Why Children Grind Teeth?

Excerpts from Webmd.com

The problem of teeth grinding is not limited to adults. 

Approximately 15% to 33% of children grind their teeth. Children who grind their teeth tend to do so at two peak times -- when their baby teeth emerge and when their permanent teeth come in. Most children lose the teeth grinding habit after these two sets of teeth have come in more fully.

Most commonly, children grind their teeth during sleep rather than during waking hours. No one knows exactly why children grind their teeth but considerations include improperly aligned teeth or irregular contact between upper and lower teeth, illnesses and other medical conditions (such as nutritional deficiencies, pinworm, allergies, endocrine disorders), and psychological factors including anxiety and stress.

Grinding of the baby teeth rarely results in problems. However, teeth grinding can cause jaw pain, headaches, wear on the teeth. 

Consult us if your child's teeth look worn or if your child complains of tooth sensitivity or pain. You can reach out to us at 080 2520 0226

Why Children Grind Teeth?

Excerpts from Webmd.com

The problem of teeth grinding is not limited to adults. 

Approximately 15% to 33% of children grind their teeth. Children who grind their teeth tend to do so at two peak times -- when their baby teeth emerge and when their permanent teeth come in. Most children lose the teeth grinding habit after these two sets of teeth have come in more fully.

Most commonly, children grind their teeth during sleep rather than during waking hours. No one knows exactly why children grind their teeth but considerations include improperly aligned teeth or irregular contact between upper and lower teeth, illnesses and other medical conditions (such as nutritional deficiencies, pinworm, allergies, endocrine disorders), and psychological factors including anxiety and stress.

Grinding of the baby teeth rarely results in problems. However, teeth grinding can cause jaw pain, headaches, wear on the teeth. 

Consult us if your child's teeth look worn or if your child complains of tooth sensitivity or pain. You can reach out to us at 080 2520 0226

Bruxism or 'Teeth Grinding' Prevents Dental Growth

Most people probably grind and clench their teeth from time to time. Occasional teeth grinding, medically called bruxism, does not usually cause harm, but when teeth grinding occurs on a regular basis the teeth can be damaged and other oral health complications can arise.

Why Do People Grind Their Teeth?

Source- http://www.flormanortho.com/

Although teeth grinding can be caused by stress and anxiety, it often occurs during sleep and is more likely caused by an abnormal bite or missing or crooked teeth. It can also be caused by a sleep disorder such as sleep apnea.

How Do I Find Out if I Grind My Teeth?

Because grinding often occurs during sleep, most people are unaware that they grind their teeth. However, a dull, constant headache or sore jaw when you wake up is a telltale symptom of bruxism. Many times people learn that they grind their teeth by their loved one who hears the grinding at night.

If you suspect you may be grinding your teeth, talk to your dentist. He or she can examine your mouth and jaw for signs of bruxism, such as jaw tenderness and excessive wear on your teeth.

Why Is Teeth Grinding Harmful?

In some cases, chronic teeth grinding can result in a fracturing, loosening, or loss of teeth. The chronic grinding may wear teeth down to stumps. When these events happen, bridges, crowns, root canals, implants, partial dentures, and even complete dentures may be needed.

Article excerpts from http://www.webmd.com/

7 Essential Tips in Baby Tooth Care

Most of us love the first glimpse of baby teeth when they appear. That's when the toothless smile, gets brighter and better. 

Although accompanied by irritation, grinding, crying and sometimes fever, baby teeth when start to appear are a milestone that all of us look forward to.

As parents we often know what to do when it comes to baby's teeth, what paste to use, how to brush, etc. However, it can be possible to miss some things, and before we know, something might have been overlooked, causing a little black spot to appear on your child's teeth that doesn't seem to be going away.

These 5 tips, are therefore compiled to give you a reference guide on what is important to keep track of, what are the absolute must-do's to ensure that your oversight or negligence doesn't cause harm to your child's teeth and often avoidable procedures at the hands of the pediatric dentist.

1. Begin even before baby teeth erupt - Even though baby teeth may not have appeared, your baby is drinking milk, and this leaves residues which should not be allowed to remain on the teeth or in the mouth.

Wiping the gums after every feed, with a soft, wet washcloth or gauze wrapped around your finger, or thimble-like rubber finger glove, will remove the excess food stuck on the teeth.

2. Care for them immediately when they appear - Once teeth erupt, take care of them immediately. Many parents think baby teeth are unimportant, since they will drop off eventually. However, these first teeth actually create the space for permanent teeth to grow and also help babies chew food and learn to articulate or talk. If left uncared for, they decay, causing gum infection or gingivitis, and mess up the space between teeth.

3. Avoid Cavities - Cavities in baby's teeth show up as discoloration or yellowing and pitting or dents in the teeth. Often, putting baby to bed with a milk bottle in the mouth is the main cause of this. 

Leaving an infant with a milk bottle in the mouth for long periods causes food collection and must be avoided. Comfort feeding or bottle chewing should also be stopped.

4. Finish meals with water, either drink or gargling - Since infants usually eat pureed food or drink milk, this can be washed off with a few sips of water. However, a good soft bristled toothbrush must be used as soon as possible so that the baby can get used to using it and it becomes a habit. A good brush will only be handy when the baby starts feeding on solids at or around 18 months. Sticky or sugary foods must be cleaned immediately with a soft brush or cloth in small babies and not left overnight.

5. Toothpaste must be used at 2 years of age - A drop sized amount of non-fluoride toothpaste must be used when toddlers begin eating semi-solid or solid food. Fluoride toothpastes must not be used until the child is much older, at 4 years or above, so they understand spitting out the paste rather than swallowing it.

Dental X-Rays and Their Importance in Correct Diagnosis

X-rays, also known as radiographs, are an essential part of any dental care treatment plan. They are diagnostic, but they can also be preventative, by helping a dentist diagnose potential oral care issues in a patient’s mouth before they become a major problem. An x-ray is a type of energy that passes through soft tissues and is absorbed by dense tissue. Teeth and bone are very dense, so they absorb X-rays, while X-rays pass more easily through gums and cheeks.

X-rays are divided into two main categories, intraoral and extraoral. Intraoral is an X-ray that is taken inside the mouth. An extraoral X-ray is taken outside of the mouth.

Intraoral X-rays are the most common type of radiograph taken in dentistry. They give a high level of detail of the tooth, bone and supporting tissues of the mouth. These X-rays allow dentists to:

• Find cavities
• Look at the tooth roots
• Check the health of the bony area around the tooth
• Determine if periodontal disease is an oral care issue
• See the status of developing teeth
• Otherwise, monitor good tooth health through prevention

X-rays, also called radiographs, are a valuable diagnostic tool. X-rays help the dentist to,

• See how your child's teeth are erupting (coming into the mouth)
• See the number, size and position of teeth that are still inside the gums
• Find out whether there are missing teeth or extra teeth
• Monitor mouth and teeth injuries
• Determine whether the teeth or mouth are infected
• Prepare for braces and other orthodontic treatment
• Detect problems that can't be seen with a visual exam
• Identify bone diseases
• Diagnose cavities in between teeth that are touching each other

There is no standard timetable for when your child's mouth should be X-rayed. The need varies with the child's development and dental health. If your child has had many cavities and fillings or has a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends X-rays every six months. This can help to detect cavities developing between teeth. Whether X-rays are needed also depends on how well your child brushes and flosses, and your child's diet.

Other children may not need X-rays taken as often. If X-rays aren't taken when they are needed, problems can become worse.

Content Excerpts from http://www.colgate.com/

Common Dental Emergencies - DENTAL IMPACTION

Dental emergencies happen when least expected. Although some, like toothache and broken tooth can be managed even after 24 hours, some others such as DENTAL IMPACTION need immediate attention at home before a dentist's visit can be arranged.

Dental impaction is the forceful pushing of the teeth inside or into the jaw bone. This is often what happens by a blunt trauma, when the child falls on their mouth or jaw. When the trauma is mild, the tooth is pushed halfway into the jaw, but in severe cases, the entire tooth gets pushed in, with possible injuries to the tooth's ligament and even fracture to the socket.

Often times in case of trauma or fall, there is plenty of bleeding (disproportionate to the trauma), including visible lip tear or injury, thereby preventing early detection of impaction.

PRIMARY MANAGEMENT

In such a case, it is necessary to manage the initial situation as quickly and conservatively as possible;

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

Once the bleeding is under control, the injury must be shown to a pediatric dentist at the earliest. Usually it is just to take advice on further course of action and check if there's any damage, tear or cut in the deeper tissues of the mouth.

TREATMENT

Baby teeth that are impacted often come out on their own, depending on the depth they have gone into the jawline. This may take 3 to 7 months and occurs due to the natural growth of the jaw in children. In case the teeth don't come out and if there are chances of damage to the root of the permanent teeth, then extrusion or teeth removal is the only remedial action performed by the pediatric dentist. 

Oral Injuries and their treatment

In case your child needs medical intervention after a fall or a pediatric dentist to look into her teeth, and decide the further course of action, reach out to Dr.Premila. She can be reached at Small Bites Dental Clinic.

Common Dental Emergencies - DENTAL IMPACTION

Dental emergencies happen when least expected. Although some, like toothache and broken tooth can be managed even after 24 hours, some others such as DENTAL IMPACTION need immediate attention at home before a dentist's visit can be arranged.

Dental impaction is the forceful pushing of the teeth inside or into the jaw bone. This is often what happens by a blunt trauma, when the child falls on their mouth or jaw. When the trauma is mild, the tooth is pushed halfway into the jaw, but in severe cases, the entire tooth gets pushed in, with possible injuries to the tooth's ligament and even fracture to the socket.

Often times in case of trauma or fall, there is plenty of bleeding (disproportionate to the trauma), including visible lip tear or injury, thereby preventing early detection of impaction.

PRIMARY MANAGEMENT

In such a case, it is necessary to manage the initial situation as quickly and conservatively as possible;

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

Once the bleeding is under control, the injury must be shown to a pediatric dentist at the earliest. Usually it is just to take advice on further course of action and check if there's any damage, tear or cut in the deeper tissues of the mouth.

TREATMENT

Baby teeth that are impacted often come out on their own, depending on the depth they have gone into the jawline. This may take 3 to 7 months and occurs due to the natural growth of the jaw in children. In case the teeth don't come out and if there are chances of damage to the root of the permanent teeth, then extrusion or teeth removal is the only remedial action performed by the pediatric dentist. 

Oral Injuries and their treatment

In case your child needs medical intervention after a fall or a pediatric dentist to look into her teeth, and decide the further course of action, reach out to Dr.Premila. She can be reached at Small Bites Dental Clinic.

Common Dental Emergencies and their Management - TOOTHACHE

Dental emergencies are more frequent than you can imagine. No parent likes to see their child in pain, and the earlier it is dealt with, the sooner is the problem identified, treated and better recovery.

Below are some of the most common dental emergencies and how they can be treated;

TOOTHACHE

Toothache is the commonest dental problem that kids face. It is experienced by children of all ages, and almost always has a specific cause that may or may not have gone unnoticed. Common causes of toothache include decay, fractures, trauma and eruption of wisdom teeth ( in adolescence).

What you can do?

CLEAN MOUTH

• ·         Cleanse or gargle with warm water first. Don't apply anything, keep warm cloth over the affected tooth or adjacent gum area.
•       Check if food has become impacted anywhere in between the teeth. Remove it as gently as possible using a clean finger, toothbrush or dental floss.

CONTROL SWELLING AND PAIN

• In case of localized swelling, apply a cold compress over the affected area. Ice cubes can also be wrapped in cloth and placed over it. This reduces swelling temporarily.
• Avoid giving any kind of medication to children at this stage without doctor's advice

VISIT A DENTIST

• ·         In case of prolonged pain that doesn't subside or swelling that doesn't relieve, it indicates a deeper dental problem that needs a dentist to look into. 
•       If the toothache is a result of an injury or fall on the face or jaw, details given to the doctor can help in the right treatment.

FOLLOW UP

• ·         The paediatric dentist will examine the child's teeth to understand the cause of pain & its origin. She will check for any decay, fracture, grinding and will treat accordingly.

·         In case of swelling or localized tenderness, it might be indicative of infection. This will need medication as per the stage of the problem.

·         In case of teeth grinding or bruxism, mouth guards may be advised (dependent on the child's age)

Toothache in children must never be ignored, because it often indicates the start of the problem or a stage at which the right treatment can reverse the deterioration process.

If you aren't sure about the cause or need a specialist to look into it, reach out to Dr.Premila of Small Bites Dental Clinic at the earliest.

Pediatric Dental X-ray Types

Dental x-rays are an essential part of any dental care treatment plan. They are diagnostic, but they can also be preventive, by helping a dentist diagnose potential oral care issues in a patient’s mouth before they become a major problem.

There are five types of X-rays your dentist may use for your child, depending on the goal:

* Bitewing X-rays (also called cavity-detecting X-rays) — These X-rays are used to view the areas between teeth that cannot be seen directly. They show where cavities are starting. These X-rays are needed only after the teeth in the back of the mouth are touching each other. In some children, this doesn't happen until the first permanent molar (also called the 6-year molar) has erupted.

* Periapical X-rays — These are used to view the entire crowns and roots of one, two or three teeth that are next to each other. The X-rays also will show the supporting bone structure of the teeth. This type of X-ray lets the dentist see a child's permanent teeth growing below the baby teeth. It also is used to look for abscesses and gum disease.

* Panoramic X-rays — These X-rays are used to view all of the teeth on one film. They also show the upper and lower jaws, the temporomandibular joints (TMJs) and the sinuses above the upper teeth. They are often used if a child has hurt his or her face, has orthodontic problems, or is mentally or physically disabled. Panoramic X-rays, unlike other types, do not require a film to be put in the child's mouth. This is helpful for children who gag easily or who have small mouths. This X-ray has to be exposed for 12 to 18 seconds. The patient must be able to sit or stand still for that whole time.

* Occlusal X-rays — These are used to view most of the upper or lower teeth on one film. This is useful when the dentist does not have a panoramic X-ray machine or when the child has difficulty in taking bitewing or periapical X-rays.

* Orthodontic X-rays (also called cephalometric or lateral skull) — This type of X-ray shows the head from the side. It is used to evaluate growth of the jaws and the relationship of bones in the skull. It helps an orthodontist make an accurate diagnosis and develop a treatment plan.

Dental X-rays are very safe and expose your child to a minimal amount of radiation. When all standard safety precautions are taken, today's X-ray equipment is able to prevent unnecessary radiation and allows the dentist to focus the X-ray beam on a specific part of the mouth. High-speed film enables the dentist to reduce the amount of radiation the patient receives. A lead body apron or shield will be placed over the child's body. Make sure the shield covers your child's neck to protect the thyroid gland. It also should extend all the way to the thighs to protect the genitals and reproductive organs.

Content excerpts from http://www.colgate.com/

Dental Hygiene for Autistic Children - A Mother's Perspective

Article excerpts from www.friendshipcircle.org

Autistic children can be difficult to handle. At the core of their behavior lies severe anxiety to face new and unknown situations, and exposure to new people.

While parents are often able to manage a majority of the tasks and develop a sense of familiarity, it is when meeting care providers such as a pediatric dentist or pediatrician that their behavior is severely tested.

Below is a detailed account of a mother, who has been there and done that. Although she started her 5 year old on dental visits only when he turned 5, it is important to begin this as early as possible (at age 1) to ensure familiarity and comfort with the dentist are developed at a very early age.

I waited until my son was 5 years old before I attempted to take him to a dentist’s office.

Between his oral defensiveness and severe anxiety, I couldn’t figure out how to make it work before then.  The only reason I made that appointment was my concern over an adult tooth that erupted at an unusual angle with the baby tooth still on top of it.

The Screamer

My son was the kid who screamed uncontrollably every time he entered anything that looked like a doctor’s office.  My son was the kid who wouldn’t let me look inside his mouth when he was teething or when he had injuries.  I used to seize the opportunity to try to get a brief glimpse at his teeth whenever he was laughing at a joke or in the middle of a tantrum.  Brushing his teeth was challenging at best, and there was no way he would rinse and spit.

Eventually my husband and I were able to reduce our son’s oral sensitivity enough so that we could take care of his teeth, and we approached his anxiety from several angles to make that first visit to the dentist a success.

Here’s how we managed our son’s dental hygiene:

Establish a daily ritual

1. Be Creative

The National Institutes of Health have a guide for caregivers emphasizing the importance of creativity and a daily oral hygiene routine – and those were the keys to my family’s success.  Finger toothbrushes for infants only encouraged my son to bite my finger.  Instead, I offered him a clean, wet washcloth to chew on for a few minutes in the morning and before bedtime.  I helped him move the washcloth around his mouth so that all of his teeth were scrubbed.  Then I offered water to drink, since he didn’t know how to rinse and spit yet.

2. Brush Together

The next step was to allow my son to chew on a child-size toothbrush while I brushed my own teeth.
This desensitized him to the toothbrush’s texture while I modeled appropriate dental hygiene for him.  Sometimes it’s necessary to try several different types of brushes, such as a spin brush.  After many months, when he was accustomed to the texture, I added non-fluoride toddler toothpaste to his toothbrush so that he would get used to the idea of flavoring on the brush.

3. Don’t Miss A Day

It was important to continue with the brushing ritual every morning and evening – if I accidentally skipped one morning, my son would be uncooperative the next time I tried to clean his teeth!

4. Slow Transitions Are Better

A few years later, my son was allowing me to brush his teeth and he had finally learned to rinse and spit.  Then we switched him to fluoridated toothpaste, because the flavor is milder than adult toothpaste.

Know the causes of tooth decay

In recent years, medical studies have documented a clear connection between oral health and overall physical health.  Tooth decay is now considered a preventable infectious disease.  The bacteria that cause tooth decay are typically transferred from one person’s saliva to another person’s mouth.  Sugary foods feed the bacteria and promote decay.

Many children with special needs may continue to bottle-feed until they are 4 or 5 years old because of delays in oral-motor skills, which is another risk factor for tooth decay.

5. Prevent Cavities

To reduce the risk of cavities, I gave my son a drink of water after his bottles and made sure his teeth were brushed immediately before bedtime.

Find a dentist who has experience with special needs

6. Referrals From Families

The best way to find a dentist is to ask for a referral from other families or find those within the community who have managed dental needs of autistic kids.

Dr. Premila of Small Bites Dental Clinic has prior experience in managing such children. The office staff too have been trained to handle them. 

7. Accessible and Sensory Friendly

Not all dental offices are equipped for special needs, some offices have a harsh sensory environment.  At Small Bites, the environment and decor has been designed to incorporate play, and children are exposed to imagery and activities that helps them get more relaxed. You can check with the office staff about our experience with children of unique needs.

Get friendly with the dentist’s office

8. Make practice visits

Consider visiting the dentist’s office several times before attempting any type of examination.  One time I had my husband bring our son in to see me get my exam and cleaning.

9. Make a Social Story

Ricki Robinson, author of Autism Solutions, suggests taking photos of the equipment, staff and waiting room – then using those photos to make a storybook about going to the dentist.

10. Prepare With Books

I got a bunch of books about the dentist from the library for my son.  The only books that interested him were those that had photos of actual dentists’ offices, not cartoons or drawings.  He liked clear, concise narratives that showed him exactly what to expect.  He also liked simple, scientific explanations about the importance of oral hygiene.

11. Divide & Conquer

Keep in mind that most dentists can bill your visit in three separate parts: cleaning, exam and x-ray.  If a child becomes anxious during the cleaning, you can reschedule the exam and x-ray for a different day.  Or you can schedule each of the three parts on different days.

12. Bring Their Favorite Toy/Blanket/Object

Ruby Gelman, DMD, advises in the book 1001 Tips for the Parents of Autistic Boys, “If your child has an object that he particularly loves (a music player or a clock, for example), bring one with you to the dental visit so that the dentist can incorporate that into the appointment.”  Familiarity with the dentist not only reduces anxiety during the visit, but it also increases compliance with dental hygiene at home.

What If Nothing Works?

On top of the increased risk for tooth decay, individuals with special needs often have damaging oral habits such as grinding teeth, picking or biting inside the mouth and tongue thrusting.  The dentist then consults with the child's pediatrician and parents to suggest the next best course of action.

Success

The last time I took my son to the dentist, he confidently went into the exam room without me.  Afterwards he couldn’t wait to show his dad how clean and shiny his teeth were.  I could hardly believe this was the same child who used to protest so vehemently every time I tried to touch – or even just look at- his mouth. 

Repetition, desensitization, persistence and familiarity helped him learn a new life skill. 

For specific questions on the services we provide especially for special needs individuals, reach out to SMALL BITES DENTAL CLINIC at 08041256715.

Dental Hygiene for Autistic Children - A Mother's Perspective

Article excerpts from www.friendshipcircle.org

Autistic children can be difficult to handle. At the core of their behavior lies severe anxiety to face new and unknown situations, and exposure to new people.

While parents are often able to manage a majority of the tasks and develop a sense of familiarity, it is when meeting care providers such as a pediatric dentist or pediatrician that their behavior is severely tested.

Below is a detailed account of a mother, who has been there and done that. Although she started her 5 year old on dental visits only when he turned 5, it is important to begin this as early as possible (at age 1) to ensure familiarity and comfort with the dentist are developed at a very early age.

I waited until my son was 5 years old before I attempted to take him to a dentist’s office.

Between his oral defensiveness and severe anxiety, I couldn’t figure out how to make it work before then.  The only reason I made that appointment was my concern over an adult tooth that erupted at an unusual angle with the baby tooth still on top of it.

The Screamer

My son was the kid who screamed uncontrollably every time he entered anything that looked like a doctor’s office.  My son was the kid who wouldn’t let me look inside his mouth when he was teething or when he had injuries.  I used to seize the opportunity to try to get a brief glimpse at his teeth whenever he was laughing at a joke or in the middle of a tantrum.  Brushing his teeth was challenging at best, and there was no way he would rinse and spit.

Eventually my husband and I were able to reduce our son’s oral sensitivity enough so that we could take care of his teeth, and we approached his anxiety from several angles to make that first visit to the dentist a success.

Here’s how we managed our son’s dental hygiene:

Establish a daily ritual

1. Be Creative

The National Institutes of Health have a guide for caregivers emphasizing the importance of creativity and a daily oral hygiene routine – and those were the keys to my family’s success.  Finger toothbrushes for infants only encouraged my son to bite my finger.  Instead, I offered him a clean, wet washcloth to chew on for a few minutes in the morning and before bedtime.  I helped him move the washcloth around his mouth so that all of his teeth were scrubbed.  Then I offered water to drink, since he didn’t know how to rinse and spit yet.

2. Brush Together

The next step was to allow my son to chew on a child-size toothbrush while I brushed my own teeth. 
This desensitized him to the toothbrush’s texture while I modeled appropriate dental hygiene for him.  Sometimes it’s necessary to try several different types of brushes, such as a spin brush.  After many months, when he was accustomed to the texture, I added non-fluoride toddler toothpaste to his toothbrush so that he would get used to the idea of flavoring on the brush.

3. Don’t Miss A Day

It was important to continue with the brushing ritual every morning and evening – if I accidentally skipped one morning, my son would be uncooperative the next time I tried to clean his teeth!

4. Slow Transitions Are Better

A few years later, my son was allowing me to brush his teeth and he had finally learned to rinse and spit.  Then we switched him to fluoridated toothpaste, because the flavor is milder than adult toothpaste.

Know the causes of tooth decay

In recent years, medical studies have documented a clear connection between oral health and overall physical health.  Tooth decay is now considered a preventable infectious disease.  The bacteria that cause tooth decay are typically transferred from one person’s saliva to another person’s mouth.  Sugary foods feed the bacteria and promote decay.

Many children with special needs may continue to bottle-feed until they are 4 or 5 years old because of delays in oral-motor skills, which is another risk factor for tooth decay.

5. Prevent Cavities

To reduce the risk of cavities, I gave my son a drink of water after his bottles and made sure his teeth were brushed immediately before bedtime.

Find a dentist who has experience with special needs

6. Referrals From Families

The best way to find a dentist is to ask for a referral from other families or find those within the community who have managed dental needs of autistic kids.

Dr. Premila of Small Bites Dental Clinic has prior experience in managing such children. The office staff too have been trained to handle them. 

7. Accessible and Sensory Friendly

Not all dental offices are equipped for special needs, some offices have a harsh sensory environment.  At Small Bites, the environment and decor has been designed to incorporate play, and children are exposed to imagery and activities that helps them get more relaxed. You can check with the office staff about our experience with children of unique needs.

Get friendly with the dentist’s office

8. Make practice visits

Consider visiting the dentist’s office several times before attempting any type of examination.  One time I had my husband bring our son in to see me get my exam and cleaning.

9. Make a Social Story

Ricki Robinson, author of Autism Solutions, suggests taking photos of the equipment, staff and waiting room – then using those photos to make a storybook about going to the dentist.

10. Prepare With Books

I got a bunch of books about the dentist from the library for my son.  The only books that interested him were those that had photos of actual dentists’ offices, not cartoons or drawings.  He liked clear, concise narratives that showed him exactly what to expect.  He also liked simple, scientific explanations about the importance of oral hygiene.

11. Divide & Conquer

Keep in mind that most dentists can bill your visit in three separate parts: cleaning, exam and x-ray.  If a child becomes anxious during the cleaning, you can reschedule the exam and x-ray for a different day.  Or you can schedule each of the three parts on different days.

12. Bring Their Favorite Toy/Blanket/Object

Ruby Gelman, DMD, advises in the book 1001 Tips for the Parents of Autistic Boys, “If your child has an object that he particularly loves (a music player or a clock, for example), bring one with you to the dental visit so that the dentist can incorporate that into the appointment.”  Familiarity with the dentist not only reduces anxiety during the visit, but it also increases compliance with dental hygiene at home.

What If Nothing Works?

On top of the increased risk for tooth decay, individuals with special needs often have damaging oral habits such as grinding teeth, picking or biting inside the mouth and tongue thrusting.  The dentist then consults with the child's pediatrician and parents to suggest the next best course of action.

Success

The last time I took my son to the dentist, he confidently went into the exam room without me.  Afterwards he couldn’t wait to show his dad how clean and shiny his teeth were.  I could hardly believe this was the same child who used to protest so vehemently every time I tried to touch – or even just look at- his mouth. 

Repetition, desensitization, persistence and familiarity helped him learn a new life skill. 

For specific questions on the services we provide especially for special needs individuals, reach out to SMALL BITES DENTAL CLINIC at 08041256715.

Management of Autistic Children at The Dentist

Children with an Autism Spectrum Disorder have impaired social interaction and limited communication abilities, combined with a restricted amount of activities and interests. While parents are often able to manage them in familiar places and situations like the home, it becomes difficult to do the same outside, especially when visiting specialized healthcare providers including dentists.

Considering that 1 in ever 30 Indian children displays signs of ASD, pediatric dentists are very sensitive to their dental needs and specialized management. Even so, parents have a large role to play in ensuring all procedures go smoothly, and children come away with the least amount of stress and mental trauma.

Dentists managing autistic children are aware of them exhibiting specific observable behavior;

IMPAIRED SOCIAL RESPONSE - Children are unable to read and respond to feelings and experiences, with absolute no understanding most times

IMPAIRED COMMUNICATION - Children are unable to use and understand gestures, repetition of words (echolalia) and a rigid body stance is often displayed

Besides the atypical behavioral and impaired communication skills that are observed and need careful handling, below are often the main dental problems that such children exhibit;

* Bruxism or teeth grinding, often when asleep or the child isn't aware of it

* Tongue thrusting or repeated tongue movements

* Chewing at all odd times without presence of food

* Self-injury, where pinching gums, biting lips and creating wounds is common

* Erosion of teeth

* Caries, when teeth aren't brushed thoroughly because the child finds it unpleasant

* Poor oral care at home, because of difficulty in managing the child

* Limited dietary preferences. Autistic children have very strong likes and dislikes (Only pureed food, no vegetables, dislike of particular vegetable color, etc.)

Management of an Autistic Child at the dentist, can be divided into two phases;

PRE MANAGEMENT or BEFORE CHILD MEETS THE DENTIST

• It is important to plan a desensitizing appointment with the dentist to help the child familiarize themselves with the doctor and the staff
• Allow the child to bring things that can comfort them, a favorite blanket, stuffed toy or even hold the parent's hand
• Parents need to discuss with the doctor about the child's tolerance to pain and discomfort, and their threshold
• Share the child's intellectual and understanding abilities with the doctor, so that they can phrase sentences or relate with the child accordingly

POST MANAGEMENT or AFTER THE CHILD MEETS THE DENTIST

• The dentist will communicate with the child at a level he/she can understand. They use phrases such as 'Tell', 'Do', 'Show' when explaining any procedures or methods, always speaking in clear, precise tones
• Oral examination is begun with only fingers first, while the hard feel of dental instruments is brought in later
• Dental instruments are only shown later. Suddeness of movements by the dentist is kept to a minimum and light is kept away from the child's face. Sensory input of any kind is kept as less as possible to avoid distraction
• Dentists place same staff at all examinations and interruptions are kept minimal
• Child's co-operative behavior is always encouraged with positive words and nods
• The child's unusual body movements are always observed and pre-empted

Most pediatric dentists are aware of the extra care and effort it takes to manage autistic children, and are extra cautious while carrying out any kind of dental procedures. As a parent, it is important to know what to expect, understand how the process can be made easy and prepare the child for any kind of dental visit.

Introducing Brushing in Autistic Children

Oral health in children is a very important aspect that must never be neglected. Children are not equipped to perform this complex task, and parents therefore step in to perform it till the child reaches an age when he can do it himself. While it can be difficult for any child to get used to the process of brushing and oral hygiene, it is particularly distressing and challenging for a child with Autism Spectrum Disorder.

Autism Spectrum encompasses a wide variety of neurodevelopmental conditions, characterized by difficulty in communication, socializing and interaction across multiple contexts. It is also accompanied by repetitive behavioral patterns, impaired functions in certain cases with heightened skills in others.

Given the nature of this condition and the fact that autism is often detected within the first year of birth, it becomes essential to handle these kids, and their special needs using a softer, more considerate approach. Autistic children are hypersensitive, do not allow anyone to touch their mouths, are oftentimes unresponsive and also non co-operative. Brushing and other oral tasks when introduced gently will enable them do their tasks themselves.

Below are a few tips that will make it easier to introduce brushing to autistic children-

• To begin with, choose the right kind of toothbrush. Since there are many sizes, colors and styles, it is important to choose a brush that is just the right size for the mouth, and also one in a color that the child will love.
• Since the children experience heightened sensitivity which makes them uncomfortable, it helps to touch the brush to the child's lips or inside of the mouth for a few days to desensitize them.
• Giving the same instructions repeatedly, such as 'open mouth wide', 'show your teeth', ensures they get used to the them as a daily practice.
• It also helps when parents set an example. Brushing, gargling and flossing can become a shared activity which the child will come to learn and love.
• Brushing the teeth of an autistic child works when there are a repetitive set of procedures to follow. This will familiarize them as well as help them open up to the ritual over time.

Below are a set of steps that can be followed for brushing the child's teeth;

1. Stand behind the child with their head resting on the front of your chest

2. Put a small pea sized amount of paste on the brush

3. Use the brush as you would on your own teeth

4. Follow this 6 step procedure for brushing

- Brush the bottom back teeth inside, out and top 5 times

- Brush the top teeth inside and out 5 times

- Brush bottom front teeth inside, out and top 5 times

- Move to the opposite teeth and brush bottom teeth inside and out 5 times

- Brush the top front teeth inside and out 5 times

- Brush the top back teeth inside  and out 5 times

5. Although brushing is normally done in the bathroom, it is advisable to brush the teeth of autistic children wherever they seem comfortable. It could be either on a couch or on their bed and gradually progressed into the bathroom.

Just as with every other activity, getting the child to look after their teeth independently is the ultimate goal of a parent. When it comes to autistic kids, it needs a little more effort and attention.

Do read our next blog to understand how to ensure how teeth brushing can be made a regular task in such children.

Oral Injuries and Their Treatment in Children

Besides tooth caries and misaligned teeth, very few children make it through to childhood without mouth injuries. The appearance of teeth in children brings with it a whole set of problems. While some are predictable, some others aren't. 

Mouth injuries, even the most gory ones need immediate and good treatment to avoid any permanent kind of damage. While home treatment often suffices, medical intervention is required in certain extreme cases. Below is all what you need to know to differentiate between the two.

How they happen?

Besides scraped knees and head bumps, cuts and bleeding on lips and inside of the mouth is very common in children. Mouth tissues are soft, and often a fall or hit pushes them against hard bones of the jaw or even the teeth. In addition, slip ups, tumbles, crawling are all activities where a child's mouth is exposed, leading to cuts and bruising.

How to treat them?

Oral injuries in children look much worse than they actually are. Because the mouth and areas in the face and head are suffuse with blood vessels, even a tiny cut can cause excessive bleeding, with the exact location becoming difficult to pinpoint. Often mouth injuries are minor and the crying bouts of the child are more out of fear than actual injury.

The below steps will help you handle any kind of mouth injury in a calm manner, reduce bleeding, minimize the pain and prevent infection.

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a Popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as Popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

When is a pediatric dentist intervention necessary?

• When bleeding is very heavy, continuous and uncontrolled, and doesn't stop despite applying pressure and ice.
• When the cut is too deep or too wide
• When a rusted or dirt filled object has caused the wound
• When there is dirt or mud in the wound
• When a puncture wound caused due to pen/pencil gets into the roof of the mouth, or hurts deeper tissues of the jaw
• When the wound is caused by bite of an animal
• If there is suspicion of bone injury, swelling of the jaw, locked jaw, broken or impacted tooth
• Any inflammatory changes such as redness, swelling, pain, fever that lasts for more than a day

It is very common for children to have mouth injuries, almost like a rite of passage in childhood. The right kind of treatment immediately, with moral support and without anxiety will help them recover faster.

For more advice on oral injuries or to get treatment for the same, reach out to Dr.Premila of Small Bites Dental Clinic at Indiranagar by contacting her at 080 4125 6715.

Braces in Children & Their Different Types

It is common to see children nowadays with braces. Some kids can't wait to get it at the earliest, while parents themselves often feel that their children may require them for reasons as varied as misaligned teeth, or for an aesthetic look.

Regardless of the reasons for wanting them, there is a clear purpose to getting your child's teeth fitted with braces, and why it should be done at a particular age. 

Below are a few details on them and their purpose;

WHY BRACES

MISALIGNED TEETH

Children may need braces for any one of the following reasons;

* Overlapping, overcrowded or crocked teeth, also called as 'bad bite' or malocclusion. Malocculsion occurs whenever the upper and lower jaws have a major difference in size, where the upper is bigger than lower (called an overbite) or lower bigger than upper (called an underbite)

* Tooth decay, accidents and thumb sucking habits

* Inherited misalignment

Not all parents realize when braces have to be put, and it is often the pediatric dentist who can advise during routine checkups if braces are required. Depending on severity of the problem and the child's age, he or she will be further advised to meet with an orthodontist to get braces fitted out as per the requirement.

TYPES OF BRACES

Braces work by correcting teeth alignment, putting pressure on developing teeth to move into a particular position. This is best done during the growth period of a child, since the jaw and muscles are still malleable. There are different kinds of braces, and the doctor decides what is apt for the child based on the lifestyle and age.

1. Wire and rubber bands - Braces like these have been used for teeth alignment since years. These traditional braces have bands or steel ties holding wires between teeth brackets

2. Damon braces - These braces do not have steel/rubber ties but brackets hold the braces in place

3. Clear braces- These braces are clear/transparent and can hold themselves in place like a mouthguard

These braces either can be inserted temporarily, wherein removable braces can be removed and cleaned as and when required. These provide gentle pressure to the teeth.

Other times, teeth are very misaligned, and therefore need to be guided more accurately. This is when fixed braces are inserted. They cannot be removed and inserted as and when one likes. These are the bracket and band braces which are stuck to the teeth, with a flexible wire joining the brackets and allowing the teeth to move.

Functional braces on the other hand, use the movement of the jaw to align the teeth, and are are fitted only in certain conditions.

Braces are made from all types of materials' metal, ceramic and even medical grade plastic.

To know whether your child really needs to be fitted with one, bring him to us at the earliest. Dr.Premila will be able to assess the teeth, and decide the plan of treatment accordingly.

To book an appointment, please visit http://www.smallbites.in/