ODONTOPEDIATRICS

Pediatric dentistry has become an increasingly relevant part of the global health concept.

Pediatric dentistry is defined as the branch of dentistry that is responsible for the treatment, maintenance and prevention of dental health of the child from childhood to adolescence, since any untreated alteration in temporary teeth (deciduous teeth), can subsequently influence the permanent pieces.

Pediatric dentistry is a very close specialty with orthodontics. The restorative treatment mainly consists of treating the traumatisms, using sealants, which consists of slightly filling the teeth fissures without hardly removing dental material to avoid possible decay, and treating the caries produced and its consequences.

The main difference between regular dentistry and pediatric dentistry regarding the treatment of caries is the presence of temporary or deciduous teeth in children which causes the treatment to change, so that lesions that occurred in the temporary dentition will be treated in a less conservative way and more aggressive than those that occurred in permanent teeth, to avoid that, in the worst case, an inadequate treatment could be given to a temporary tooth that would later affect the permanent tooth.

It is essential to perform radiographs in children with dental problems if we suspect the possibility of very frequent pathologies such as dental agenesis, ectopias, supernumeraries and multiple caries.

It’s important to keep the temporary pieces until the exfoliation by the permanent ones, so they must be treated in all cases without exception and if we lose any piece, no matter how temporary, we must take measures to avoid displacements of the other pieces.

ORAL HYGIENE TEACHING AND PATIENT MENTALIZATION

Children in general are lazy to perform daily dental hygiene and even, general hygiene, so it is the parents’ duty to try to get the habit of brushing their teeth every day. It is more than proven that daily hygiene contributes to a great decrease in the suffering of dental diseases. If the child doesn’t have the habit of brushing his teeth, we must study the parents, in many cases it turns out that the parents don’t have it either, and then our mission and task becomes even more difficult.

We must tint their teeth in the clinic to prove the existence of bacterial plaque, today there are many explanatory pamphlets for children that make pediatric patients understand that there are “bugs” that can destroy their teeth.

Many specialists prefer treating children without the presence of the parents, but if the parents want to be present, it is important that parents are present while explaining the plaque and at the time of dyeing their teeth.

Many specialists prefer treating children without the presence of the parents, but if the parents want to be present, it is important that parents are present while explaining the plaque and at the time of dyeing their teeth.

The dental pieces are in contact with each other at a point of maximum convexity, which is the so-called contact point. When we lose tooth contact, the teeth tend to move mesially (forward) and this can lead to the displacement of a whole tooth group, even permanent pieces, if there are already erupted. This alteration of the dental pieces is transmitted when the patient changes the temporary pieces for the permanent ones, arriving in most of the cases to an anomalous position of the dental pieces and the establishment of a bad dental occlusion.

Classically, temporary pieces have been sealed with amalgam, but today there are countries that have banned their use in children. The choice of a filling goes with the age of the child, their collaboration in the clinic and their risk of caries.

Composite resins modified with polyacid (Dyract®), have a very promising result, are easy to handle and are radiopaque.

When a caries can’t be treated, and the only solution is the extraction of the piece, we must place some system to maintain space and prevent dental displacement as we will see later.

When we want to perform tooth extraction, it is essential to have an X-ray of the piece. In general, they are very easy extractions, the temporary pieces leave without roots because there has been a physiological reabsorption by the permanent piece, but it is very common that the piece has roots or some of them haven’t been reabsorbed.

PREMATURE LOSS OF TEETH

The early loss of temporary dental pieces, either by extraction or by trauma, produces some dental displacements so the pieces occupy spaces that correspond to other dental pieces and when they erupt chronically, having their space occupied, they can’t erupt properly and in most cases, dental crowding occurs, or ectopic eruptions.

To avoid these dental displacements, if the piece that must replace the lost one takes time to erupt, we must maintain the space and avoid the dental displacements, in these cases we will place some devices called space maintainers.

SPACE MAINTAINER

Space maintainers can be removable or fixed types.

Fixed maintainers are devices that consist of a crown or a band of steel and a wire that is welded to it, and the wire that rests on the previous piece. The band or crown is cemented in the posterior piece and the tooth movement of both pieces is avoided.

PROLONGED RETENTION OF TEMPORARY PIECES

In the cases that the permanent tooth erupts, and the temporary has not fallen, we will proceed to extract the deciduous. We will never extract a temporary tooth without first making sure that there is no dental agenesis, or an inclusion that makes it impossible for the piece to erupt.

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