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/

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.

Bruxism - Teeth Grinding Isn't Always Harmless

When children are growing, there are several things you need to be aware of, their weight gain, their food intake and the general state of their health. Often parents tend to ignore the mouth, assuming that as long as teeth are brushed and general mouth hygiene is maintained, everything will be alright.

Teeth brushing and observing the regular milestones of milk and permanent teeth aren’t the only things that need to be observed, since there are many other problems that point out to underlying issues in children, which if not treated affect teeth and their physical health, as well as add to the stress as they grow up.

One such condition that many parents tend to overlook, is Teeth Grinding or Bruxism. Although not a symptom, it points to an underlying .

Teeth grinding, teeth gnashing, or the unconscious act of clenching and unclenching teeth is present in most kids, with 2-3 out of 10 children having this problem. Most children grow out of it by the age of 7 years, but many others carry this habit well into adulthood. 

 Although the reasons are unknown, experts have given a few reasons for this condition,

• Stress induced teeth grinding, especially when children aren’t able to cope with a new situation, such as a test at school or meeting new people. An argument with parents or siblings or arrival of a second sibling is also seen as a probable cause
•  Mal-aligned top and bottom teeth which causes irritation and subsequent teeth gnashing
•  Pain anywhere in the face is also a cause, whether earache or appearance of new teeth 
•  Hyperactivity and restlessness
•  Kids with medical conditions ( such as cerebral palsy) or who take certain medication.

 How does one whether your child is grinding their teeth?

Have you heard your child’s jaw moving continuously or regular sounds from their mouth during bedtime? If you hear them grind their teeth while asleep, without being aware of it, and they experience a painful jaw or mouth on waking up or pain when chewing, it indicates they suffer from the condition.

What harm can it cause?

Bruxism as such is a temporary harmless condition, and children most often outgrow it. In those children where this condition persists, symptoms of headache or earaches are often complained. 

What harm can it cause the teeth?

A side effect of bruxism is the harm it can do to the child’s teeth. Nightime grinding, gnashing and clenching the teeth, can wear down tooth enamel, gradually chip off teeth, make the tooth temperature sensitive and also cause lingering jaw and mouth problems and pain.

It is important to take the child to a pediatric dentist, before the condition causes severe irreparable damage to the teeth in the long run. A dentist will examine the child’s teeth for chipped tooth enamel, and any other wear and tear.  In addition questions related to stress or tension will try to be discerned.

All these observations will give the dentist information on whether the cause for bruxism is psychological (stress induced) or structural (misaligned teeth) and treat the child accordingly. 

 Treatment

While the condition is outgrown by most children, some kids who have severe pain and wearing out, are prescribed a mouthguard; a thin protective mouthpiece moulded to the child’s teeth that acts as a barrier between the opposing sets. This can take care of the major problem.

If the cause is emotional or psychological, the underlying cause needs to be found out by talking to the child, understand reasons that are upsetting them, and try and resolve the issue. If it seems more complicated, then their fears will need to be eased by counseling.

Bruxism usually stops when the milk teeth are lost. In few cases the condition might continue well into teenage years. The condition cannot altogether be avoided, because most often, it is a coping mechanism in children, and their natural reaction to growth and development. It can however be avoided by talking to children frequently, letting them open up and ensuring regular visits to the pediatric dentist are carried out for optimal dental health.

Why choose a Paediatric Dentist?

It's time to take your child to visit the dentist. 

Do they really need to see a different dentist than you? 

How do you choose the best dentist for your child?

What is a Paediatric Dentist?

Paediatric dentists, sometimes called pedodontists, are the paediatricians of dentistry. They specialise in dental care for children, from babies up teenagers. Paediatric dentists have done two or more years of training specifically in children's dentistry after completing their dental degree.

How are they different from other dentists?

Paediatric dentists treat only children and so their practices are designed to be a welcoming and child friendly. They have a lot of experience in working with children who are anxious and can spend extra time to reassure them  and explain things in a way kids can understand. During their training, paediatric dentists study developmental psychology to understand how children think differently from adults. They also receive training in working with individuals with special needs.

Paediatric dentists are experts in monitoring dental development as children grow and mature. Therefore they are more easily able to spot potential problems which may require early orthodontic treatment. 

Due to their training and experience pedodontists are proficient in the latest techniques and procedures for children's dentistry.

Paediatric dentists tend to emphasis prevention of dental diseases. They recognise the importance of giving children a good start by helping them to develop healthy habits such as tooth brushing and a good diet early in life. They can also offer treatments that can help to prevent dental decay such as fissure sealants. 

Why choose a Paediatric Dentist?

A child's early dental experiences have a lasting impact. Positive experiences will lead to a child becoming comfortable in visiting the dentist and motivated to look after their teeth. Dentists tend to have an area of dentistry which they enjoy and specialise in. Why not choose a dentist who has the motivation, training and experience to give your child the best care?

The Small Bites Experience

Small Bites is the first exclusive dental centre for children in Bangalore. The Small Bites team offers the full range of dental care in a fun and child-friendly environment. Our little clients soon feel at home with the inviting waiting area and fun décor. 

We take time to understand and reassure children, especially those who are anxious or have special needs. Pain management is a priority, so that children can feel comfortable and relaxed.

Children can even watch cartoons to help distract them and put them at ease during their dental treatment.

At Small Bites, we are always keeping up to date, using the latest materials and techniques to provide high quality care. We follow strict standards in sterilization and cleanliness. We are the first dental clinic in Bangalore to offer stem cell banking from baby teeth and nitrous oxide sedation.

At Small Bites (click for link to website) we firmly believe that, working together with children and their parents, we can give children healthy smiles to last a life time. 

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

Fluoride: What parents need to know - Part 2

In Part 1 we discussed the benefits of fluoride and the risks of over-exposure to fluoride.

Fluoride can be useful in strengthening teeth and protecting them from decay, if used in the right way. 

As we discussed in the previous section, there is a risk of dental fluorosis, or mottling of teeth, if children swallow too much fluoride.

In this second part we will look at the uses of fluoride and safety guidelines.

Products which contain fluoride

Fluoride Toothpaste 

This is the most common application of fluoride as it can easily be used regularly at home. Regular use of fluoridated toothpastes has been shown to reduce tooth decay by up to 50%. 

Safety guidelines for using fluoride toothpaste:

• Young children who cannot spit out should use either plain drinking water or a training toothpaste which does not contain fluoride for brushing.
• Children generally learn to spit out from around 5 or 6 years old. At this stage fluoride toothpaste can be introduced with adult supervision.
• It is best to use a lower fluoride toothpaste up to 7 or 8 years old, when children still tend to swallow some paste and their developing teeth could still be at risk of fluorosis.
• The amount of fluoride is usually shown on the toothpaste packet in parts per million (ppm). In India, most adult toothpastes contain 1000 ppm and toothpastes designed for children often contain 500 ppm or less of fluoride. 
• No more than a small pea-sized amount of toothpaste should be used. Instruct your child to spit out after brushing and not to swallow it. 

• Keep toothpaste out of the reach of young children. Swallowing large amounts can cause stomach problems and other health issues. Seek immediate medical attention if a child swallows a large amount of toothpaste. 

Fluoride Mouthwash or Rinses

Mouthwashes are not recommended for children. If a teenager or young adult is at a high risk of cavities, or wearing braces which make their teeth more difficult to clean, their dentist may recommend a fluoride mouth rinse to be used at a different time from brushing. This should of course not be swallowed. Avoid mouthwashes that contain alcohol.

Fluoride Varnish

Fluoride varnishes are useful for children who are at a higher risk of tooth decay. As they contain a very high level of fluoride they can only be used by dentists and applied no more than twice a year. 

The varnish is painted onto teeth and sets quickly, sticking to the tooth surface to minimize swallowing and maximize its effect. If a tooth has very early dental caries in enamel, it can help to stop the decay and prevent it becoming a cavity. Fluoride varnish is also beneficial for sensitive teeth.

Glass Ionomer Fillings

Glass Ionomer is commonly used for fillings and sealants in baby teeth. In addition to being able to adhere directly to tooth surfaces it also releases small amounts of fluoride over an long period of time. The level of fluoride released is too low to cause any health problems but helps to prevent decay and the need for future fillings.

In Summary

When used in a controlled way, the benefits of fluoride outweigh the risks. 

Parents and dentists need to take into account the overall fluoride exposure from all sources when making decisions about the use of products or treatments which contain fluoride. 

In areas with high levels of fluoride in drinking water, fluorosis  (mottling and staining of the teeth) is common. In these areas it is wise to minimise fluoride exposure as much as possible. 

Dental Fluorosis

In areas where the is no significant fluoride in water the appropriate use of some fluoride therapies will be important in preventing decay.

If you need more information and advice, please speak to your dentist.

If you live in Bangalore, you can contact us at Small Bites, Exclusive Dental Care Centre for Children (click for link) where we will be happy to help.