Pediatric Dentistry is a dental specialty that concentrates its attention on infants and children providing preventive and therapeutic oral health care. During the "growth" phase of a child, special approaches are needed to guide the dental growth and development in order to avoid future dental problems.

A common question that parents ask is “why spend on the maintenance of milk teeth when they are to be finally replaced by the permanent ones?”

Milk teeth are as important as the permanent ones because

• Baby teeth are important in proper feeding and nutrition.

• Milk teeth serve as space maintainers for the proper spacing and alignment of the permanent teeth.

• Healthy milk teeth are crucial in helping the baby learn how to speak properly.

• Healthy looking teeth are important in building self-confidence at an early age. Small children because of immaturity are quick to tease peers about ugly looking or decayed teeth.

Baby Bottle Tooth Decay (Nursing Bottle Caries): The term describes a dental condition which involves the rapid decay of many or all the baby teeth of an infant or child. The teeth most likely to be damaged are the upper front teeth since they are the first teeth to erupt and thus have the longest exposure time to the sugars in the feeding bottle. The lower front teeth tend to be protected by the tongue as the child sucks on the nipple of the bottle or the breast.

Baby Bottle Tooth Decay is caused by long exposure of a child’s teeth to liquid containing sugars generally when the baby falls asleep with a bottle containing milk or juice or a pacifier dipped in honey. The liquid pools around the front teeth. During sleep, the bacteria living in every baby’s mouth, turns the milk sugar or other sugars to acid which causes the decay.

By the time the condition is noticed by the parents it may be too late and extractions of the decayed teeth may be necessary. As a result, your child may suffer from long term disorders which include speech impediments, possible psychological damage, crooked or crowded teeth, and poor oral health.
The condition can be easily prevented by

• Clean your child’s teeth daily
• Giving plain water after a bottle of juice, milk, or formula (or when awake, sip on it for long periods of time as a pacifier)
• Start bottle weaning by at least a year
• Make sure your child gets the fluoride needed to prevent decay
• Have regular dental visits for your child beginning when their first tooth erupts

We hope that you realize this and give your child the best means possible to achieve optimal dental health.

Root Canal Treatment in milk teeth: In cases where tooth decay extends deep into the nerve portion of the tooth it might be necessary to perform a root canal as described for the permanent tooth. Although the morphology of milk teeth makes the treatment difficult, it might still be considered as a better alternative to tooth extraction.

Space Maintainers: A space maintainer is a removable or fixed appliance designed to maintain an existing space.
Space maintainers are usually fitted in children when they have lost baby teeth early. The gap left from losing this tooth needs to be held open for the permanent tooth to erupt in the
correct position.

Fluoride application: A child’s teeth are more prone to decay due to lack of proper dexterity of brushing. Application of fluoride varnishes at regular intervals strengthens the tooth structure by incorporating fluoride ions into the structure making them more prone to acid dissolution. Not only do the permanent but also milk teeth benefit from fluoride treatment.

For children under 3 years of age

• The professional application of fluoride is particularly recommended because of the ease of application, patient acceptance and proven anti -decay benefits. For maximum benefits, reapplication should be made every 4 months.

• Of the various home-use fluoride products( toothpastes, mouthwashes and gels) only fluoride toothpastes are recommended for young children, but caution must be exercised to minimize fluoride ingestion.

Oral habits in children
Frequently children acquire certain habits that may either temporarily or permanently be harmful to teeth and tooth supporting structures. These habits are acquired as a result of repetition. In the initial stages there is a conscious effort to perform the act. Later the act becomes less conscious and if repeated often enough may enter the realms of unconsciousness.

Some common oral habits seen in children include thumb sucking, mouth breathing, tongue thrusting, lip biting, grinding of teeth and nail biting.

Treatment
Psychological approach: It is generally said that children lacking parental care, love and affection resort to this habit. Thus the parents should provide the child with adequate love and affection. Also the child's attention be diverted to other things as games and toys. The dentist and the parents should together work to motivate the child to discontinue the habit.

Mechanical Aids: They are basically reminding appliances that assist the child who is willing to quit the habit but is not able to do so as the habit has entered the subconscious level. They may be removable or fixed appliances.

Pit and Fissure sealants
The chewing surfaces of teeth are never flat. They have infact certain depressions called Pit and Fissures which serve as potential traps for food and bacteria making the teeth susceptible for decay. Although other factors such as dietary habits, oral hygiene and amount of sugar intake do pay an important role but the pits and fissures have been suggested as " the single most important anatomic feature leading to the development of tooth decay". Therefore as a preventive measure certain pits and fissure sealants are placed.

The decay inhibiting properties of sealants are attributed to the physical obstruction of the pits and grooves. This prevents penetration of fermentable sugars and the bacteria cannot produce acid that causes tooth decay. The safety and effectiveness of pit and fissure sealants as a decay preventive measure has been confirmed by the American Dental Association .

However, good professional judgment should be used in the selection of teeth and patients. These are contraindicated in cases of already existing decay which require fillings. Finally, although sealant application is relatively simple, the meticulous technique requires patient cooperation and should be postponed for uncooperative patients until the procedure can be properly executed.