Dr. Saleha Shah
Aga Khan University Hospital, Karachi
Paediatric Dentistry is a branch of dentistry dealing with children from birth through adolescence. This speciality encompasses all of dentistry’s technical skills against a background of understanding child development in health and disease. Infants, children and adolescents in deciduous, mixed and permanent dentition may present with dental caries, periodontal disease, dental trauma, dental anomalies, oral pathology, special needs (mental or physical impairment or intellectual delay), paediatric systemic medical conditions ranging from haematology, cardiology, endocrinology, gastrointestinal, renal, hepatic, pulmonary, neurological, and dermatological and organ transplant among various other surgical needs to Cleft lip and Palate. Practice of paediatric dentistry entails examination, diagnosis and treatment planning for restorative, prosthetic, interceptive and minor surgical orthodontic care in conjunction with behaviour management and prevention.
World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity “and Oral health “as a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity”. Child Oral health is an integral part of their general health and a conceptual model by the National Committee on Vital and Health Statistics indicates that oral health outcomes of children are influenced by a triad of child level influences including physical and demographic, biological and genetic endowment, development, health behaviors and practice, use of dental care, family level influences encompassing family composition, socioeconomic status, social support, physical safety, health status of parents, family function and culture, health behaviors and coping skills of the family and community level influences incorporating social environment, dental care system characteristics, health care system characteristics, physical safety, physical environment, community and health environment, social capital and culture. Barriers to better oral health for children are multifaceted and we need to increase our attention to children’s oral health in both pediatrics and in dentistry.
Primary teeth are vital because they facilitate mastication (chewing) and phonetics (speech), maintain aesthetics and a beautiful smile, maintain space and guide secondary tooth eruption, influence the facial and jaw muscle growth and determine occlusion of the permanent teeth. Difficulties like access to the oral health system, continued high prevalence of largely preventable diseases, insufficient collaboration across fields, insufficient training of both dental and pediatric professionals and public policies that hinder access to oral health care may be addressed by improvements in pediatricians’ and dentists’ understanding of oral health; new and exciting educational programs for dentists, hygienists, nurses, pediatricians, and family physicians; the potential to train and employ new types of oral health professionals; institution of effective policies and evidence-based strategies in oral health promotion, prevention and treatment of oral diseases worldwide, health systems research and development. Collaboration between the medical and dental homes and making pediatricians and other health professionals an essential part of the oral health team can therefore make a difference.
A visit to the paediatric dentist provides a platform for acquiring contextual information on issues affecting children’s oral health and is the first step in voicing out concern’s about your child’s teeth, gums or mouth. Other concerns may include questions such as; when should I start teaching my child about tooth brushing? When should I take my child to the dentist for the first time? When do a child’s teeth first come through? I live in a fluoridated area-is fluoride in toothpaste still necessary? Is it okay to give my child a dummy (pacifier)? Should thumb-sucking be discouraged? I would like to bottle-feed my child; is there a reason why not? What is your advice on breast feeding? Why is fluoride important?
The primary dentition , transitioning from primary dentition early and late mixed dentition to finally permanent dentition are a transition period. They involve regular consultation, clinical and radio graphic monitoring and follow up visits, communication of preventive advice based on diet, oral hygiene, fluoride and fissure sealants and a multidisciplinary patient management in conjunction with an orthodontist, oral surgeon, prosthodontist, periodontist and a general dentist.
A pediatric dentist therefore aims to promote the importance of good oral health for children, inculcate optimal oral health habits, monitor the development and maintain a healthy and attractive primary and permanent dentition, instill a positive dental attitude through favorable early childhood dental experiences and provide holistic evidence-based management via interventions and preventive advice exclusive to every child patient to ensure not only an adequate oral health status but also an overall maintenance of the child’s well being leading to a healthy and progressive life.