless way.
Since not all cracks are at the risk of cavities, your dentist will be the one to tell you if it is necessary or not to seal your child´s teeth.
This operation is usually done on permanent teeth which have just erupted and does not require anesthetics nor the use of a drill. The child will not feel any difference when chewing.
Dental sealings last many years, but need to be kept under control to avoid the formation of cavities.
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Traumas or severe pathologies involving the oral cavity
Traumas can cause teeth to break or come out of their natural position and even the fracture of structures supporting them. If this is the case, we advice you to go to the nearest hospital. If the trauma is violent, you should contact both your pediatrician and orthodontist, so that they can consider the trauma´s consequences on the child´s growth.
If a permanent tooth comes out of its position, we can try to save the ligament´s fibers which, otherwise, die very rapidly. In this case, we proceed with an immediate reimplant which means manually inserting the tooth in its natural position.
Before doing this, we need to clean the wound and remove possible remains which can cause infections and carefully rinse the tooth with lukewarm water, without ever touching the root and the delicate fibers.
After the reinsertion, it is important to immediately go to the dental office where the tooth will be anchored to neighboring teeth in order to resettle.
If we want the dentist to reinsert the tooth, we need to dip it in a physiological solution or in milk, in order to maintain hydration and avoid the root fibers to die during their rapid transport to the dental office.
Its conservation in a physiological solution or milk is necessary if a tooth fragment breaks.
If the trauma involves baby teeth, they cannot be reinserted since it would damage the gem of the permanent tooth already present underneath the baby one.
In these cases, we can apply a sterile gauze to contain the bleeding and ice to kill the pain.
If a baby tooth with exposed pulp breaks, the pedodontist will depulp the tooth by keeping it in its position until its natural substitution. This will enable it to create the necessary space for the permanent tooth.
Read the article dedicated to Dental Accidents
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What is a space mantainer and what is is used for?
It is an appliance used to maintain the space created from a baby tooth loss which, if fallen out in advance, makes its corresponding permanent tooth lose its guide, letting neighboring teeth incline or moving in a wrong way and therefore blocking the eruption.
The mantainer can be fixed or mobile and is made of steel and/or plastic. It can also host an artificial tooth to close the empty space left from the lost tooth.
Its use is monitored by the dentist who periodically carries out check-up X-rays and provides for its removal, once the permanent tooth is ready to erupt.
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What are the symptoms of celiac disease in the oral cavity?
The celiac disease usually causes the flattening and disappearance of the villuses of the small intestine.
The reaction is caused by the assumption of gluten, a protein-based complex present in many cereals (wheat, spelt, barley, kamut etc…).
The celiac disease presents various symptoms: diarrhea and vomit are common, but there are other symptoms which should not be ignored. Among these are specific clinical signs of the oral cavity. The most obvious ones are mainly one involving the lingual papillae of the tongue, that is the presence of areas without papillae on the tongue and which give it the aspect of a “geographical map”. Another symptom is the recurring aphthous ulceration, which appears with a circular erosion of the internal mucosa of the mouth, and the hypoplasia of the dental enamel which occurs with a chromatic alteration (spots) or alterations in the tooth surface (stripes).
If present, these symptoms should encourage the orthodontist to proceed with further analyses.
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What are the symptoms of diabetes in children?
Regular dental check-ups are important to intercept and treat diabetes in advance, thanks to the analysis of the saliva, teeth and gums, especially in patients not already diagnosed.
In cases of diabetes, the child should undergo oral check-ups more often because the reduced salivary flow and the thicker saliva increase the risk of dental cavities, compared to patients not affected by this pathology.
We should also consider that having frequent meals during the day is associated to a higher risk of inaccurate oral hygiene and a higher presence of tartar. This damages the tissues around the teeth and causes frequent inflammations of gums and papillae. If not taken care of in time, they can develop into severe periodontal diseases.
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There are some spots in my child´s mouth. What are they and what should I do?
They are spots caused by a common infection called thrush and due to the hyperproduction of the “candida albicans” yeast.
It is usually present in our mouth and stomach and is maintained at normal levels from our immune system which, if weakened by a disease or by antibiotics, causes the reddening of the mucosa, associated to a painful feeling and the appearance of whitish formations on the reddened tissue. These can be easily removed with a sterile gauze.
Spots tend to appear on the palate, on the sides of the mouth and sometimes on the tongue and they normally affect children under six months.
Symptoms disappear in one or two weeks, but it is always advisable to contact both the pediatrician and the dentist.
Other times there might be small black spots on every teeth of the dental neck, which is the nearest enamel part to the gum.
They are due to bacterial pigmentations which can be kept under control with mouthwashes containing chlorhexidine and regular oral hygiene sessions. They tend to disappear with growth.
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Can the space between central incisors be reduced?
The diastema, meaning the gap between central-upper incisors, is very common during growth.
Once permanent cuspids have erupted, it closes by itself. If this does not happen, we need to intervene orthodontically.
If the diastema is caused by the upper labial frenulum, that is the tissue between the gum and the inner part of the upper lip, we need to intervene surgically in order to remove it and allow incisors to get close.
The gap can sometimes be caused by the inferior size of upper incisors, mostly lateral ones, and can be fixed using dental facets or crowns.
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What are sleeping disorders in children and what do they cause?
In the last few years, much importance has been given to sleeping disorders in children, especially during preschool. These are episodes of decrease in the air flow which occur during sleep and are mainly caused by an obstruction of the air ways. This pathology is called Obstructive sleep apnoea syndrome (OSAS).
There are children who regularly snore and others who do it discontinuously, but some among these present a real decrease in the air they breathe. The causes are: tonsillar and adenoid hypertrophy, allergies and malocclusions.
Besides snoring, children present other symptoms which can be divided into nocturnal and diurnal.
Nocturnal ones:
- disturbed sleep
- sweating
- enuresis (bedwetting)
- bruxism (teeth grinding)
Diurnal ones:
- restlessness
- headache
- loss of concentration during school hours
The diagnosis is sometimes expressed by the pediatrician, other times by the otolaryngologist or the dentist-orthodontist.
The orthodontist always asks the otolaryngologist a special consultation. He/she can intervene by suggesting to remove tonsils and adenoids in severe cases or to proceed with specific pharmacotherapies.
How can the orthodontist intervene in sleeping disorders?
By doing a working plan together with the otolaryngologist. If the palate is narrow, it can be expanded through an appropriate appliance (rapid palatal expander) which will also increase the air flow passing through air ways. If the lower jaw is very backward, we can correct its position through removable appliances.
How can the pediatrician intervene in sleeping disorders?
By asking the otolaryngologist and the orthodontist a special consultation and, in more severe cases or if she/has doubts, by sending the patient to asleeping disorders center. This is a place where the child can get more specific and in-depth examinations, such as polysomnography.
