Last week, I had a 10-year old boy lying on my dental chair and his mouth looked like this:
Well, actually this is not his teeth. The little boy's dad told me he was concerned about the severe crowding of his son's teeth. Also, he told me that the boy was complaining of pain on his molars. Upon clinical examination I discovered the following:
a. His permanent molars were all beyond restoration (cannot be saved by fillings, alone). All four molars should either face extraction or root canal treatment (pulp therapy).
b. He was obviously on the mixed dentition stage (he had a mixture of his deciduous "baby" teeth and permanent teeth).
c. His permanent teeth came out in weird places.
d. A lot of his baby teeth had been retained (his baby teeth were not removed, even when the replacement permanent teeth arrived).
After mouth examination, I called the parents and explained to them everything that I saw and when I asked them why they did not have his baby teeth removed before, they said that it was because on the boy's first visit to the dentist, he had such an awful experience and did not want to come back anymore. I turned to face the boy.
Me: If we pull out your teeth now, are you still going to cry?
Me: You're a big boy now, soon you are going to like girls, how can you smile at a girl with teeth like that?
Boy: (He smiled at me --- I think he already knows what I mean)
Me: We have to take out your baby teeth okay?
One time I treated a boy with the same problem. The parents were problematic about the state of their child's teeth. They were crowded and they did not know what to do. I began to tell the parents about the “sequence of eruption” and explained to them how baby teeth naturally sheds off to receive the permanent.
Me: Sir, all of the baby teeth have to go when their permanent counterpart arrives. Why didn't you have them extracted before?
Dad: Oh no, I really don't have the baby teeth taken out because they are still okay. Look at them, they are not decayed. They're strong, right?
Me: Well yeah, but now your son's teeth is in this state! (referring to the mess that the baby and permanent teeth made in the mouth).
Dad: (he looked like he wanted to brag about something else, but just kept it to himself).
I get more of these in the clinic. I get to meet a lot of entertaining patients everyday. Unfortunately, my purpose here is not really to talk about my experiences… Instead, I would like to take this opportunity to talk to you about your baby's teeth. I reckon these things should be mentioned in advertisements on television, along with the repetitive instruction to use their brand of toothpaste. I also realized that every pediatrician should have a pediatric dentist as a partner (or be briefed about these things), because while all parents understand that vaccination and visits to the pediatrician is a must, many parents neglect the teeth until after their children first complains of a toothache.
Anyway, here it goes (Mind you, I am not an expert on parenting (not even in Dentistry), but I feel that this world would be a better place, if all parents knew about these):
- The incisors are the first ones to erupt. The lower incisors can come out as early as 6 months, the upper ones can come as early as eight. Their teeth continue to erupt into their gum pads until 33 months and the complete set is composed of 20 teeth (ten on the upper, ten on the lower). Here is an eruption chart that could help you track your baby's teeth.
- The 1st permanent molars erupt when your baby is 6 (hence they are called "the 6-year old molars") and they erupt at the back of the last baby molar. It does not replace any baby teeth and because of this, parents do not realize that this molar is already permanent. Being the first ones to erupt into the mouth, they are also the first ones lost (due to decay). The next permanent teeth to erupt are the permanent incisors, at age 7 to 8 years. Here is another eruption chart to guide you.
- Milk is the “meanest” culprit for tooth decay in children (hence the term: milk caries) and it is important for parents to make sure that their babies don't sleep sucking on milk.
- The moment your baby's first tooth comes out, you are immediately responsible for it.You cannot come to the dentist blaming the "yaya" or your child (believe me, I get moms who wash their hands and blame their children). As the parent, you are the authority and this is your responsibility.
Given the above information... WHAT CAN YOU DO??????????
- It is important to brush your baby's teeth. Sometimes it is not even important to use toothpaste. The most important thing is that you remove the milk from the surface of the teeth. You can use toothbrush with or without toothpaste. You can even use cotton and water. Just as long as you are able to clean the teeth before the baby sleeps, that will be fine.
- If your baby cannot sleep without his bottle, wait until he is almost about to doze off and switch the milk bottle with a bottle of water, to wash away the milk on the teeth.
- If you cannot do the switch properly (or if your baby does not permit you to trick him/her), wait until you baby is already asleep and get a toothbrush or cotton (with water) and try to clean the teeth and tongue.
- Make tooth brushing an enjoyable thing to do. Brush your teeth with them, if you must. Play his or her favorite song and encourage them to brush their teeth for the entire length of the song (or 2-3 minutes)
- As soon as your baby can be spoken to, can take small instructions, take him/her to the dentist (or before their 1st birthday). This first appointment does not have to be anything more than just "chit-chatting" and "counting teeth". In my clinic, I use the first appointment to get to know the patient. I do not even show the dental chair immediately, unless I feel that it is going to be okay. Please be merciful to your children and do not make their first visit to the dentist an EXTRACTION procedure, a PULP THERAPY or even a FILLING. You can always start with oral prophylaxis or cleaning, fluoride and sealant application.
- Take your child with you when you go for your annual dental check-ups, so that they can watch you, get to know the dentist and see the clinic for the first time.
- Regular visits to the dentist is important, especially during the time when the permanent teeth are already due to come out. Extractions can be timed so that the baby teeth will not be a hindrance to the eruption of the permanent teeth. NEVER choose to “prolong the life” of any of his primary teeth, especially if the permanent successor is already erupting. If you want to save money on orthodontic treatment (braces), take this seriously. Loosening of teeth in the gums is a good indication. If you can pull it out with cotton you can do it at home (believe me a lot of my teeth were taken out that way), but please do not do the "string on the door" method.
- Make "extractions" fun by being the tooth fairy! I help parents by giving the kids stickers and toys, every after the appointment and it works wonders. I have a little boy who even makes his dad call me for an appointment. He doesn't mind me pulling out his teeth. One time, I almost forgot to give him a sticker and when he was saying goodbye, he looked at me and said: "Can I have a sticker?" (It's not bribery --- it's reward!)
- PLEASE, DO NOT USE THE WORDS “INJECTION” and “DENTIST” as a THREAT or PUNISHMENT!!!
I hope that helped!!!