Treatment of children’s permanent teeth

The first permanent tooth erupts pretty early at about 6 years old. Around the same time the lower jaw’s central incisor and the first molar tooth are erupting. Before the eruption of the first incisor the milk tooth falls out so the parents know that this will now be the permanent tooth which needs to be taken care of.

But in the place of the first molar tooth nothing falls out before since it erupts behind the temporary teeth arch when the upper and lower jaws have grown so the parents might not notice that it has erupted or think that it also is a milk tooth.

This moment is very important because this is the most effective time to cover the tooth pits with sealants – a special substance that prevents the accumulation of plaque in the pits and also the fluoride present in the sealants strengthens the tooth from inside.

If the eruption of the first molar tooth is overlooked and the oral hygiene is poor caries will very soon damage the enamel and dentin. The layer of dentin in a newly erupted tooth is thinner in comparison with older people’s teeth also the pulp is much more close to the surface which means that even a shallow cavity can cause a pulp inflammation.

At an early age the treatment of permanent teeth can be complicated by the distant position of the teeth and the small size of the patient’s mouth. After all the child is still small but we are already treating a permanent i.e. adult tooth. It is a difficult situation for both the patient and the doctor because it is not always possible to properly restore the damaged dental tissues.

If the tooth begins to cause pain especially in the evenings or at night it means that the caries has progressed and a pulp inflammation might have developed. In this case endodontic – root canal therapy – treatment is needed. For the 6 to 10 years old patients the endodontic treatment is problematic because of the incompletely formed tooth root tips. It becomes harder or impossible to properly fill the tip of the root canal which won’t guarantee a successful and lasting functioning of the tooth.

Sometimes we have to put a filling into a cavity that hasn’t been fully cleaned if after the full cleaning pulp tissue might open. In this case a lining layer is put at the bottom to protect the pulp from an inflammation and for the upper layer a composite or glass ionomer filling for molar teeth is chosen. If such treatment method is chosen and the tooth is watched during time we can expect positive results and preserve the tooth’s vitality. With time secondary dentin appears and makes the pulp cavity smaller and retracts the nerve from the caries. After a few years the old filling is removed, the caries is cleaned completely and a permanent filling is put in. In this way we gain time for the pulp cavity to shrink and the root tips to close. If the vitality of the tooth can’t be preserved we could still perform quality root canal therapy and filling.

Thus whatever the case we recommend to come for a consultation at “Odonteja” so that the caries could be diagnosed and treated as early as possible.