I am highlighting all these four issues in this 7-year old boy whose father brought him for pain and swelling in his lower left milk molar (temporary molar). The child was already prescribed some medicines after which the swelling and pain is considerably gone. His dad wants to be reassured that everything is O.K.
No, all is not fine in this case. His dad is ignorant about the all the four issues which I explained to him in detail. Spending 15-20 minutes with kids of this age-group are well spent because their dentition and occlusion is in formative stage.
Issue 1: Child’s lower front tooth is erupting in a position. So, the adjoining milk tooth is required to be removed (extracted) so that ‘tilted tooth’ is given an opportunity to straighten itself. It may not come in perfect alignment with just one extraction but we can always review the progreses periodically so that further intervention is done as and when needed.
Issue 2: Like most of parents of kids of this age-group, this dad does not know that in child’s mouth three permanent molas have already erupted. The two back molars at the last in the upper jaw and one molar on the child’s lower left side are first permanent molars which are also known as 6-year molars just because of the reason that these erupt at 6-year.
However, the tragedy with these 6-year molars is that parents think the kid is having only milk teeth in his mouth. Even if these are involved with caries and develop cavities, little attention is given thinking that these would fall off to make room for the permanent molars.
Dental Caries in such first molars (these are disease-free in this child) like caries in other milk teeth (see the pictures) is neglected until these start causing spontaneous pain. It usually indicates that the teeth won’t be managed with just restorations (fillings) – these would require Root canal therapy later on followed by capping (“Crowns”). This treatment is beyond the reach of 99% population (due to various reasons) and so a life-long cycle of suffeing starts —one after the other!
So, parents are to be made aware of taking utmost care of those newly erupted 6-year permanent molars.
Issue 3: Multiple Caries – The child has dental caries in many teeth which require restorations. The tooth in which child has suffered swelling and pain would require endodontic care (just like Root canal treatment) because these would still in the mouth for next 4-5 years approximately. This is the ideal situation. But just only a fraction of kids requiring such treatment (say less than 1%) can get such elaborate care resulting in further destruction of dental structure, repeated swellings, repeated antibiotics and so on … ultimately, some day this would break off on its own leaving behind roots stumps of milk teeth in the jaw. But the important point is that at times we choose not to remove those roots —which act as space maintainer by keeping the space reserved for permanent teeth developing underneath . And when the erupting permanent tooth pushes such roots they shed off later on.
Issue 4: Best Oral Hygiene Practice – this child is not trained in any oral hygiene practice. On his next visit, he would come with his toothpaste and brush when he would be taught the correct technique of brushing. His father was asked to buy a good tongue-cleaner for him so that he gets initiated into tongue hygiene at this age –the earlier the better. He and his father has been explained about the factors which are “eating away” his teeth and therefore dietary restrictions with respect to the frequency of carbohydrates, their form , frequency and timings have been taken care of so that evil is nipped in the bud.
Once again this post highlights the importance of regular periodic check-ups every 6-month or earlier if the parents find anything unusual in between. Are you listening, folks?