What is the scope of pediatric dentistry (pedodontics)?
Pediatric dentistry (pedodontics)a branch of dentistry that aims to protect the health of primary and permanent teeth in children aged 0-13 and treat any diseases that arise; it works to instill good oral and dental health habits in children, protect them from future dental problems, and create lifelong positive impressions by providing a positive dental experience.
How does tooth development occur in children aged 0-13?
Tooth development in children aged 0-13 is a complex physiological process that begins in infancy and continues until the permanent teeth erupt. Throughout this process, both tooth eruption and the development of the jaw and facial structures undergo significant changes. Pediatric dentists play an important role in early diagnosis and intervention for potential problems during this developmental period.
Tooth development in children according to age groups is as follows:
Toothless period (0-6 months):
This covers the period from birth to the appearance of the first baby tooth in the mouth and lasts an average of 6-7 months.
Prenatal foundations:
Tooth development actually begins before the baby is born. Tooth buds form in the womb. At birth, both baby and permanent tooth buds are hidden under the gums in the baby's jaw.
Jaw relationship:
In newborns, the lower jaw (mandible) is usually smaller and set back relative to the upper jaw (maxilla). Sucking stimulates the forward growth of the lower jaw, helping this difference close over time.
Development:
With growth and development, the three-dimensional growth of the alveolar bones provides the necessary space for tooth eruption and proper tongue positioning.
Primary dentition period (6 months-6 years):
Eruption of primary teeth:
Primary teeth begin to erupt between 6 and 8 months after birth, and primary dentition is completed between 30 and 36 months.
Teething times:
- First teeth to appear: The lower front incisors usually appear at 6-8 months.
- Last teeth to appear: The baby molars appear last, at around 24-36 months.
- Full set: By age 3, all 20 baby teeth are usually in place.
Important physiological characteristics:
Developmental gaps (Diastema):
Gaps between baby teeth are perfectly normal and healthy. These gaps make room for permanent teeth, which are wider than baby teeth. A gap called a “monkey diastema” is expected between the upper incisors in particular. The absence of these gaps may be an early sign of future crowding of the permanent teeth.
Terminal plane:
This is the alignment of the rear tips of the primary molars. The shape of this alignment determines the future occlusion of the molars.
Early childhood caries/bottle caries:
The risk of caries is very high due to the thin enamel of milk teeth and children's inability to brush their teeth effectively. Milk, formula, or fruit juice given in a bottle before bedtime or during sleep causes severe cavities that spread rapidly in the upper incisors.
The destructive effect of habits:
Thumb sucking, pacifier use, or tongue thrusting habits that continue after the age of 3-4 cause the following results:
- The upper teeth being pushed too far forward and the lower teeth being pushed inward (open bite),
- The upper jaw narrowing and taking on a “V” shape,
- The upper and lower front teeth not touching each other (open bite)
Trauma:
Front tooth injuries and fractures due to falls are common in toddlers who are just learning to walk.
Mixed dentition period (ages 6-12)
This is the period when both primary and permanent teeth are present, permanent occlusion is established, and it requires the most active monitoring and preventive dentistry.
Tooth eruption sequence and important teeth:
Six-year molars (first permanent molars):
These are the first permanent teeth to erupt from the back of the mouth, without shedding any baby teeth and before the baby teeth are replaced. These teeth, which are exposed to the most chewing force in the mouth and should remain in the mouth for life, are unfortunately the teeth most prone to decay. They must be protected with fissure sealants.
Front incisors:
Between the ages of 6 and 8,6 and 8, the baby incisors fall out and are replaced by permanent incisors. When these teeth erupt, they may appear “egg yolk” colored because they are in the front; this is normal. Over time, the enamel thickens, and their color matches the other teeth.
Canine teeth and premolars:
- They erupt between the ages of 9 and 12.
- Wisdom teeth (second molars):
- They erupt around the ages of 11 to 13, behind the 6-year molars.
Critical issues:
Space maintainers:
If a baby tooth is extracted or falls out before the permanent tooth that will replace it erupts, the adjacent teeth shift into this space. This causes the permanent tooth to become impacted or erupt crooked. To prevent this, simple appliances called space maintainers are made.
Space gain:
Baby molars are wider than the small molars (premolars) that will replace them. This extra space naturally provides room for the permanent teeth coming in underneath. For this mechanism to work properly, baby teeth must be protected from decay.
Early diagnosis of orthodontic problems:
This period is the “early orthodontic intervention” period when crowding, narrow jaws, or malocclusions can be detected early and resolved with simple appliances (removable braces).
Trauma and root development:
The roots of permanent teeth emerging at this age are not yet fully developed. A blow to the mouth can cause the tooth to lose its vitality and halt root development. Therefore, the use of mouth guards is vital, especially for children who play sports.
Prevention and protection:
The main goal of pediatric dentistry is to control and prevent tooth decay. Preventive measures and early intervention help avoid complex orthodontic treatments and surgical procedures.
Individualized treatment:
A personalized treatment plan should be developed for each child, taking into account their caries risk status, appropriate treatment options, and behavior.
Behavior management:
Behavior management techniques (explain-show-do, voice control, positive reinforcement, distraction) and, when necessary, advanced techniques (protective stabilization, sedation, and general anesthesia) are used for treatment, especially in uncooperative children. General anesthesia offers advantages such as preventing the development of dental phobia and ensuring treatment quality.
Oral hygiene education:
- It is very important to start oral hygiene habits as early as possible and to educate parents on this subject.
- With a comprehensive and careful approach during this period, the foundations for lifelong oral and dental health are laid for children.
The main issues and areas addressed by pediatric dentists (pedodontists) are as follows:
Problems related to baby teeth and permanent teeth:
Problems related to baby teeth and permanent teeth and their treatments are as follows:
- Cavities (childhood cavities, bottle tooth decay)
- Early loss of baby teeth and space maintainers
- Treatment of tooth decay (fillings, root canal treatment, amputation)
- Enamel defects (hypomineralization, fluorosis)
Preventive dentistry:
Preventing tooth decay and other oral diseases is one of the main goals. Preventive dentistry practices include:
- Fissure sealants (prevention of tooth decay)
- Fluoride applications (varnish, gel, or enamel)
- Teaching children proper oral hygiene
- Nutrition counseling (sugar consumption, bottle feeding habits)
Orthodontic problems:
Early orthodontic interventions are critical to prevent or correct malocclusions during the permanent dentition period. Premolar teeth (small molars): teeth located on the sides of the mouth, between the incisors and the large molars. There are a total of 8 premolars in adults, 2 on each jaw, on the right and left sides, and agenesia (congenital absence of one or more teeth).
- Orthodontic problems:
- Crowding, malocclusion (incorrect bite)
- Bad habits such as thumb sucking and tongue thrusting
- Orthodontic problems associated with early loss of baby teeth
Traumatic dental injuries:
Emergency care, diagnosis, and long-term follow-up of traumatic injuries to teeth and supporting tissues in children and adolescents are performed.
- Trauma and emergency interventions include:
- Broken/avulsed teeth in falls or accidents
- Tooth displacement (avulsed tooth) and replantation
- Soft tissue injuries (lip, tongue, gum)
Pulp treatment (root canal treatments):
Diagnosis and treatment of pulp lesions in primary teeth and young permanent teeth are performed.
Techniques such as pulpotomy (removal of infected pulp tissue only from the crown of the tooth) and pulpectomy (removal of all pulp tissue from both the crown and roots of the tooth) are performed.
Behavior management:
- Psychological and pharmacological techniques are used to manage dental fear, anxiety, and cooperation issues in pediatric patients.
- The “Tell-Show-Do” technique is widely used to help children understand dental procedures.
- Distraction aids such as virtual reality glasses can be effective in reducing anxiety in children.
- Ensuring the physical environment of the clinic is child-friendly, for example, with pictures on the walls showing children playing, can help foster a positive attitude.
Dental treatment for children with special needs:
- Oral health care for children with disabilities and systemic diseases is adapted to the specific conditions of these patients.
- Systemic diseases (e.g., diabetes mellitus, cancer, epilepsy, hypophosphatemia) and their effects on oral health are taken into account.
- Special access (barrier-free facilities), behavioral approaches, and, if necessary, sedation or general anesthesia are used in the treatment of these patients.
Other Areas:
- Oral habits (thumb sucking, tongue thrusting) and their effects on dental development.
- Oral and maxillofacial (diagnosis and treatment of congenital, traumatic, or pathological problems affecting the face, jaw, mouth, and neck regions), particularly local anesthesia techniques and procedures such as tooth extraction.
- Diagnosis and management of temporomandibular joint (TMJ) disorders.
- Forensic dentistry (child abuse, age determination, bite mark analysis).
- Teledentistry is an approach used for remote consultation and patient management, especially in situations such as a pandemic.
- Dental radiology and new imaging techniques for accurate diagnosis.
Surgical approaches play an important role in pediatric dentistry (pedodontics). However, the term “surgical” here refers to interventions that are specific to the child's psychology and anatomical structure, usually shorter in duration and minimal, rather than complex procedures as in adults.
Common surgical approaches used in pediatric dentistry include:
Baby tooth extractions:
- Baby teeth that are too damaged to be saved due to deep decay, have caused infection, or have been broken due to trauma may need to be extracted.
- After extraction, appliances called space maintainers are often used to preserve the space for the permanent tooth coming in underneath. Otherwise, adjacent teeth may shift into the gap, leaving no space for the permanent tooth to erupt, which can lead to severe crowding.
Extraction of impacted or partially impacted teeth:
- Baby teeth: Sometimes the roots of baby teeth do not dissolve and prevent the permanent tooth from erupting. In this case, the baby tooth must be surgically removed.
- Supernumerary teeth: Some children may have extra teeth (usually in the upper front region) beyond the normal number. These can prevent permanent teeth from erupting, causing crowding or remaining impacted. They must be surgically removed.
Root-end resection in permanent teeth:
This is a procedure performed to save a tooth when irreversible inflammation occurs in a young permanent tooth whose root has not yet fully developed as a result of trauma or deep decay. The inflamed root tip and surrounding tissues are cleaned. This prevents the tooth from being extracted and ensures it remains in the mouth.
Treatment of dental cysts and lesions:
Cysts can form around the roots of teeth or around impacted teeth in children. These cysts are surgically removed, and the affected tooth is treated or extracted.
Tongue tie (Ankyloglossia) and lip tie (Frenectomy) surgery:
Tongue tie: If the tie (frenulum) under the tongue is too short and thick, it can negatively affect sucking, swallowing, speaking, and tooth alignment. Surgical release of this tie (frenotomy/frenectomy) may be necessary.
Upper lip tie: If the tissue connecting the upper lip to the gum is too tight and thick, it can cause a diastema (gap) between the two front teeth. This tissue may need to be removed before or during orthodontic treatment.
Surgical interventions after trauma:
Luxation injuries: In cases where the tooth is displaced or embedded in the jawbone, the tooth is repositioned (put back in place).
Avulsion: If the tooth is completely knocked out, it is reimplanted and stabilized under appropriate conditions.
Special situations in pediatric surgery: Sedation and general anesthesia:
The most distinctive feature of pediatric dental surgery is behavior management and the widespread use of treatment under sedation or general anesthesia when necessary.
Local anesthesia: Used in all surgical procedures to eliminate pain.
Sedation: Procedures performed by sedating children with mild to moderate anxiety who are able to cooperate, while maintaining consciousness. It reduces the child's fear and minimizes the risk of post-traumatic stress disorder.
General anesthesia: It is preferred in very young children, disabled individuals, children who are very fearful and unable to cooperate, or in cases where multiple teeth need to be treated/extracted in the same session. The child is put to sleep, and all procedures are completed in a single session without pain or stress. This both protects the child's psychology and maximizes the quality of treatment.
- Fissure sealants, planned according to each child's tooth structure, can reduce tooth decay by 70-80%.
- Maximum protection is provided with fluoride concentrations (gel, varnish, foam) determined according to age and decay risk group.
- Effective brushing techniques are taught through interactive education for children and parents.
- In cases of early primary tooth loss, specially designed space maintainers ensure that permanent teeth erupt in the ideal position.
- Three-dimensional imaging techniques are used to assess the growth potential of the jawbones.
- Early intervention is performed using special appliances for habits such as thumb sucking and abnormal swallowing.
- More comfortable and tissue-friendly interventions are performed with air abrasion and laser-assisted treatments.
- The natural appearance of teeth is preserved with composite laminates and prefabricated crowns.
- Each procedure is first demonstrated to children using toy models.
- The treatment process is made enjoyable with virtual reality glasses and interactive games.
- Trust is built in fearful children through sessions planned from simple to complex.
- Jaw development is guided with functional appliances during the mixed dentition period.
- Cognitive behavioral therapy is applied to children with high dental anxiety.
- Comprehensive treatment is performed in a single session with an anesthesiologist for children with special needs.
- Growth is monitored annually with digital measurements between the ages of 7 and 14.
- Personalized check-ups are performed every 3-6 months based on caries activity tests.
- A healthy transition to adult dentistry is ensured as permanent dentition is completed.
Pediatric dental treatment cannot be performed in some cases or requires special conditions. These cases are as follows:
- Children with heart problems that are not yet under control
- Children with bleeding disorders (such as hemophilia) that have not been treated
- Children undergoing severe cancer treatment and with very low immunity
- Children who can open their mouths very little (e.g., certain specific syndromes)
- Those with widespread mouth sores (such as canker sores or cold sores)
- Those with very severe gum inflammation (inflammation treatment is required first)
- Children who are extremely fearful and cannot be calmed
- Children with special needs (sedation or general anesthesia may be required)
- If the family does not give consent (legal situations)
- Young people over 15 years of age (they should now see an adult dentist)
- Very small premature babies (newborns weighing less than 3 kg)
- Baby teeth that are about to fall out (they are extracted if a new one will replace it)
- Teeth with completely dissolved roots (cannot be treated)
Who is a pedodontist?
A pedodontist is a dentist who has completed a 5-year undergraduate degree at a Faculty of dentistry and then received specialist or doctoral training in the Department of Pedodontics within the Faculty of Dentistry's Clinical Sciences. A pedodontist is also known as a “children's dentist.”
When should you see a pediatric dentist?
It is recommended to see a pediatric dentist in the following situations:
- When your baby's first tooth appears (between 6 and 12 months)
- Regular dental checkups (every 6 months)
- For preventive treatments such as fissure sealants or fluoride application
- Tooth decay (especially in baby teeth)
- Toothache or swelling
- A tooth that is broken or knocked out due to a fall or impact
- Gum bleeding or inflammation
- Early loss of a baby tooth (to determine if a space maintainer is needed)
- Malocclusion, narrow jaw, or improper bite
- Bad habits such as thumb sucking or tongue thrusting
- Impacted teeth (especially when permanent teeth fail to erupt)
- Dental treatment for children with disabilities
- Behavior management for children with dental anxiety
- Need for treatment under sedation or general anesthesia
When should children start brushing their teeth?
Cleaning should begin as soon as the first tooth appears, using a soft-bristled baby toothbrush or gauze pad.
Can root canal treatment be performed on baby teeth?
Yes, infected baby teeth can be saved with pulpotomy/pulpectomy.
My child is afraid of the dentist. What should I do?
You can take them to a pediatric dentist. Pediatric dentists use behavior management techniques (e.g., “tell-show-do”) in child-friendly clinics with playrooms.
What is a fissure sealant?
It is a protective filling applied to the grooves in molars. It can reduce the risk of decay by 70-80%.
Can teeth be whitened in children?
It is not recommended for children under 12 years of age. Conservative methods can only be used in adolescents under the supervision of a pediatric dentist.