Our children’s teeth are a concern for us all. Are they brushing enough?
What age should they have their adult teeth? Is thumb-sucking really the end of the world?
We visited our friends Marie Baldo, dental associate with a postgraduate degree in children’s dentistry, and Amina Abdel-Karim, orthodontist, at Glow on Northcote Road to get the lowdown on the main problems to look out for and the treatments available to help.
Tooth decay is a major health concern worldwide and it’s still a big problem in the UK – it’s one of the most common causes of hospital admission in children. Dentists recommend that children and adults brush their teeth using toothpaste that contains fluoride, but sometimes more is needed.
Marie explains: “Fluoride application is a treatment that can be used to help protect against tooth decay and it is done here, in the dentist chair. A mousse is topically applied onto the surface of the tooth. It works by strengthening the tooth enamel, making it more resistant to decay. It’s very effective for patients with cavity problems or abnormalities such as weak enamel.” Fluoride tablets should not be given to children.
To help prevent tooth decay, fissure sealant is recommended. “On permanent molars (from about age seven or eight), we can paint on a small amount of fluoride inside the fissure which seals the tooth and protects it,” says Marie. This must be done early on healthy teeth only.
Some children have permanent white spots caused by a trauma on a baby tooth which has left a scar on a permanent tooth; they can also be caused by excess fluoride. These can look unsightly and although they can never be removed, they can be disguised using a clever micro-invasive treatment called iCon.
“We use a solution to make micro holes on the white spots, then we spread on a gel, which fills the holes and disguises the spot,” Marie tells me. “It all depends on how deep the lesion is, but it is most effective on superficial spots.”
Trauma on baby teeth
Baby teeth have a big nerve compared to adult teeth which means if a baby tooth suffers a trauma, it may recover by itself. Marie explains: “It goes grey because it has no blood flowing to it because the nerve has been damaged. But the nerve can recover after the bruising has come down, and the tooth may go back to how it was. A loose tooth can re-attach, but if the tooth is mobile, then you should have no hard food for one week. If it’s very wobbly, extraction may be necessary, but initially you should keep the tooth as re-attachment is always the best option.” It’s very important to monitor the gum above the tooth as there could be an abscess there. “An infection in the root can go unnoticed,“ warns Marie. “You should lift the top lip and look for a bump or yellow spot. Treatment would normally involve antibiotics but if the abscess keeps coming back, it would be best to remove the tooth.” Frustratingly, it is impossible to predict if a permanent tooth has been damaged by trauma on a baby tooth, even with an X-ray. It is just a waiting game.
Trauma on adult teeth
Amina suggests: “If you have an accident and an adult tooth comes out, as long as it’s clean, push it back in if you can; if not, put the tooth in milk and endeavour to get to the dentist within two hours maximum – but within half an hour if possible. If we replant a tooth, we may opt for a small fixed brace to hold the tooth in place, or we will use an implant. Your child will need antibiotics to stop any infection.”
According to Amina, at seven and a half years old, check the central incisors are there – they should come down within six months of each other; if not, there maybe an obstruction stopping the tooth erupting. Extra teeth could be preventing a tooth from coming down, so around eight years old is a good time to have an X-ray to check if there is a problem.
At around 11 years old, the adult canine tooth in the upper jaw should be there – that’s the 3rd tooth from the central incisor. Sometimes these adult canines can ‘drift off’ in the jaw and become stuck or even damage the roots of the other teeth. Research shows that in certain circumstances if the ‘baby canine’ tooth is removed, the adult canine will come down into the correct position.
This is a frequent problem between the central incisors in the upper jaw and often the gap will close by itself as canines come down. But there are common causes:
• Smaller teeth can cause a gappy smile – this could be hereditary.
• A fleshy frenulum (the ‘fleshy’ tissue flap above the front teeth).
• Missing teeth.
Whilst in very rare circumstances the frenulum can be removed, generally gaps close by themselves or a permanent wire, also known as a lateral retainer, may be used.
Around four to six per cent of people have missing teeth – it’s a genetic condition. The most common missing teeth are the lower second premolars – that’s no.5 in the lower jaw. The second most common missing tooth is the lateral incisor – that’s no.2 in the upper jaw. Signs of missing teeth are gaps or baby teeth that are there for a very long time. Usually your dentist will pick this up early. Amina says, “You should expect the upper lateral incisor to come through at around eight and a half years, and the lower second premolar by 12 years – if you have any concerns then you should go and see your dentist.”
There are two treatment options here:
- Closing the space down.
- Keeping the space or making it the ideal size for a prosthetic tooth.
Which option is best really depends on your child’s bite and how the teeth will fit together at the end. Usually, but not necessarily always, the treatment will involve fixed braces.
We all know how comforting kids find their thumb but it is a habit that should be broken as early as possible.
“Thumb-sucking turns the ‘U’ shape of the jaw in to a ‘V’ as it pushes the front teeth forward, preventing downward growth and creating ‘buck teeth’, whilst pulling the sides in, narrowing the jaw, leading to a cross bite,” explains Amina. “If your child can stop while they have baby teeth, the chances are everything will go back to normal; if they have a mix of baby and adult teeth, up until about nine years it might also be ok. Past 10 years old the problem may improve, but after 12 they will most likely suffer from a permanent bite issue.”
Amina says she has managed to get all her patients to stop sucking their thumbs within three to six months by using counselling over intervention, e.g. gentle reminders and reward charts. Then they can have a brace – using a brace before they have stopped the habit can lead to root damage.
There are different types for different ages and issues.
“An example is the twin block, removable brace used to encourage growth of the lower jaw and close a gap down, usually suitable for boys age 11/12 and girls age 10/11,” says Amina.
“This simple removable brace is used from an early age, eight to 10, for issues such as a top incisor that needs straightening or a cross bite,” says Amina.
“With this brace you can move teeth individually in all directions on all four planes,” explains Amina. “It’s the only method that achieves super-perfect teeth and is best for permanent teeth, for crowding or for complex problems, from 12 years and up.”
Following on from braces, permanent wires or retainers may be recommended so the teeth don’t move. In addition to this Amina also recommends see-through retainers which are initially worn full-time, but over future years as little as two to three nights a week.
Amina says, “Retainers are for life! Whether you have had braces or not, as we get older our teeth become more crooked. So it’s very important that you carry on wearing your retainers!”
Whatever the issue you and your child face, at Glow you will be in safe, trustworthy hands, where every case is carefully looked at and intervention only taken where absolutely necessary.