1. “Is the cleaning really necessary today?”
Many parents do not see the benefits of dental prophylaxis as they see it as treatment they can easily do themselves at home. The goal of dental prophylaxis is to remove supragingival plaque, stains, and calculus from the patient’s teeth. It provides an opportunity for oral hygiene instruction to the child and caregiver. It also introduces dental procedures to new and apprehensive patients. Most importantly, it allows for a high-quality oral examination by the dentist.
2. “Is fluoride safe for my child?”
It is well established that the consumption of fluoridated water and brushing with fluoridated toothpaste has helped reduce the prevalence of dental caries in children. Supervised fluoride use in appropriately dosed amounts has been shown in the literature to be one of the easiest at-home caries prevention measures. It is helpful to note that a toxic dose of fluoride is 5 mg/kg, and a lethal dose is 15 mg/kg. This means that a 10 kg child would have to consume 1-2 oz of toothpaste to reach a toxic dose and 5 oz of toothpaste to reach a lethal dose. With proper care and instruction, dental professionals can help families understand the safe and recommended amounts of fluoride for their individual child.
3. “When should my child stop using a pacifier?”
Pacifier use in newborns and infants is beneficial for offering comfort, decreasing the risk of SIDS, and preventing a digit-sucking habit. In premature babies, a pacifier may help develop the sucking reflex. The main concern with prolonged pacifier use is its effect on the development of the orofacial complex, which can lead to anterior open bites, high palatal vaults, posterior crossbites, and Class II malocclusion. Non-nutritive sucking is common in children under 24 months old and less common in those aged 24-48 months. The AAPD recommends intervention after 36 months old. However, earlier intervention may be recommended if there are early signs of malocclusion.
4. “Do they need braces?”
The word ‘need’ is subjective. Placing children in orthodontic appliances before full permanent dentition increases the risk of caries, demands more from caregivers in terms of attending additional appointments, and is not well tolerated by all patients. The goal of phase I (interceptive) orthodontics is to prevent small problems from becoming bigger problems in the future. This includes preventing dental crossbites from developing into skeletal crossbites, preventing severe crowding from leading to ectopic eruptions or impaction, and preventing malocclusion that requires surgical intervention. The question we, as dental healthcare providers, need to ask is, “can this issue be easily addressed when the patient has full permanent dentition, and can we minimise the total time in orthodontic treatment by delaying treatment until the patient is no longer in primary dentition?”
5. “My child grinds his teeth at night, what can we do?”
Generally, no treatment is recommended other than reassuring the caregiver. Juvenile bruxism is common and is usually self-limiting. It does not necessarily persist into adulthood. Splints can potentially inhibit growth and would require follow-up appointments for potential remakes or adjustments as patients rapidly grow and change, adding cost for the caregivers. Placing a removable appliance at night could potentially pose a choking hazard as well as increase the risk of caries. Most children with nocturnal bruxism are asymptomatic. In severe cases that lead to anterior attrition and a decrease in vertical dimension, occlusal build-ups on the primary molars can be placed.
6. “Does my child have a tongue tie?”
Frenotomies/frenectomies/frenuloplasties have become increasingly common practice in the last few decades. Although more research is still needed, the AAPD recognizes that a restrictive oral frenulum can affect a child’s health by hindering speech and breastfeeding. There are seven frenula present in the oral cavity, with the most common areas of concern being the ‘lip tie’ (maxillary frenum) and ‘tongue tie’ (lingual frenum).
Ankyloglossia has been associated with difficulties in feeding in neonates, limited tongue mobility, difficulties with speech, and malocclusion. There are many different classifications, but many simply describe the appearance of the frenum rather than the more important characteristics of the tongue’s ability to elevate. Given the nature of the patient population, studies showing improvement in breastfeeding and speech following surgical intervention have been difficult to produce. However, studies have shown that neonates with feeding difficulties, seen by a multidisciplinary team, have required less surgical intervention. Difficulties in breastfeeding are a multifactorial problem, and while surgical intervention can improve breastfeeding, not all infants with ankyloglossia require surgical intervention. Ultimately, this is a decision that needs to be made with a team that may include a speech pathologist, lactation consultant, and paediatric dentist.
7. “Does my child have a lip tie?”
Severe cases of ‘lip tie’ can be associated with feeding difficulties in newborns by inhibiting a seal with the breast. A poor seal can lead to greater air intake, resulting in reflux and irritability. There are different classifications for maxillary frenum attachment based on its insertion, with the most severe being insertion into the papilla crossing the alveolar process and extending up to the palatine papilla. However, recent research suggests that anatomical classification alone is not an accurate predictor of breastfeeding success, and assessment of lip flexibility and flanging are better predictors.
Hyperplastic maxillary frenums have also been associated with a midline diastema. A diastema in the primary dentition is considered normal. The maxillary frenum is generally not a static structure during growth and development. In many cases, the maxillary frenum migrates apically as the alveolar process descends. If the diastema persists into permanent dentition, then surgical intervention is indicated if aesthetics are a concern. Treatment is not recommended before the permanent canines erupt and only after orthodontic closure. If treatment is done before, relapse may occur due to scarring.
Oral Health welcomes this original article.
The information provided was taken from The 5th Edition Handbook of Pediatric Dentistry and The Reference Manual of Pediatric Dentistry 2023-2024.
About the Author:
Dr. Adam Hasanee completed his DDS at Western University in 2020. He then went on to complete a GPR at McGill University in Montreal Children’s Hospital. In 2023, he completed his Advanced Training in Pediatric Dentistry at the University of Minnesota. He is currently working in London, Ontario at Ari Pediatric Dentistry.
