Children's dentistry up to what age according to the law. Pediatric dentistry: important points

When is the first time to go to the dentist? Is dental fluoridation effective? Do milk teeth need to be treated? Answered these and other questions dentist, head of the children's dental department of the medical clinic "Akvus", and simply the favorite dentist of many little Nizhny Novgorod residents - Evgenia Olegovna Panasenko.

1. Evgenia Olegovna, tell me, at what age should the first visit to the dentist take place? How will the first teeth appear in a baby or already at the first complaints? When do you need to check the frenulum of the tongue?

The very first reason to visit a pediatric dentist should be to check the frenulum of the tongue. Usually this is checked immediately after birth in maternity hospitals or at one of the first appointments with a pediatrician. If this did not happen, then parents themselves need to take the initiative and pay attention to this moment - with a short bridle, the tongue simply does not rise up and this can prevent the child from taking the breast normally.

The dissection of the frenulum of the tongue is best done up to 3 months, because during this period it is a thin film without any blood vessels and nerves. From the age of 3 months, the risk of bleeding increases due to the interweaving of blood vessels, so many clinics do the dissection already under general anesthesia. It is better to avoid this and make a dissection on time.

If the bridle does not interfere with the feeding of the child, then the next moment when this defect may appear is the age when the child begins to speak, since a short bridle disrupts the pronunciation of the sounds r, l, sh. In this case, the frenulum is dissected already at the age of 6, when the jaw changes, permanent teeth appear.

The next examination by the dentist should be done when the four upper central incisors appear to see what the quality of the teeth is. It is approximately, 1.5 - 2 years.

2. Evgenia Olegovna, what are the main reasons for the development of caries in milk teeth? A common situation is that the teeth have just come out, you look, and there are already black spots on them. What is the reason?

One of the first causes of caries can be misaligned teeth during pregnancy and, as a result, "bad enamel". It is immediately visible - it is either bright white or yellow.

Night feedings, even if it is breast milk, no matter how strange it may sound. Most often, a child’s teeth appear even during the period of breastfeeding, the child receives breasts when he wants, and especially at night, because mommy wants to sleep. And I'm not at all against breastfeeding, but moms should know that frequent nighttime feedings cause the same damage to tooth enamel as nightly supplements with juice, tea, anything but water. Pathogenic flora develops in the child's mouth, an acidic environment is created, which very quickly "eats" the still weak enamel of children's teeth. The situation is especially aggravated if mommy eats carbohydrate food at night.

To prevent the early development of caries, night feedings should be reduced to a minimum, and even better, they should be replaced with water. In no case do not offer the child juices, teas and other drinks. Only water. If it is not possible to remove the feeding, then try to feed the child reclining and after feeding wipe the baby's teeth with a bandage with any paste (quite a bit), this will prevent the microflora from developing.

Of course, not all children have night feedings that cause tooth decay. It must be remembered that all children are different, and if night feedings did not harm one, then another may lose teeth because of them.

Food is also one of the main reasons. After all, what modern children eat: rolls, waffles, breakfast cereals, chips, sweets with soft caramel - refined, soft, sticky, sweet food. In the diet of children, there are practically no foods that need to be gnawed - whole apples, carrots. And this is important for the development of the jaw.

Poor dental hygiene- a very important point. It is necessary from early childhood to teach children to brush their teeth, especially at night. When the baby still cannot brush his teeth, the simplest thing is to wrap a bandage, squeeze out a little paste and wipe his teeth. All these silicone brushes only stroke, I don’t believe in them and I prefer to use a bandage in the old fashioned way, because it has a porous structure.

The causes of caries, poor condition of the teeth can be the frequent use of antibiotics, anesthesia.

3. Of the existing caries treatment methods, which are the most effective? Why are fluorination and silvering procedures necessary?

Silvering- This is a procedure in which I do not see the point. There is no result from it, except for black teeth and psychological trauma in a child who will then be teased for these black teeth. The only positive thing is that mom is at least a little reassured that she did something.

Concerning fluorination. On every children's toothpaste they write - does not contain fluorine - for some reason they write it? For what? Fluorine is a highly toxic substance that tends to accumulate in the body, it is harmful to children. In the Nizhny Novgorod region, there is no lack of fluorine, unlike the same iodine, for example, therefore, our body does not need additional fluorine.

And to be completely honest, how can you believe that they anointed your teeth with some kind of composition and everything became fine? You should always look for the cause and eliminate it, and not smear your teeth with incomprehensible compounds.

I am for sealing- the good old method that has proven its effectiveness. The meaning of this procedure is that a special composition, an analogue of tooth enamel, is applied to the cleaned fissures (grooves on chewing teeth). By doing this, we seal the tooth and prevent food debris from clogging into it. This procedure is done as soon as the 6th teeth erupt. Although, this procedure can be done for milk teeth.

However, it must be understood that sealing protects teeth only from masticatory caries, it is impossible to protect a tooth from contact caries (the one that develops between teeth). Therefore, as soon as they saw something incomprehensible on their teeth, they ran to the doctor. Early caries develops very quickly.

4. What are the signs of early caries? A small brown dot - is this already caries?

The point is already caries, and not even early. Early caries is a white strip near the gum, which is slightly brighter in color than the main tone of the tooth. As soon as you see something like this - do not hesitate, make an appointment with a doctor.

Early caries is very easy to cure, it's a matter of a few minutes. But we have such intimidated parents that they are pulling to the last, when all the teeth are already with pulpitis. And treating pulpitis in children is not the same as treating it in adults. In case of acute pain, you can give any dosage of an anesthetic to an adult, and a strictly age-specific dose, which is calculated per kg of weight, to a child. And if, for example, a child has a toothache for two days, then an adult dosage is needed to freeze the tooth. No doctor will take responsibility, because the reactions are different, up to the most serious.

As a result, it turns out that mom was afraid that the child would be hurt, she missed the time, and when they came to the dentist, you can’t do normal anesthesia anymore. It is better to come right away, especially since the examination of the dentist is free in the largest clinics in the city! Take the time to bring your child in for a checkup. This will save you money and nerves, yours and your child's.

5. Do milk teeth need to be treated? They still fall out..

To begin with, I would like to dispel the myth that milk teeth do not have nerves. This is not true. There are nerves, and roots, and in general they are the same teeth as permanent ones, with the only difference being that the roots dissolve over time. And the pain from a sick tooth, children experience the same as adults.

Now imagine - the fifth, the largest milk tooth, resolves only by 10 - 11 years. He needs to stay until this age. And if for some reason the tooth had to be removed earlier, then the 6th tooth (already permanent) will take the place of the missing tooth, and when the time comes for the fifth permanent tooth, there is no place for it, it goes to the side and it is removed. The situation is the same with the upper central incisors - the permanent incisors are larger, so they stand unevenly. Parents come running in a panic and ask to remove neighboring teeth. Under no circumstances should this be done! The jaw will grow and the teeth will fall into place. Each tooth has its own function and should fall out when it is supposed to.

6. At what age does the change of milk teeth to permanent teeth begin?

Girls and boys do this at different times. In girls, at the age of 5-5.5, the lower central incisors begin to erupt, in boys - at about 6.5. I want to draw the attention of parents to the fact that in 70% of cases the central lower incisors change in such a way that permanent teeth appear behind milk teeth that have not yet fallen out. You don't need to be afraid of this. The reason is that the size of the permanent teeth is larger than that of the milk teeth, so it is easier for them to erupt behind the teeth. Then the milk teeth fall out or are removed if necessary, and the permanent teeth fall into place.

It is not necessary to delay the first visit of the child to the dental clinic: it is important that the acquaintance with the doctor begins not with treatment, but with a preventive examination - this is how you can lay the foundation for a long-term friendship.

For a modern children's clinic, all the little things are important: the presence of a comfortable playroom and a room where small patients can relax after treatment under anesthesia, a wide selection of toys - not simple, but dental ones, which will help to involve small patients and patients in the treatment process. Doctors and nurses in a children's clinic wear brightly colored overalls so as not to evoke unpleasant associations with a white coat in a child. Even the specific smells of medicines in the children's clinic are trying to be removed. An aquarium with fish, a TV with cartoons, coloring books and sketchbooks - all this will help the child to relax and feel comfortable. In a situation where a large amount of assistance is required, children undergo dental treatment in their sleep, for which the clinic has a full-fledged anesthesia room.

What is the difference between dental treatment for children and adults?

Of course, the main difference is the age of the patient. Children perceive any sensations very acutely, and one bad experience with a dentist can lead to the fact that it will be difficult to seat the child in a chair and persuade him to open his mouth. Therefore, the personality of the doctor is of great importance - the ability to establish contact with the child, to show genuine interest in him, attention to all the little things.

Dental treatment for children is carried out in a playful way, but at the same time, the doctor performs all the manipulations as quickly and painlessly as possible. In the presence of multiple caries and other problems that create a large amount of work, the doctor may recommend, in the absence of contraindications, to carry out. After all, even the most calm and sociable little patients get tired of sitting in a chair for a long time, which negates the positive impressions of visiting a dental clinic.

Baby teeth are another important difference between pediatric and adult dentistry. Parents are often mistaken that milk teeth do not need to be treated - they will fall out soon anyway (another version of this delusion: it is better to immediately remove a sick milk tooth - let a new one grow as soon as possible). In fact, the treatment and preservation of milk teeth is very important. Why?

Firstly, with the premature removal of a milk tooth, a shift in the dentition will begin: neighboring teeth will shift towards the missing one, and a permanent tooth may grow incorrectly. Secondly, under the milk teeth are the rudiments of permanent ones (they are laid even in the prenatal period), and deep caries that hit the milk tooth can go deeper and affect the permanent tooth.

Dental problems in children require an immediate response, as inflammatory processes develop very quickly: yesterday the child felt fine, but today he suffers from toothache and high fever. In this case, you need to contact the clinic for treatment as soon as possible, and not try to relieve the pain and temperature at home.

Prevention is the most important

For children even more than for adults, prevention is important: you need to visit at least twice a year, without waiting until the child begins to complain of a toothache. Timely detection of caries will allow you to avoid future problems with your teeth and carry out treatment quickly and painlessly.

Often, as a preventive measure, pediatric dentists recommend sealing fissures, protecting the weak enamel of the chewing surface of the teeth. Fissures - depressions, pits on chewing surfaces - become breeding grounds for bacteria. Thin enamel and the inability to clean these recesses with a brush and paste leads to the rapid development of caries.

In addition to carrying out preventive and therapeutic procedures, the doctor must teach the child how to properly care for the oral cavity. Parents often have questions about how to instill the right habits in their son or daughter - and a dentist will help here, who will tell you how to help your child learn to brush their teeth regularly.

A pediatric dentist is a doctor who specializes in the diagnosis, treatment and prevention of diseases and disorders of the teeth, jaws and other organs of the oral cavity and maxillofacial apparatus. Note that the pediatric dentist accepts children under the age of 14.

The work of a pediatric dentist involves examining the oral cavity, the condition of the frenulum and lips, identifying any pathological processes, assessing the hygienic condition of the teeth, monitoring teething, monitoring the implementation of recommendations.

What does a pediatric dentist do?

Mostly, a pediatric dentist deals with diseases and disorders such as:

Malocclusion;

If the child's chewing apparatus does not work enough;

Inflammatory processes of the gums and oral cavity.

How are teeth formed?

First of all, it is necessary to indicate that already at the 6-7th week of pregnancy, the fetus has an ingrowth of the epithelium covering the oral fossa into the underlying tissue, the so-called. parenchyma.

Two dental plates are formed, upper and lower, having the form of horseshoes. Flask-shaped epithelial growths form along the edge of these plates, ten on each plate, which corresponds to the number of future milk teeth. At this stage, pediatric dentistry without pain is possible.

Qualitatively different cellular elements differentiate from the initially homogeneous cells of the dental organ and the tissue that has grown into it, called the dental papilla. From the inner layer of the dental organ, cells (enameloblasts) are formed that are involved in the formation of enamel; odontoblasts are released from the dental papilla, and later - dentin. Around the dental organ and the dental papilla, a special membrane is formed from the mesenchyme - the dental sac.

Milk teeth begin to erupt at six months. This is a painful process for many children. The anterior incisors appear first. From the age of six, permanent teeth erupt, starting with the molars. Before the age of 25, a person should have a full set of teeth.

The edges of the dental sac continue to grow in depth, acquiring the outlines of a root. This process begins immediately before eruption and continues for about a year from the moment of eruption of milk teeth. As modern pediatric dentistry demonstrates, the bite in newborns is formed not by teeth, but by gums. The child is born, as a rule, without teeth; cases of intrauterine eruption are extremely rare.

By the beginning of the 2nd year of life, the child should have 8 teeth. At this stage, you need an appointment with a pediatric dentist - he will check the correct development of the child's teeth. By 2-3 years, the eruption of all 20 milk teeth ends. Having erupted, almost immediately the teeth begin to move a little to the sides. This is normal and is due to the growth of the baby's jaw and preparation for the eruption of large permanent teeth, while the milk teeth remain just as small.

Many parents have an incomplete and often incorrect understanding of pediatric dentistry. The reason for this is a few ingrained in the public mind and at the same time erroneous opinions. Let's look at just a few of these misconceptions and try to evaluate them.

MISTAKE N1: Milk teeth do not need to be treated, as they will be replaced by permanent ones anyway.

REAL: The quality of permanent teeth depends on the health of milk teeth. Most diseases of milk teeth can pass to permanent teeth, in which case by the time of eruption they will already be affected by diseases. Another problem is related to the incorrect location of milk teeth. This can lead to malocclusion later in life. In this case, the child will definitely have complexes that will negatively affect his formation and life in general. So you need to take care of your dental health from the birth of a child.

MISTAKE N2: Children's teeth can be cured by any dentist, therefore, in case of problems, it is not necessary to contact a pediatric dentist or a specialized children's dental clinic.

REALLY: Pediatric dentistry is a separate dental field that takes into account all the characteristics of the child's body. When working with children, dentists use completely different tools, materials and medicines. Pediatric dentistry is many times painless, and this is its advantage. In addition, not every dentist can work with children. In general, the requirements for pediatric dentists are much higher, because in addition to excellent knowledge in the field of dentistry, he must also be an excellent psychologist in order to easily find contact with a child, and carry out treatment without pain and blood. This is extremely important for children, especially in psychological terms. After all, if the first visit to the dentist did not cause him any unrest and pain, in the future he will visit the doctor very calmly. This approach has long been practiced in the developed countries of the world, where visiting a pediatric dentist has become something like a holiday. Before going to the doctor himself, children play with toys, communicate with other children, watch cartoons, draw and read books, and receive nice gifts. The treatment procedure itself also does not cause any particular problems, since for drilling teeth they do not use a drill, but a completely painless and silent laser. The same applies to pain relief, for which application anesthesia is used, for example, a safe and effective lidocaine spray. A child leaves such a clinic with good emotions, healthy teeth and a new toy in his hands. Such a child will visit the dentist without a shudder all his life, carefully follow all his recommendations and take care of his teeth.

MISTAKE N3: Carious teeth of children should not be treated, it is useless. It is better to immediately remove them so that permanent ones appear in their place.

REAL: It has long been proven that the early extraction of milk teeth leads to serious problems. First of all, this concerns the difficulties associated with the eruption of a permanent tooth. The fact is that after the removal of a tooth affected by caries, neighboring teeth begin to move from their places, trying to fill the empty space. In this case, the permanent tooth may erupt in the wrong place. This is fraught with the fact that at a more mature age it will be necessary to correct the incorrect bite of the child. The absence of milk teeth has an extremely negative effect on chewing food. In addition, the development of bite, facial skeleton, diction may be disturbed, and cosmetic defects may form. That is why doctors believe that children's caries must be treated.

MISTAKE N4: Children's teeth cannot be filled with composite materials.

REALLY: That's not true. It's just that in many of our dental clinics there are not enough conditions for the child to sit in the chair for the necessary time and allow the doctor to carry out the treatment normally.
This is possible only in specialized children's clinics, where treatment is combined with play, and modern composite materials are used for filling, which are durable, hygienic and at the same time aesthetic. If necessary, nitrous oxide is also used - an oxygen mask. All these technologies allow the child to relax, and help the doctor to heal the tooth qualitatively. If all the necessary conditions are met, it will be easy for the child to put crowns and / or accurate removable dentures.

MISTAKE N5: If you scare a child with a dentist, he will take better care of his dental hygiene.

REAL: One of the biggest misconceptions, bordering on stupidity. If you do this, then the child will take the fear and negative attitude towards the dentist into adulthood. On the contrary, it is necessary to instill in the child that visiting the dentist is a harmless and even pleasant experience. This is done in many countries of the world, where the problem of fear of the dentist has long been resolved. In these countries, dental treatment is a very expensive treatment. Therefore, people there are well aware that dental diseases are much easier and cheaper to prevent than to treat later. Therefore, children there are not scared by dentists. In our country, such behavior of parents, unfortunately, is still considered quite normal. However, if you look at the root of the problem, in our country it is often not the parents who are to blame, but the dentists themselves, who, during the first visit to the child, caused him pain and instilled hostility. In this case, it is immediately necessary to change the dentist. Ask your friends and acquaintances about specialists in pediatric dentistry. Make sure that this is a good specialist and only then entrust the health of your baby in his hands. Remember, in early childhood, a negative impression of a visit to the dentist can be changed into a positive one, but when the child grows up, this will be almost impossible.

MISTAKE N6: Treating a child's teeth in a specialized children's clinic is too expensive.

REAL: At first glance, this is true. But only if you do not consider how much money and time you and your child will save in the future. What if, as adults, your son or daughter will have a panic fear of the dentist and turn to him only when it is simply impossible to resist the pain? How much will the forced visits to the dentist cost him then? It can be easily calculated that the amount will be many times more than the prevention and treatment of a child's teeth in a specialized clinic, where he will not experience any excitement or fear of the doctor.

MISTAKE N7: It is not necessary for a child to brush his teeth with a special toothpaste, any will do.

REAL: Baby's teeth must be cleaned with special children's pastes, which are designed specifically for milk teeth. These pastes have a pleasant taste, but the main thing is that they contain a protective mineral composition.
You need to start brushing your child's teeth from the moment they erupted. First, use a silicone brush on your finger for this, and then, closer to a year old, you can use a special children's toothbrush in the form of a toy. Such a brush has both gentle bristles and the required size, and the toy will help to amuse the child. But the most important thing is to teach your child to brush their teeth every day in the morning and in the evening and do it correctly.

MISTAKE N8: It doesn't matter how well a child eats, the main thing is that he eats enough.

FACT: Improper nutrition is one of the main causes of dental diseases in childhood. To avoid such problems, immediately after the birth of a child, parents are obliged to do everything so that the child eats mother's milk. Breast milk is the most valuable source of nutrients and protective substances. But even more important is the way in which the child receives it. To do this, he makes a lot of efforts, and this, in turn, has a huge impact on the growth, development and formation of the child's dental system.

In general, dairy products are extremely important for the development of the child's body, as they supply him with calcium - the main element of teeth and bones. So dairy products should always be in the child's diet, especially until they reach the age of three, when the laying and formation of the rudiments of permanent teeth is completed. By the way, there is another common mistake parents make when a child is fed with sweet mixtures or juices, especially at night and during the night. This can lead to caries in milk teeth. Therefore, this should not be done under any circumstances.

MISTAKE N9: A child should only be taken to the dentist when they develop toothache or other dental problems.

REAL: This is a terrible mistake, fraught with serious problems. For the first time, the child should be taken to the dentist no later than the first birthday. In the future, if the child does not have problems with his teeth, it is recommended to make preventive visits to the dentist 2 times a year, but if the child has such problems, this should be done once every 3 months or more often, as prescribed by the doctor. In this case, all problems and diseases will be eradicated in the bud. Indeed, in childhood, pathological processes develop very quickly, and their early diagnosis will allow for a simple, quick, painless and inexpensive treatment. In addition, preventive examinations of the teeth do not cause a feeling of fear in the child, as the child realizes that he has nothing to be afraid of.

MISTAKE N10: The best treatment for bottle caries is silvering.

REAL: The effectiveness of the method of silvering teeth has not been proven during extensive dental research. Most dentists rightly believe that teeth silvering for children should be used only when the dental clinic is not equipped with modern equipment and technologies. The fact is that silvering is effective only with superficial caries. If caries has already penetrated the inside of the tooth, silvering will not be able to help, as caries will continue to destroy it from the inside. Another disadvantage of this method is that it is not aesthetically pleasing: the silver gradually begins to blacken, and very soon the child begins to complex because of his smile. Modern medicine has developed many alternative methods to prevent tooth decay, so it is not surprising that many dental clinics have abandoned the silvering of milk teeth.

MISTAKE #11: Children shouldn't get crowns on their front teeth because it's pointless.

REAL: Perhaps a few years ago it was true. In the case when the tooth was significantly destroyed, it was proposed to remove it or seal the root with cement. For a long time, medical scientists have been struggling to create a method for saving and restoring destroyed front teeth, because, as we have already said, tooth extraction further negatively affects the development of the dentition and diction of the child. And so, quite recently, a solution was found: if the tooth root is preserved, it can be saved with a crown. Often this is the only chance to save a diseased tooth and extend its life. To date, this is the most reliable way to save a child's teeth until they are replaced by permanent ones. The very fact that a child will be able to fully bite off food and will not be embarrassed by his smile speaks of the advantage of this method, which is already used in all the leading dental clinics on the planet. At the same time, preference should be given to metal-ceramic crowns, which are not only durable, but also outwardly indistinguishable from the surrounding healthy teeth.

MISTAKE N12: The period of teething in babies is always accompanied by fever, anxiety, indigestion and other factors.

REAL: For many children, teething is painless. But most still have short periods of irritability, soreness, sleep and eating disorders. It is very rare that this process is extremely painful for the child. In the event of such a relapse, parents should consult a pediatrician or pediatric dentist. As for a slight increase in temperature in a child, it can be caused by swelling of the gums through which teeth are cut. However, the process of teething alone does not cause significant fever or indigestion. So if these symptoms appear, it is also recommended to consult a pediatrician, as it is quite possible that they are caused by something else.

MISTAKE N13: The correct bite of a child should be dealt with when he completes the change of milk teeth to permanent ones.

REALLY: Correct bite of the child should be addressed from the very minute when you notice the problem. Do not think that the wrong bite creates only cosmetic problems. It can also cause much more serious problems - damage to the teeth, their supporting apparatus, gums. The fact is that crooked and crowded teeth are more susceptible to diseases that are fraught with their loss, since such teeth are extremely difficult to clean. In addition, other problems threaten such teeth: increased abrasion, inefficient chewing, additional stress and diseases of the jaw joints that cause chronic migraines, pain in the face and neck, as well as problems with the gastrointestinal tract and breathing. Modern dentistry makes it possible to eliminate bite problems at any age. However, dentists recommend doing this in childhood, as this process takes much less time in children. It has been proven that children are much easier to tolerate the presence of orthodontic devices in their mouths and are not shy, and often even proud of their multi-colored braces in the form of animals or stars. The best age for a preventive examination of a child by an orthodontist is 6-7 years. It is at this age that the first permanent teeth erupt. From them it is already possible to determine whether the child will have malocclusion. If there is a problem, the orthodontist will find ways to influence the direction of tooth growth, correct the rate of development and the size of the jaws.

MISTAKE N14: Orthodontic appliances disfigure the child's appearance.

REAL: Once it was really so. But now dentistry offers several options at once to solve bite problems. This may be a removable plate, which is usually used between the ages of 6 and 10 when the bite is forming. It can also be special kappa trainers that prevent malocclusion. Outwardly, they look like a boxing splint, but they are completely transparent. Mouthguards are used at the age of 6 to 15 years. Children usually wear a mouthguard during the day for 1.5-2 hours. At a more mature age, at 11-12 years old, when the formation of the tops of the roots is completed, orthodontists recommend using bracket systems to correct the bite.

MISTAKE N15: Bracket systems are the subject of ridicule of peers and others.

REALLY: Dentists have long stopped using bulky and ugly braces. Modern braces are so cute and diverse that children and teenagers wear them with pleasure, without fear of ridicule from their peers. Bracket systems are small locks that are glued to the teeth from the outside or inside. These locks are connected to each other by a thin metal arc that has a shape memory and takes on its original state, no matter how it is bent. Today, a child can choose the color of his braces himself, since it is very easy to paint it in any color - from transparent to multi-colored. In addition, another advantage of braces is that it can contain figurines loved by the child - animals, toys, patterns. By the way, braces are made from different materials and therefore have a different appearance and different degrees of effectiveness. Among the variety of metal (steel), plastic, sapphire (made of artificial sapphires) and ceramic braces, dentists prefer metal braces, as they are both high quality and inexpensive. The most recent medical developments are translucent and very effective braces, which are even smaller than traditional ones and therefore much less noticeable on the teeth.