Pediatric Dental Health Topics 10

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Unsightly defects and discolorations of baby teeth are a cause of concern for many parents. Nearly 40% of all baby front teeth have some sort of enamel defect. These defects cause aesthetic problems and predispose the affected teeth to dental caries. The two most common causes of enamel defects are: developmental insults and minor facial trauma. These problems can develop before, during, or after birth. The treatment options for enamel defects in young children include: aesthetic veneering and microabrasion.

The process of enamel formation (amelogenesis) begins before birth, and is sensitive to physiologic changes. The enamel of baby (primary) incisors begins to harden (mineralize) at about 15 week after conception, and the process of enamel maturation is finished two months after birth. The primary eye teeth (canines) begin their mineralization at 19 weeks of intrauterine life, and complete their enamel maturation process 9 months after birth. The cells that produce the enamel are called ameloblasts, and they are very sensitive to any developmental disturbances. Evidence of developmental insults, as well as perinatal and postnatal trauma, can therefore be seen in the enamel of the primary anterior teeth.

More than 75% of enamel defects in primary teeth are considered to be developmental in nature. Most developmental enamel defects (DED) occur in the middle third of the upper (maxillary) incisors. These location of these defects coincide with the location of the so-called neonatal line. This faint line, often visible on the facial surface of primary incisors, is thought to be caused by physiologic, transient, neonatal hypocalcemia. DED of maxillary incisors can be caused by: premature birth, systemic insults at birth, early childhood infections, nutritional problems, maternal illness or drug intake during pregnancy, or genetic problems associated with enamel formation.

Less than 25% of enamel defects in primary teeth are caused by minor facial trauma or pressure. Such defects mostly appear as hypoplastic spots on the primary canines. These hypoplastic defects result from perinatal or postnatal minor facial trauma or pressure, including passage through the birth canal. Hypoplastic defects in primary canines are quantitative defects, which means that they are associated with a reduced thickness of enamel.

Treatment of dental defects should take into account the variability in children's ability to cooperate during dental treatment. One option for treating enamel defects is to cover up the unsightly areas with a tooth-colored cosmetic material. This may be the best option for very young children. In this technique, the surface of the tooth is covered by a bonded microfilled composite resin. Another treatment option is microabrasion. Enamel microabrasion is the process of removing dental stains and surface defects - using a combination of acid and abrasives. Enamel microabrasion is useful for the removal of superficial enamel dysmineralization defects and decalcification lesions. Enamel microabrasion can be used in children as young as six years of age.

A dental journal article reviews a common type of defect in baby teeth:
Seow WK. Enamel hypoplasia in the primary dentition: a review. ASDC Journal of Dentistry for Children. 58:441-452,1991

National Children's Dental Health Month (NCDHM) is a month-long nationwide program which promotes healthy smiles in children. The American Dental Association has sponsored this annual event every February, since 1981.

NCDHM originated in 1941 in Cleveland, Ohio as a one-day dental health program. Since then, it has grown into a month-long observance, and every February it reaches millions of people. Local observances often include: school programs, dental society promotions, health fairs, and public service announcements.

In spite of the current national emphasis on preventive dental health, however, many children are still affected by dental caries. Caries in the baby (primary) teeth is one of the most common health problems affecting young children. In 1996, a national oral health survey found that 38% of children, ages 2 through 9, had dental caries. Caries prevalence in children attending Head Start programs has reached 90% in some group samples. Early childhood caries (ECC) is also a leading cause of operating room admissions for children requiring dental restorations and extractions. Obtaining treatment for caries can be difficult, since according to a 1997 study, almost 4.2 million children in the U.S. were unable to obtain dental care.

In the past, children went to the dentist only after a problem was severe enough to be noticed by a parent. Such an outdated, reactive, approach is no longer appropriate in the age of preventive health, however. The infant oral health visit is now the foundation upon which a lifetime of oral and dental health can be built!

The American Dental Association, the American Academy of General Dentistry, and the American Academy of Pediatric Dentistry all recommend that a child's first oral health visit take place at 12 months of age, or shortly after the eruption of the first baby teeth. This is the ideal time for a dentist to evaluate a child's oral and dental health, as well as to diagnose any problems which may exist.

Oral health is a vital component of a child's overall health. A partnership between families, dental professionals, and other health professionals is necessary for achieving oral health in children.

Children�s oral and dental health is achievable! By providing a healthy diet, minimizing the consumption of sweets, cleaning a child's teeth twice a day, and getting early dental examinations, a child can have a happy, healthy smile.

Parents are often concerned when they see a "double row" of teeth developing in their 6-year-old's mouth. This should not be a cause for alarm, however. It occurs when the adult lower front teeth begin to erupt into the mouth, but the baby teeth have not fallen out yet. It is usually not necessary to have the over-retained primary incisors extracted in this situation, however.

Lower permanent incisors normally develop and erupt behind the primary incisors. Lower primary incisors can be over-retained when the adult teeth erupt too far away from the baby teeth. In this situation, the normal process of loosening (resorption) of the primary teeth may not occur.

When the lower (mandibular) permanent incisors erupt, some temporary crowding will occur, amounting to 1.6 mm in boys, and 1.8 mm in girls. Only after the full eruption of the lower lateral incisors is the growth and widening of the supporting (alveolar) bone completed. In fact, the strongest stimulus for widening of the anterior part of the jaw during childhood is the pressure created by the eruption of the lower lateral incisors. The bottom line is: a little bit of crowding during the eruption of the lower incisors can be beneficial for dental arch development.

There are two rules of thumb used by dentists to determine whether or not to remove an over-retained lower incisor.

Rule #1: A primary lower incisor should be extracted when three fourths of the permanent incisor's root has been formed.

Rule #2: The latest suggested time for removal of any over-retained primary incisor is 8 years of age.

Here are some helpful tips for parents:

If the permanent incisor is erupting behind the primary incisor, and the primary incisor is loose, ask your child to wiggle the tooth out.

If there is pain or bleeding associated with an over-retained baby tooth, see your dentist for an evaluation.

If your child is over 8 years old, and still has over-retained primary incisors, see your dentist for an evaluation.

Schedule periodic dental examinations for your child so that any developing problems can be diagnosed in a timely manner.

A dental journal article provides a case report:
Adams, TW. An impacted primary lateral incisor as a cause of delayed eruption of a permanent tooth: case report. Pediatric Dentistry, 20:121-123. 1998