The primary teeth are treated like the primary ones | Eva Magazine | Jully 2015

Advice by Dr. Cvetelina Ducheva, pediatric dentist from DENTAL CLINIC PETAR DUCHEV
By Mariana Antonova
Photo: Archive of Dental Clinic Petar Duchev

Dr. Ducheva, you have been working mostly with children for the last 12 years. Do they have good hygiene habits and health culture?

I always say that more can be done. The caries are a contagious infectious disease and as such, they need prophylaxis and treatment. Only 4% of the children in Sweden have cavities. In Bulgaria the 12-year-olds have cavities on 4 to 7 of their teeth on average, and one in every four 18-year-olds is missing a permanent tooth. This is why we created and we work on a program, the main goal of which is prevention and prophylaxis of early cavities in children.

A lot of people think that primary teeth do not need serious care. Primary teeth must be treated. They have crowns and roots just like the permanent ones, and they get damaged and ache just like them. In the majority of the cases with primary teeth, the cavities appear between two neighboring teeth and they cannot be seen by the parents. This is why the children must be brought to a dental checkup twice a year. Our clinic works only with children during the weekends, because the needs of children and adults differ. During the weekends we have colorful puzzles, lego bricks and toys on the floor, the team is dressed in colorful uniforms. We try to make the little patients feel as if they are at a children’s center, not at a dental clinic. In most cases we make the examinations while playing with them. We give to every parent a "ruler of the dental health". The parents can use it to inform themselves about what their child needs at every stage of his/her dental development. For example, the child should be introduced to a dentist within the first year after its birth. During these meetings we advise the parents about the way to wash their child’s teeth, when to start, what oral hygiene products to use. From 3 to 6 years of age it is reasonable to diagnose possible occlusion problems and to think about correction, if needed.
At six years of age it is good to give the child his/her first professional hygiene session, i.e. – to have his/her teeth brushed with a brush and toothpaste by us. This is when the permanent teeth begin to erupt and our goal is to train the child to be more careful with his/her health and dental hygiene. If the examination shows that the child has teeth problems, we provide the details and price of a treatment plan – when each treatment stage will take place, what its duration will be, what the preparation will be comprised of. It is a good idea to take the children to a pediatric dentist who is prepared and motivated to work with little patients. My team and I, for example, we have been trained at pediatric dental clinics with traditions in Europe and Ukraine.

What happens if we don’t treat a rotten primary tooth?

If the permanent tooth erupts under a rotten primary one, the infection of the latter will inevitably be transferred to the former. If a permanent tooth has erupted next to a rotten primary one, there is a possibility that the former gets damaged, too. A rotten primary tooth is one of the reasons why the first permanent teeth of the children – the sixth ones, which grow furthest and behind the primary ones when the child is six, need fillings. Many parents don’t know that a chewing tooth which requires more careful brushing, will grow there.

When should the brushing with a toothbrush and toothpaste begin?

It should start from the 9th or 10th month, when the child can sit at a stable position. The brush should move on the teeth with circular movements. After the third year, we can let the child brush his/her own teeth, but we always need to check on the quality of the job s/he has done. This is especially important for the age when the teeth change, because during this period the jaws grow and food remains in the spaces between the teeth. As a rule, teeth brushing is obligatory in the evenings and recommended in the mornings. This applies to children as well as to adults. Some parents make an extra effort and use electrical toothbrushes, dental floss or mouthwash. The product should be appropriate for the age of the child and be selected in accordance with his/her needs – this is best decided by the experts.

What is your advice for the toothbrush and toothpaste for children?

With children up to 3 years of age, the head of the toothbrush should not be longer than 1 cm, with soft hairs and in shiny colors, with a shape that both resembles a toy and can be firmly held in the hand. It should also be changed often since at the beginning the children chew on it and it cannot function as intended. The children up to 3 years of age tend to swallow the toothpaste so it should be fluoride free. In Bulgaria most waters are rich in fluoride, it is also added to formula milks, baby purees and foods and can therefore be easily overdosed. As a result, the permanent teeth grow with brownish or bright white stains which are both unsightly and susceptible to cavities. Children aged 4 and above can use toothpaste with fluoride, because it helps the mineralization of teeth.

What is the reason for the early cavities?

The first cavities in patients who were born in the 70s and 80s appeared around the age of 4 ½ or 5. Nowadays this problem arises as early as three years or less. One of the reasons is that the food and water contain a lot of additives, sweeteners, paints and preservatives, while our children are strongly tempted by advertising to try everything. I tell every parent that they should take their child for a dental examination during the first year after birth – even if only 3 or 4 teeth have grown. Only the dentist can provide expert advice on how to keep the child’s teeth healthy. It is common for parents to take their babies only to the pediatrician during the first year, but many of the pediatricians do not pay appropriate attention to dental hygiene and health, although it is the healthy teeth that provide for the normal nourishment of the organism, and it is teeth problems that affect the health of kidneys, heart and joints.

For or against the babies’ favorite toy – the pacifier?

The pacifier is one of the most harmful toys for the child. If its use is not discontinued until the age of 18 months, occlusion problems start. Our orthodontist currently treats a large number of children whose problems started either with a pacifier, thumb-sucking or a third tonsil that was never properly treated. If the intervention had taken place earlier, the treatment would have been much easier, faster and cheaper.

Do you think that snacking between meals is a bad habit?

Snacking between meals is a problem. Children are usually given crackers, crisps, wafers, jelly sweets, lollipops and other similar foods. These mostly contain carbohydrates that stick to the teeth, decay and create highly acidic medium where pathogenic microorganisms develop and the destruction of the enamel of the teeth happens rapidly. If the child is 3 years or older, after the consumption of such foods it is good to offer him/her a piece of chewing gum which is a very good way to clean the teeth. If the child is younger than three years, you can add a glass of milk to the piece of cake for late breakfast or afternoon snack. You could also finish the snack between meals with a piece of apple or another fruit or vegetable which requires chewing effort and works as a natural toothbrush. You can replace it with a piece of yellow cheese that cleans very well, stimulates salivating, washes off the food leftovers and decreases the pH level in the mouth. There are simple pieces of advice that the parents can learn if they take their child for a dental checkup.

Are there any other activities that harm the teeth and depend on the parent?

There are, yes, for example letting your child have yoghurt or formula in the evenings after you have brushed his/her teeth, up until the age of 2 or 3. The milk that is given when your child falls asleep remains in the mouth throughout the night and is a serious reason for numerous cavities.

What else do you advise the parents?

I tell them that the pure milk chocolate without additives is a very good dessert for our children, but control over the amount and frequency of its consumption is needed. The chocolate does not stay long in the mouth because it is easily dissolved and the saliva washes it off very quickly. I also explain that we should not give children too much homemade fruit juice. It is better for the child to eat the fruit, because it contains fibers that provide natural cleaning of the teeth.

Shall we take the child to the dentist if a primary tooth is loose?

If the child goes for a regular dental examination every 6 or 8 months and the dentist notices that the tooth is loose but there is enough room for the erupting permanent tooth, it is not a problem if one of the parents extracts the primary tooth or lets if fall off while the child is having an apple for example. However, when there is not enough room or the permanent tooth has started to erupt before the primary one gets loose, it is best to consult a dentist.

A lot of parents fear the radiation when a panoramic X-ray of their child’s teeth is made.

With the modern digital X-ray machines, the radiation is the same as the natural radiation from the environment we would get by spending a day at the beach. The equipment at our clinic is among the most advanced on the market and the radiation dose is different for every age. This is why I tell every parent that with children above 6 years of age, the use of the X-ray examination is of huge diagnostic value – much larger than the possible harm.

It is the parents who fear the dentist the most and they transfer their fear to their children.

I am a lecturer at a school for future parents and my favorite lecture slide represents a photo of a dental practice, which was taken before 1989, the kind of practice that some of us remember. It is really frightening! This is why when we were planning the clinic I insisted on having transparent walls and doors. When the child is in the dentist’s chair and mom and dad are outside so that s/he can see them and vice versa, everyone is calm. The children that are harder to work with, have one of their parents sit in the chair with them. It is most important to win the trust of the child. If you do, you will have the trust of the parent, as well.

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