Regular Teeth brushing is the most effective way to prevent caries and gum disease In adults and children. You should start brushing your kid’s teeth once the first tooth erupt around 6 months. and you should continue to supervise your child during brushing till 7 years age to avoid too much ingestion of toothpaste that contains fluoride. Remember good oral hygiene is the master key to a happy and  healthy kid.

So here are some advices that will help:

1-when to start??

some authors say that no brushing is needed in the first year you just has to wipe your baby’s teeth with a wet gauze after feeding  but many oral hygiene and pediatric dentistry text books says that  You should start brushing your kid’s teeth once the first tooth erupt around 6 months and i agree to this opinion as we saw many cases where caries start just after this first year . Also  you should continue to supervise your child during teeth washing  till 7 years age to avoid too much ingestion of toothpaste that contains fluoride.

2-child should brush twice daily with fluoride containing toothpaste (the selection of the fluoride concentration in the tooth paste will be discussed later) . Also routine kids oral hygiene should include flossing that we will discuss later on a separate post.

3-how to choose your child’s toothbrush??

first the brush should be soft brush not hard (you will find that written on the package) also the brush size must fit your child’s age as using large brush will cause discomfort to your baby and also will prevent you from brushing properly also using very small toothbrush will make the process takes much longer.

last thing you should find a toothbrush that you kid likes, usually kid’s tooth brushes have painting and decoration on it’s handle so let your kid choose what he likes as this will make it fun when he use it.

4-How to choose your child’s toothpaste??

we have two main important factors here fluoride concentration and taste.

fluoride concentration is very important  as topical use of fluoride is proved to help in the prevention of teeth decay also too many fluoride ingestion can cause fluorosis that may make the teeth pitted and discolored. so it is very important to choose the toothpaste with the appropriate fluoride concentration. For children under 6 years the tooth paste should contains 600-1000 ppm fluoride concentration according to the caries risk (children with multiple cavities and fillings or children from families that suffer from caries problems should use 1000ppm toothpaste ). children above 6 years should use toothpaste with fluoride concentration 1000-1500 ppm according to the caries risk.

You should also choose toothpaste that has a good taste and smell and let your child choose the flavor he likes as this will make it much easier to let him used to tooth brushing.

5-Choose the position that make you and your child feel comfortable during the  process i prefer to stand beside or a little behind my Childs.

6-how much toothpaste you need??

put a very small amount (smear or pea size blob < 0.3 ml ) of the toothpaste on the brush bristles. Remember using too much toothpaste can be harmful and may cause teeth discoloration and roughness as the child may swallow much fluoride containing toothpaste.

7-Duration and how to brush:

the process should take from 2.5- 3 min to assure complete plaque removal 2 thirds of the  time to the posterior teeth and one third to the interiors . a short forward and backward or circular movement should be used to clean the chewing surface of molars. To clean the tongue side and lip side of the teeth the toothbrush should be 45 degrees to gum line and use short gentle circular movement and you should concentrate not to hurt the gums or push it down.  Remember each millimeter of every tooth should be cleaned so don’t neglect un accessible hard to reach surfaces. you may also brush your kids tongue very gently.

8-After finishing the process you kid should rinse his mouth gently (not to take all the fluoride away ) and you should rinse the brush completely.

last thing you should give your kid the chance to help as this will make him happy and get  used to tooth brushing.

thanks for reading,

Dr A. Galal

choosing between extraction and filling or conservation is a very common decision that both dentists and patients have to take every day. With adults the decision making is much more easier, if the tooth is restorable and the patient can pay for the treatment then we simply conserve the tooth. If the patient is a child then the process of decision making is much more harder as many factors affect the selection of the treatment plan that the dentist have to follow.

1-Child’s age:

This factor is very important as it well judge the cooperation of the child during treatment process so the cooperative patient is giving more chance to the success of lengthy treatments like filling or even root canal when uncooperative patient may drive the dentist to extraction.

2- The time left for the tooth to come out or shedding:

The dentist here estimate the time left for the milk tooth in the mouth by considering the normal eruption time averages and also the eruption time variations of your kid. Some kids tend to change their teeth earlier of later than normal and this should be taken in consideration when the dentist calculate the estimated of the milk tooth left.

if the dentist estimated that the permanent tooth needs only 6 months or less to come out then it would be better not to waste money and time in filling or root canal.

We have to know that premature extraction of the milk teeth will result in less effective chewing also may cause malalignment or crowding in the permanent teeth which will need an expensive orthodontic treatment after that.

3-General medical state of the child:

If the child suffer from generalized medical illness this may change the treatment plan dramatically. For example if the kid suffers from cardiac disease or the immunity of the child is compromised for any reason like uncontrolled diabetes etc. The recurrence of infection here should be avoided so extracting the affected tooth with a antibiotic coverage may be better than performing deep filling or root canal treatment that may fail and cause recurrence of infection.

In other cases if the child suffers from diseases that affect blood coagulation (like hemophilia ) then the extraction should be avoided and we should try to conserve the tooth till it fall out or shedd normally to avoid the risk of bleeding after extraction.

4-Parents insistence:

Most of the parents of our patients have a good knowledge about problems of early extraction of milk teeth but sometimes we meet parents who insist in extraction and keep saying “the tooth will fall naturally any way in a year or two why should i spend money on it ” In many of this cases the dentist will just pull the tooth as he feels that the patient is not believing what he say about early extraction.

5-Number of decayed milk teeth:

If the child has only one carious tooth then we should conserve this tooth and his mouth clean. But if we have extensive caries allover the mouth sometimes we have to sacrifice some teeth to keep the treatment plan affordable and realistic. The very common decision here is to extract the first milk molar and conserve the second milk molar as the first milk molars tend to cause less problems when extracted early.

6-The degree of tooth destruction:

simply some teeth are too late to be fixed

7-position of the tooth:

Although loss of first incisor will have less effect on permanents alignment, loss of canines or molars will lead to more problems especially in patient with a crowding susceptibility .

8-orthodontic consecrations:

Many times the orthodontist can give an order of early extraction or insist on keeping a tooth that may require lengthy treatment to avoid serious orthodontic problems in the future.

last thing we have to say that early extraction of deciduous teeth can cause really bad problems in permanents alignment or even affect the child’s chewing and psychology. so take your time to think before pulling the tooth

Before any thing we have to say that these cases need to be managed by the pediatric  dentist  as soon as possible in a matter of minutes if possible so don’t waste time don’t wait an appointment with a busy dentist just find the nearest and the most available one.

Causes of teeth trauma and breaking in children:

Teeth trauma begins when child is able to move and run. So it begins about 18 m of age.causes includes toddlers trips and falls,older children bicycle accidents and school fights even contact sports in early teenagers.

Trauma in children can affect both milk (primary) and permanent teeth prognosis and treatment differ according to wither the traumatized tooth is permanent or milk teeth .

First we have to know what is milk teeth. Milk teeth is temporary teeth which is replaced later by others (permanent teeth)

Trauma to permanent teeth in children:

Trauma can break the child the tooth  in different ways

• Breaking can happen to tooth enamel (external layer of tooth hard material) only.
• Breaking in tooth enamel and dentine(the internal layer of tooth hard material) without pulp(tooth nerve) exposure.
• Breaking in tooth enamel and dentine(the internal layer of tooth hard material) with pulp(tooth nerve) exposure.
• permanent child tooth root breaking.
• permanent child Tooth traumatized but not loosened.
• permanent child Tooth move little in it’s place without getting out.
• Tooth is knocked out from the mouth(avulsed).

So the case management depend on he degree and position of fracture

If the traumatized child tooth remain in place:

Rule of mother in broken or loosened child tooth :

1-Don’t panic it will be treated with no problems at all.

2-Try to visit your dentist as soon as possible(matter of few hours) any delay can cause the tooth pulp( nerve )to die which will cost more time and money.

what will the dentist do to treat broken tooth:

Role of pediatric dentist:

Immediate treatment:

The dentist will relief the pain first then if the fracture is within the dentine or exposing the child tooth nerve the dentist will try to protect the pulp by covering it with special therapeutic material .

If there is any lip tongue or cheek wounds the dentist will have to suture it .

Fixation of mobile teeth if present.

Intermediate treatment:

If the tooth pulp is affected the dentist will have to perform root canal treatment of the broken tooth.

Permanent treatment :

crown, replacement of the lost teeth, orthodontic therapy to close the spaces or removable or fixed prosthodontics.

If the broken tooth is AVULSED (the tooth knocked out completely with its root  ):

Role of mother in case of avulsed tooth of the child:

1-put the knocked out child tooth quickly in milk or normal saline  without touching the root(to conserve the cells that present on the root surface from dying )

2-You have to reach to the dentist in less than 30 min- 1 hour maximum to give him a chance to reimplant the tooth in place again if the knocked out child tooth is reimplanted in more than 2 hours the reimplantation will probably fail.

Role of the dentist:

The dentist will just place the tooth in its place again and fix it in any way giving the tooth a chance to heal. then may be the tooth will need root canal treatment afterwards.

Trauma or breaking of child milk (primary) teeth:

The main concern here is to protect the growing permanent  tooth germ that is located just behind the milk teeth root. The injury to child milk teeth due to trauma is usually pushing of the tooth inside into bone, or the tooth knocked out completely out of the mouth or child tooth loosened

the treatment in that cases is usually extraction if the x ray show that there is a problem close to the permanent tooth germ . If the permanent tooth germ is away from the root then the case should be left with no interaction and the dentist have to check the case periodically till the milk tooth is replaced by the permanent one .

The author

MY LOVELY WIFE

Dr R. Nagaty

pediatric dentist