Diwali and Dental Caries - Here's What To Expect

It is time for Diwali, the season of celebration that starts now and lasts till the end of the year. This festival is also all about fun, frolic and most definitely food. It is difficult to imagine celebrations without food, without elaborate mithais prepared for friends and family, ladoos and jalebis enjoyed by the family, and children rushing about with sweets stuffed in their mouth.

As much as this whole scenario conjures up happiness and fun, there is a lot to deal with once the festivities are up, and the most important being BAD TEETH and oral problems.

Sweets and delicacies are unavoidable, and so are the after-effects of gorging on them; bad teeth, bad oral odour, and with children, the first signs of caries and gum trouble. 

As much as we love snacking on food throughout Diwali and thereafter, there are little unwelcome visitors snacking on the food collected in our and the kid’s mouth, that if left untreated or not looked after, can cause a whole host of problems, many of which are already known.

• Plaque and Caries - Sugary foods cause tooth decay. Period. Whether you give your child something mildly sweet or chocolates and desserts loaded with sugar, they will cause harm in the mouth and eventually caries. Another important factor, is the frequency at which they are eaten.

Eating foods of different kinds, almost always causes something to remain in the mouth, debris that gets accumulated between teeth and gums. Bacteria present in the mouth, feed on all these foods. In the case of sweet stuff, these bacteria feed on the carbohydrates in sugar, especially refined sugars in desserts to produce acids, which combine with saliva to form plaque. The plaque deposits itself on the teeth over a period of time, causing erosion of the tooth and caries.

• Bad Odor – Infrequent brushing and rinsing of teeth, causes the accumulated food build-up to cause an additional set of problems. Bad odour from the mouth is one such. Acid build-up in the mouth due to remaining food, tends to cause further damage to the teeth, leading to bad breath. The tongue is also a storage of bacteria and contributes to it.

• Dry Mouth – The more you eat, the more saliva is produced, yet consequently, the more sugars you consume, makes that saliva get used up quickly and causes dry mouth and bad breath. Dry mouth can result in frequent gum irritation, pain, inflammation and difficulty in swallowing.
  

As much as the harm that sweets can do during this time, Diwali is really incomplete without indulging in them. You really can’t stop the children from eating what they like. Here are a few practices to follow during this festive period;

• Brush the children’s teeth twice daily, even more frequently if required. No matter how long the day is, how tired and sleepy they are, never put them to bed without cleaning their mouth and brushing their teeth. This will help them in the long run by also enforcing a good habit.
  
  
  
  

• Avoid kids indulging in frequent snacking, in between meals. This helps reduce food accumulation in the mouth, and also lowers the exposure to sugar. Let them eat whatever they like, but in one sitting at one time.

• Drink juices, milk and other liquids with a straw. Sweetened liquids remain longer on children’s teeth than solids. Using straws will limit their contact with teeth, and also make it easier to get rid of them when brushing.

• Ensure they drink a glass of water after having sweets, or rinse their mouth every time they do. This can loosen up any accumulated food particles and prevent further damage.

• Enjoy sweets and sugary foods during a meal, rather than before or after it. Indulging in juices or snacks throughout the day, is giving bacteria a fertile ground to grow and flourish. But letting children have sweets together with their meals, ensures that the other foods prevent these sugars from sticking to the teeth and remaining in the mouth.

• Reduce rewarding good behavior with a sweet treat. Occasional snacking on sweets is fine, but keeping children busy with such foods for distraction, or as reward for a good job, sends across a wrong message. This not just harms their behavior, but teeth as well.

• Brush, rinse, clean and ensure nothing remains in the mouth. This cannot be emphasized enough. Brushing all areas of the teeth, especially the ones at the back and the molars, cleaning the tongue and flossing the mouth whenever possible, ensures that the festivities don’t leave children with harmful, long-lasting effects.

Children can and must enjoy Diwali, indulge themselves with sweets, but it is left up to us as parents to ensure their teeth and dental health don't take a hit because of this.

Fillings for baby teeth

Maybe you have just found out that your child has one or more cavities in their baby teeth?

It is normal for parents to have concerns and questions. 

In this blog, we hope to give some answers and reassurance about fillings for baby teeth.


Children can develop tooth decay soon after their baby teeth come through. Prolonged bottle feeding with sweetened drinks, or frequently falling asleep with a bottle of milk or whilst nursing are the most common causes of decay in babies. Cavities usually do not cause pain in the early stages and young children may be reluctant to open wide to let their parents see or brush their teeth. So, it can come as a surprise to find out that your child has a cavity at a young age. 

Why should we fill baby teeth, won't they fall out later anyway?




Baby teeth are important for normal eating and speech development. A healthy smile is also beneficial for a child's self-esteem once they reach school age. 





Once a cavity has formed it usually progresses resulting in pain and infection. If an abscess on a baby tooth is not properly treated the infection can spread to and affect the developing adult tooth underneath.



Baby teeth also maintain the spaces for permanent teeth to erupt into. Although front baby teeth can start to fall out from around 6 years old, the back teeth need to last until around 12 years old. If baby teeth are lost too early other teeth may tilt or drift into the vacant space, forcing the adult teeth to come through crooked. 

If my child has a cavity what are the treatment options?

Fillings

If the decay is in the enamel or dentine layer only (not close to the nerve of the tooth) the decay can be removed and a filling placed in the cavity. 

Basic procedure:

• Smaller cavities in baby teeth can often be cleaned without using local anaesthetic. If the cavity is deep or the tooth is particularly sensitive, a small injection may be required to numb the tooth. For more information, see this blog post: Questions about local anaesthetic
• The decay is removed and the cavity is washed. There will be some mild vibrations and noise at this stage. A suction tip is used to remove water from the mouth, or your child may spit out when required. 
• The clean cavity is dried by blowing air onto it and then the filling is placed.

At Small Bites, we keep up to date with the latest filling materials and techniques. The two most commonly used filling materials for children’s teeth are:

Glass Ionomer Cement  

• Bonds directly to the tooth surface and so helps prevents leakage around the edge of the filling.
• Releases fluoride which can help prevent further decay.
• It is relatively quick and easy to place and is therefore popular for use with young children where cooperation for treatment is sometimes difficult.
• It  is quite brittle and prone to wear and so it is usually used in areas which are not under a lot of pressure from chewing.
• Reinforced Glass Ionomers have recently been developed which can be used in higher stress areas, such as the biting surfaces of the teeth.
• Glass Ionomer is white in colour but, unlike composite, it does not come in various shades to match the teeth more accurately. It also available in other bright colours for use in back teeth, if children prefer this.

Composite filling

• Composite fillings come in many shades which match and blend in well with the tooth. Therefore, it may be advised for front teeth where appearance is important.
• Composite is stronger and more wear resistant then glass ionomer.

• A blue etching gel, used to prepare the cavity surface, is painted onto the cavity surface and washed off after about 30 seconds. 
• A bonding agent painted onto the cavity surfaces. This adheres the filling material to the tooth.
• Next, the filling is placed in the cavity.
• A blue light is often used to give faster setting of the filling.
• The filling procedure takes a bit longer than for glass ionomer.

Your dentist will check the filling, and polish it, if required. Please follow instructions for looking after your teeth following treatment. It is usually advisable to wait half an hour before eating and drinking and to avoid hard, sticky and chewy foods on the same day. 

Pulpectomy

If the decay has started to affect the area containing the nerve of the tooth (the pulp), a pulpectomy is often required. For more information, see this link: Pulpectomy - Root canal treatment for baby teeth

Crowns

Teeth which are too broken down to adequately hold a filling or which have undergone pulpectomy usually require a crown to strengthen the tooth. This will be covered in a future post.

At Small Bites, the exclusive dental care centre for children in Bangalore, we have plenty of experience with young children and work to put them (and their parents!) at ease. If you have any questions or concerns, please contact us.



Don't forget to read our other posts for advice on preventing dental decay:

It's Never to Early to Start Preventing Tooth Decay
What Causes Dental Cavities?
Top Toothbrushing Tips

How to help a child who is anxious about the dentist - Part 2

In the first part of this blog we discussed finding a child-friendly dentist and how to help your child before an appointment.

Maybe you have a dental appointment approaching. How can both you and your dentist make things easier for your child during their visit?

How can the dentist help my child?

Treatment room at Small Bites

• Taking things one step at a time will help to build up confidence. It is usually best to start with a check-up and simple cleaning before moving onto other treatment.  
• Young children are not able to sit still or concentrate for long periods of time, so visits are best kept shorter or have breaks when needed.
• The dentist may introduce a "stop signal," like raising a hand, that can be used so that your child can let the dentist know if they are not comfortable or need a break.
• Distraction can be used to give your child something else to think about other than the dental treatment. For example, music, cartoons on a TV screen or simply chatting about something else.
• A good dentist will explain things in a way that your child can understand as they go along. Long explanations and words may be confusing for your child. It is best to have a separate chat with parents while the child plays it the waiting room if required.
• The dentist can first explain, and then demonstrate any tools or materials before using them. For example, an instrument can be used on the back of the hand or finger nail before it is used in the mouth so your child knows what it feels like. 
• Although the dentist should be friendly with your child they may need to use a sterner tone of voice if a child is not listening and following instructions much the same as a schoolteacher would.

Certificate of Bravery

• Positive Reinforcement - when a child behaves and cooperates well they should be rewarded with praise, stickers, a small gift or "bravery" certificate.

Should parents stay in the room for dental treatment?

This depends on your child's age and behaviour. Young children (below 4 years) tend to experience separation anxiety and therefore it is usually advised that parents stay in the room. 

Some children "play up" to their parents and behave better when they are not in the room. One solution for this is to allow the parent or carer to stay in the treatment room whilst the child behaves well, but ask them to go to the waiting room if the child is not listening and following instructions.  

How can I help my child during a dental visit?

• In the previous post we discussed the importance of staying positive and encouraging your child. 
• For young children, you may need to help support your child on your lap while that dentist checks their teeth as shown in the picture.

• If your child makes a fuss try to remain calm. Dentists who treat children regularly will have seen their share of tantrums and be prepared for this. Allow the dentist to guide you on how to best support you child.  
• Some children will "act up" at the dentist to try to avoid treatment. If they are immediately taken out of the treatment room they are more likely to do the same thing the next time. Instead it should be explained to the child what needs to be accomplished in that visit. If cooperation is difficult it is better to achieve a lesser goal than planned, for example, placing a temporary filling, than abandon treatment altogether.

It is better to use rewards after the treatment is over than to promise bribes before hand. 

Show your child how proud you are of them for each new achievement.

Finally - Prevention is better than cure

Although, with some help, the majority of children can learn to cope with (or maybe even enjoy!) visiting the dentist the goal should be to prevent the need for dental treatment as far as possible.

It's a great feeling to take your child for a check up and be told that there are no cavities!

Here are some tips for preventing dental decay and gum disease:

• Thorough tooth brushing twice a day, morning and night. For more brushing tips see this post (click for link).
• Rinsing out the mouth with water after eating.
• Eating a healthy diet and making snacks and drinks, between meals, sugar free as far as possible. 
• Dental sealants are a coating placed on the biting surface of the back molar teeth by a dentist. They protect the narrow pits and grooves of the tooth which can be prone to decay. See this post for more information (click for link).
• Regular check-ups not only get your child used to visiting the dentist but enable any early signs of dental disease to be spotted and prevented from progressing into a bigger problem.

Root Canal Treatment for Baby Teeth - Pulpectomy

What is a Pulpectomy?

Pulpectomy is the name given to root canal therapy for baby teeth. This is required when decay or injury to a tooth has caused infection of the nerve. The aim is to keep the tooth until the correct time for it to fall out. 

I have been told my child needs a pulpectomy - why can't he just have a normal filling?

It is possible to place a filling in cases where the decay is only affecting the first two layers of the tooth - the enamel and the dentine. 

Diagram is of an adult tooth but illustrates the same stages of decay

Once there is infection within the nerve of the tooth this needs to be dealt with properly. If this is not done the nerve will eventually die and an abscess can occur when the infection spreads outside the tooth. Apart from causing severe pain, dental abscesses can cause fever and other health problems. As adult teeth develop close to the roots of baby teeth untreated infection can spread to and affect the normal development of the permanent teeth.

It's just a baby tooth - wouldn't it be better to pull it out?

Although they are lost early in life, primary teeth, also called baby teeth or milk teeth, are essential in the development and placement of the permanent teeth.

Baby teeth maintain the spaces for permanent teeth to erupt into. If baby teeth are lost too early other teeth may tilt into or take up the vacant space, forcing permanent teeth to come in crooked. 





If the baby tooth is getting close to being pushed out by the adult tooth that replaces it, a pulpectomy may not be advised. This can be judged by looking at an x-ray of the teeth. In this case the baby tooth can be left to fall out naturally or, if there is spreading infection, may need to be extracted.

How is a pulpectomy done?

1. An opening is made through the top of the tooth. If the nerve is not completely dead, local anaesthetic will be required to numb the tooth first - click here for more information on this.
2. The decay and infected nerve are removed. The root canals are cleaned and shaped using small files and then washed and dried. 
3. The empty root canal space is then filled with a paste which is able to resorb as the tooth root loosens to make way for the new adult tooth.
4. A filling is then placed in the top part of the tooth. An x-ray will be taken to check the root filling.

Most teeth with pulpectomies will require a crown (cap), as when the nerve is dead or removed the tooth is more brittle and more likely to fracture. For baby teeth near the back of the mouth a pre-formed metal crown is most often used. This may be done or the same or the next visit.

Will the procedure be difficult for my child to cope with?

Pulpectomies do require slightly more cooperation from your child than for a simple filling. However, as baby teeth have shorter, wider and less complex root canals than adult teeth the procedure is less complicated and takes less time than for root canal treatment in adult teeth. There should be no pain, as long the tooth has been numbed where this is required. Your child might feel a slight tugging sensation while the canals are being shaped using the files. The procedure is usually completed in one visit of approximately half an hour, but make take two visits if the nerve is very infected.

What is the success rate for pulpectomies?

Clinical studies have shown a 78 to 96% success rate with the latest materials use for filling root canals in baby teeth. 

Are there any precautions that should be taken after treatment?

• Avoid eating and drinking for the first 20 minutes.
• If your child had local anaesthetic to numb the tooth they will need to be careful not to bite their lip or tongue until the numbness has worn off.
• On the day of treatment it is best to stick to softer foods that don't require a lot of chewing and avoid very hot food and drinks.
• There is sometimes some mild pain or discomfort as the tooth settles down. This can be relieved using children's paracetomol. (Calpol or Crocin).
• Your child should avoid biting heavily on the tooth until it is restored with a crown, as it may be brittle and prone to fracture.
• The teeth should be brushed normally.

Does a mother's dental health affect her baby?

When should we start thinking about our children's oral health?

Newborn babies do not yet have teeth - surely this is too early to worry about cavities or gum problems? 

What about during pregnancy?

Expectant mothers are keen to do everything they can for the health of their baby. However, many are unaware that  their own dental health problems can have effects on their general health and their unborn child. 

Research has shown that mothers with gum disease have a three times greater risk of poor and pregnancy and birth outcomes such as pre-term deliveries and low birth weight. This can occur as bacteria from the mouth and their by-products have the ability to cross the placenta to the developing baby and trigger inflammatory responses. Another study has shown a link between gum disease and pregnancy (gestational) diabetes.

Also, mothers with poor oral health and high levels of the bacteria which cause dental decay are at greater risk of passing these bacteria to their newborn babies, putting them at an increased risk of developing dental cavities at an early age. For more information on this, click for the previous blog post.

Problems with oral health in pregnancy

Unfortunately, due to pregnancy hormones, some women can be more susceptible to gum problems during pregnancy. Warning signs of periodontal (gum) disease include swelling, redness, bleeding and sensitivity.

Nausea and vomiting and extreme tiredness can also cause problems and lead to dental hygiene being neglected. Pregnancy cravings and the need to each more frequently may increase the risk of dental decay if sugary snacks are consumed often. 

Many women are concerned about the safety of dental treatment during pregnancy. However, treatment should not be unnecessarily delayed if appropriate safety precautions are taken. Active decay should be removed and the cavity filled. Pain and infection should not be left untreated, as these can cause stress and danger to both the mother and her developing baby. 

Guidance for expectant and new mothers

• Remember that your own dental health can have an effect on your baby, both during pregnancy and after birth.
• See a dentist for a consultation as soon as possible. Be sure to tell your dentist if you are pregnant as this may affect the treatment or medication prescribed. 
• Cleaning (scaling and polishing) and many other treatments are safe during pregnancy, you can discuss the best options with your dentist. 
• The second trimester (14th to 20th week) of pregnancy is usually the best time to get treatment done if required.
• X-rays are generally avoided during pregnancy but if they are required for urgent treatment then small x-rays using a lead apron to protect the rest of your body can be taken.  
• Maintain your oral health during pregnancy to prevent gum disease and decay. Try not to neglect brushing and flossing.
• If you are having gum problems, in addition to regular professional cleaning, using a chlorhexidine (antibacterial) mouthwash may help.
• Diet and nutrition is especially important during pregnancy. Although you will need to eat more frequently, try to choose snacks that are sugar free between meals.
• Take your new baby to see a dentist when they are 1 year old. An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice.