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Pediatric  Dental   Health

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What Are Space Maintainers?
Space maintainers are intraoral appliances (spacers) which prevent teeth from tipping and moving into an extraction area. Space maintainers work by keeping a space open so that adult replacement teeth will be able to erupt into the mouth in the correct location.

Children often need space maintainers after they have had a primary (baby) tooth extracted. A space maintainer can either be cemented to one or more remaining teeth, or it can be a removable appliance. The space maintainer will need to stay in place until the succedaneous (adult replacement) tooth erupts into the extraction area. Space maintainers need to be checked by a dentist twice a year, and adjusted, if necessary.

After the extraction of a primary posterior tooth, the adjacent teeth will often move into the extraction space. This unwanted movement of adjacent teeth leads to a loss of space - space that will be needed in the future by the succedaneous (adult) teeth.

If an extraction space is allowed to "close up," the future adult tooth will not able to erupt (grow into) the mouth correctly. If teeth are allowed to tip into an extraction area, the unerupted future adult tooth may end up being impacted (stuck). Space loss often leads to an adult dentition that is crowded, and a child with this problem will need orthodontic treatment later on to correct it.

Space maintainers can also be used as "preventive orthodontic appliances." In cases involving moderate crowding in the mixed dentition (the dental arches from ages 6 - 12), a LLA (lower lingual arch) space maintainer may be used to prevent unwanted shifting of the permanent lower molars. A LLA designed for this purpose uses the principle of saving "leeway space."

The "leeway space" principle states that since primary molars are wider than their adult replacements, the potential "extra space" can be "saved up" and utilized later to relieve crowding in other parts of the dental arch.

A recent journal article reviews the management of dental space problems in children:
Ngan P, Alkire RG, Fields H. Management of space problems in the primary and mixed dentitions.
JADA 1999; 130:1330-39.

Learn more about Space Maintainers.

Can Sleep Disorders Affect Dental Health?
Some children have sleep disorders which affect their dental health. These disorders include sleep-related bruxism and sleep-related gastroesophageal reflux.

Sleep-related bruxism (SB) is the contraction of jaw-closing muscles with dental grinding. SB can lead to attrition (excessive wear) of the teeth, and to increased orofacial pain. There is growing evidence that light sleep and altered brain chemistry may also be associated with bruxism.

Emotional stress is no longer considered to be a major factor in most cases of SB. Likewise, heredity is no longer thought to play an important role in most cases of SB.

Sleep-related gastroesophageal reflux (GR) can chemically erode the enamel away from teeth. GR often creates dished-out areas of missing enamel on children's teeth. GR occurs when there is regurgitation of the acidic stomach contents into the esophagus and mouth.

If your child complains of a sour taste upon awakening, or has epigastric pain (pain above the stomach), then he/she may have GR. A child with such symptoms should be evaluated by a physician.

If you suspect that your child has a sleep disorder, you should also have your child evaluated by a physician. The physician will examine your child for enlarged tonsils and adenoids, GR, CNS disease, craniofacial abnormalities, and hypothyroidism.

Your physician may suggest an evaluation by a pediatric dentist, who will check for signs of abnormal tooth wear, chemical erosion of enamel, tooth hypersensitivity, and jaw muscle discomfort.

If indicated, a pediatric dentist will recommend a soft or hard night guard. Night guards will decrease the destructive effects of sleep-related bruxism in some cases. Night guards can also help protect teeth from the acid damage caused by GR.

Children with sleep disorders should:
1. Wind-down and relax 60-90 minutes before bedtime. 2. Avoid caffeine-laden soft drinks.
3. Sleep in a comfortable bed, located in a quiet, dark, and cool room.
4. Take a few sips of water right before bedtime to help reduce acid reflux.

A recent scientific article reviews the dental aspects of sleep disorders:
Lavigne GJ, Goulet J, Zuconni M, Morisson F, Lobbezoo F. Sleep disorders and the dental patient.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:257-72.

Lean more about Sleep Disorders.

Can Children Get Gum Disease?
Children can be affected by early-onset periodontitis. This disease affects the health of the gingival tissue, as well as the root covering, dental ligaments, and supporting bone.

There are several types of children's periodontal disease, including: prepubertal periodontitis, juvenile periodontitis, and periodontitis associated with systemic disease.

Periodontal disease is the destruction of: the gingival tissue, the root's outer layer, the ligaments surrounding the roots, and the supporting bone. This destruction is the result of periodontal inflammation. The inflammation is caused by the battle between destructive oral bacteria and the body's natural defense system.

Prepubertal periodontitis (PP) occurs in children who are between four and twelve years old. The health of a child's immune system can affect the severity of periodontal disease. One type of PP is called generalized prepubertal periodontitis (GPP). GPP occurs frequently in children who have otitis (earaches) and URI (upper respiratory infections).

Juvenile periodontitis can occur in children who reach puberty. Since some children attain puberty as early as eight years of age, they can suffer from hormonal-induced gingivitis while they are still young.

Periodontitis associated with systemic disease can occur in children of any age. This type of periodontal disease is often found in children with uncontrolled diabetes, cyclic neutropenia, agranulocytosis, syndromes, AIDS, cancer, and children taking anticonvulsant or post-transplant medications.

Current treatment for children's periodontitis includes periodic deep cleanings (scaling and root planing), as well as a ten-day course of oral antibiotics (amoxicillin and metronidazole).

If you suspect that your child has early-onset periodontitis, you should have your child evaluated by a pediatric dentist. He/she will take a complete medical history and vital signs, perform an oral and dental exam, measure the depth of periodontal pockets, take and evaluate a series of radiographs (x-rays), and order any necessary blood tests. The pediatric dentist may also refer your child to a pediatrician for an evaluation.

A recent scientific article provides a review of this important topic:
Wara-aswapati, Nawarat; Howell, T. Howard; Needleman, Howard L. et al: Periodontitis in the child and adolescent.
J Dent Child, 66:167-174, May-June 1999.

Learn more about the American Academy of Periodontology.

What Makes Baby Teeth Turn Dark?
A baby tooth may change color after being subjected to trauma. A front tooth can be traumatized during a fall, while running into furniture, while engaging in rough play, or from impact with a blunt object. Dental trauma affects the blood supply to the tooth, and therefore its health and color.

Different color changes suggest specific problems with traumatized baby teeth (primary incisors). Such teeth may turn dark, but in many cases the color will change back to normal after a few months. Traumatized primary incisors may develop yellow, grey, or pink discolorations.

A yellow or yellow-brown discoloration indicates calcification and obliteration of the dental pulp (nerve canal). No treatment is usually needed with this type of discoloration.

A grey or black discoloration indicates necrosis (death) of the dental pulp in 98% of cases. Such teeth will usually require root canal treatment or extraction.

A pink tooth indicates either internal resorption, or the presence of blood pigments in the dentinal tubules of the tooth. The pink tooth needs to be monitored closely.

If your child has a discolored incisor, you should obtain a consultation with a pediatric dentist. He/she will take a medical history, perform a quick neurologic assessment and extraoral examination, obtain details of the traumatic incident, examine the discolored tooth and the surrounding oral structures, attempt to take X-rays of the tooth, and suggest a treatment plan for our child. You may be asked to hold your child in your lap during the X-ray procedure.

Treatment of a discolored primary incisor may involve periodic radiographic and clinical evaluation, root canal treatment, or extraction of the tooth - depending on the health of the tooth and your child's ability to cooperate with dental treatment.

A scientific article reviews this topic:
Holan G, Fuks AB: The diagnostic value of coronal dark-grey discoloration in primary teeth following traumatic injuries.
Pediatr Dent 18:224-27, 1996.

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