Imagine that tomorrow is your child's visit to the dentist. Surely you wondered whether to leave a small patient in the care of a doctor or be in the office for support and control? Have you already read our tips for preparing your child for an appointment and watched all the cartoons from our selection with him? Then we move on to the next step.

After reading the article, you will learn how to determine the best path for your child - an appointment with parents or independent contact between the doctor and the baby. We will give an answer to the question at what age the presence of parents is mandatory, and when you can do without it.

Depending on the age of the child and on the advice of a doctor, a parent may:

• sit in the dental chair and place the child on your lap;
• sit on a chair next to the child, holding his hand;
• sit at a distance, simply indicating your presence;
• discuss with the doctor the treatment for today and leave the office;
• draw up a general treatment plan with the doctor and wait for the child in the lobby with a cup of coffee.

The smallest patients, 3-5 years old, of course, are treated only in the presence of their parents. Moreover - on the knees of one of them. Such young patients cannot always control their movements, this task lies with you, dear parents. In order to avoid unexpected sudden movements that can interfere with the doctor and injure the child, you should put his legs between your own and hug him, not allowing playful hands to “loose their belts”.

You can start thinking about admission without parents if two conditions are met:

• the child has reached the age when you can ask his opinion on this issue;
• you have come to the doctor not for the first time, the child knows him, trusts him, behaves calmly in the chair, listens to the doctor, the atmosphere of the office is familiar.

It is advisable to move on to self-administration in stages. When the child has reached the age of 6-8 years, take a closer look at how he behaves when you come to an unfamiliar team? Does he huddle up to you, or, on the contrary, does he run to meet and play with children? Is he shy, does the new place and the team bother him? In this case, take your time, the child needs your support.

Do not be afraid to "sit out" in the office. Sooner or later, the young patient himself will ask you "not to interfere" or "not to distract" - this happens in 99% of cases. There are families in our clinic who together bring three or four children to an appointment, leaving one adult “for insurance”, while they themselves go about their business.

If your child is on his own and independently, then you can gradually "leave the game" - first sit at a distance in the office, then go out to "talk on the phone" for a few minutes, and, finally, one fine day before the appointment, just ask the child if whether to him your presence.

No matter how old your child is, no matter how grown-up, or, conversely, how small he seems to you, the best way is to take your time, look carefully and listen to him. And then everything will definitely work out.

Teen dentistry

Patients of teenage dentists are the owners of the so-called interchangeable dentition, that is, those children whose milk teeth have begun to change to permanent, or molars. And the essence of teenage dentistry lies in the treatment, on the one hand, permanent, on the other hand, still children's teeth, which have some differences in structure from the teeth of an adult. Firstly, the roots of permanent teeth in children are not yet fully formed, and the apical foramina (tops of the canals of the teeth) are expanded. Secondly, these teeth have a very wide and massive coronal pulp, the horns of which are located close to the hard tissues of the tooth - dentin and enamel.

Only with time, in adulthood, does the final formation of the tops of the roots occur, strengthening (due to mineralization) of the internal tissues of the teeth and enamel, and due to this, the "reduction" of the crown pulp. And since there are features in the structure of the teeth, then a special approach is needed in their treatment ...

Age of adolescent dentist patients

It is important to understand that in the case of "adolescent dentistry" we are not talking about the period of puberty as such, that is, the actual adolescence. We are talking about the period of interchangeable bite, when milk teeth gradually change to permanent ones.

Thus, adolescent dentistry begins at the age of 6. It is at this age that the first permanent teeth appear. If up to this point a pediatric dentist has dealt with the problems of milk teeth, then with the advent of the first molar (and the first problems with it), the baby should visit two doctors - a child, while there are still milk teeth in the mouth, and a teenager, under whose "jurisdiction" fall erupted permanent. The complete change of bite is completed by the age of 13. And at the age of 14, a teenager passes into the hands of already adult doctors.

Main problems and features of treatment

Even in six-year-old children, we have to deal with a situation where a newly erupted permanent tooth is already affected by caries, as well as complications of this disease - pulpitis and periodontitis. In these cases, it is necessary to partially remove the root pulp and temporarily (!) Fill the canals with medical paste. In the future, we observe such a tooth in dynamics: perhaps, after some time, the root of the tooth will be completed and the apical opening will begin to narrow, and we will obturate the root canals with a permanent filling material.

But in difficult cases, such teeth must be removed. And this is due to the fact that it is impossible to obturate and create hermetism in the root canal with incomplete root formation, and this can lead to further complications. Just imagine: in the canal of the 6th chewing tooth, the inflammatory process continues due to poor sealing, as a result of which a cyst is formed, which can seriously affect the germ of the neighboring 7th tooth, causing inflammation there as well. As a result, the baby may lose both teeth involved in the act of chewing. To prevent this, we have to remove the "troublemaker". However, after a child’s tooth is removed, an orthodontist comes to the rescue: he is able to “move” the permanent 7th and 8th teeth, which will erupt later, to the place of the lost “six” and thus completely restore the dentition.

Chewing (permanent) teeth, such as the 6th, are most susceptible to caries - they are the very first to erupt and the first to become victims of the carious process. This is due, first of all, to difficult hygiene, which is often characteristic even of an adult, and often with its complete absence, since babies still cannot or are too lazy to brush their teeth themselves. As we said at the very beginning, in “baby” molars, the coronal pulp is located too close to the hard tissues of the tooth. Because of this, rapidly developing caries quickly turns into pulpitis, that is, into inflammation of the nerve.

In general, the occurrence of complications of caries is, of course, the mistake of parents. The cause of caries is non-compliance with hygiene and timely prevention, and pulpitis and periodontitis are the result of a running process. It is obvious that the child is not yet able to control and assess the problems that have arisen on his own, he cannot go to the doctor for a medical check-up, etc. And this responsibility, of course, parents must take upon themselves ...

Just like adults

Erupted molars - quite large with a large nerve, affected by pulpitis - disturb children no less than adults, as they say, in full. Pulpitis causes terrible pain, does not allow you to eat, sleep at night, brush your teeth ...

Another misfortune that most often concerns little fidgets. In the process of active games and sports, children receive various injuries, including dental injuries - breaking off the crown part of the tooth, fracture of the root, chipping with the opening of the tooth pulp. In these cases, we resort to sparing methods of treatment with preservation of the pulp. A therapeutic pad is placed on the opened pulp horn, and then we observe in dynamics how the process of formation of replacement dentin will proceed. In general, in children, the pulp tends to regenerate quickly. But it is very important that an infection does not get into the open, unprotected pulp. That is why the success of the application of this technique is very much influenced by the time frame. For example, the best results can be achieved if the child is brought to the appointment within 24 hours of the injury.

But if more than two days have passed since the injury, then you will have to completely extract the coronal and root pulp (that is, remove the nerve). And further treatment will depend on the age of the child. If the canals of the tooth are not yet fully formed, then we fill them with temporary paste and observe how the process will go in the future. It is likely that in the future, if the channels form correctly, we will be able to replace the temporary paste with a permanent material. If the apical foramen is sufficiently formed (at a later age) and we have the opportunity to obturate the canal well, we immediately use permanent materials that are used in adult dentistry. In case of an injury, the rule applies: the earlier you go to the dentist, the easier it is to save such a tooth, and in case of a late visit, the more unfavorable the prognosis for the future awaits you.

Adolescent orthopedics

In adult dentistry, treated and pulpless teeth are necessarily covered with a crown. Likewise with teenagers. The main task is to preserve the root of the tooth, so if the crown part has been destroyed by more than 50%, such a tooth must be covered with a crown.

However, there are some temporary exceptions in adolescent dentistry. For example, if a patient is preparing for orthodontic treatment, then we often make a temporary restoration of the tooth with the help of filling material. This allows the orthodontist to put a bracket system and completely correct the bite. And after that, a stump tab is made and the tooth is covered with a crown.

Yes, this whole process stretches for a long time, sometimes for several years, but it is impossible to put a bracket system on “crowned” teeth. The fact is that an artificial crown is placed half a millimeter under the gum in order to completely cover the crown part of the tooth. And when the teeth begin to move under the influence of the bracket system, this will inevitably affect the condition of the gums, the edge of the crown may be exposed. As a result, after correcting the bite, you will have to make a new crown and ... again spend money on orthopedic treatment. And this, you see, is inappropriate.

Peculiarities in the extraction of permanent teeth

The main difficulty lies in the preservation of the rudiments of the permanent teeth that have not yet erupted adjacent to the affected tooth. Therefore, the most non-traumatic, careful handling of surgical instruments is necessary, since excessive force can damage the adjacent germ.

It also happens that the resulting cyst borders on the germ of an adjacent tooth or deep and serious ones have arisen in the bone tissue. In this case, you need a particularly thorough, literally jewelry, work. If the cyst has reached a very large size, then the child has to be sent to the hospital.

And of course, after removal, if necessary, antibiotic therapy is prescribed, if the diseased tooth has been removed, we necessarily observe the germ of the adjacent tooth in dynamics until we make sure that everything is in order with it. If the tooth germ develops normally, then a normal healthy tooth will subsequently grow.

What should be done at the mixed dentition stage to avoid dental caries and more severe complications?

First of all, thorough oral hygiene is necessary: ​​it involves proper brushing of teeth (How to brush your teeth correctly!) 2 times a day - in the morning and in the evening. This is very important, because their health depends on the technique of brushing your teeth. Even if you brush your teeth for 5-7 minutes, but do it without observing the necessary rules, plaque will still accumulate in the cervical area and enamel will be affected. There will be its demineralization and the formation of caries. Therefore, it is very important to brush your teeth well, but not to overdo it. If, on the contrary, too much effort is applied, then non-carious lesions of the teeth occur: a wedge-shaped defect, abrasion in the neck of the tooth and exposure of the internal tissues (dentin) of the tooth. What can we say, not even all adults are fluent in this seemingly uncomplicated "art" ... All our doctors, regardless of the age of the patient, will be happy to show and tell you how to do this.

It is equally important to choose the right toothbrush. In general, the stiffness of the brush depends on the structure of the enamel. As for children and adolescents, we advise you to purchase, like adults, a medium-hard brush, provided that the teeth are normally mineralized and the enamel is strong and healthy. But in the presence of fluorosis (excessive amount of fluorine), the enamel becomes very fragile, in which case soft toothbrushes should be used. In childhood and adolescence, you should not use electric toothbrushes - the child, in fact, does not get along very well with the usual one either. And an electric brush, if used improperly, can only cause harm: it will damage the enamel in the cervical region, which will lead to erosion. Again, the doctor should help make the right choice.

For teenagers, ordinary adult pastes are used, which must be chosen taking into account the structure of the enamel. For example, with fluorosis, it is recommended to use a paste with calcium.

Regular visits to the dentist

Regular check-ups can detect caries in its early stages or even prevent its development. For example, if we notice teeth in a child’s mouth with deep, already pigmented fissures (and often even newly erupted teeth can be pigmented), then in this case, in order to prevent the development of caries, we perform invasive or non-invasive fissure sealing, that is, we clean the fissures and fill them with special sealant. Such procedures are carried out every 3-6 months (since the sealant tends to crack) depending on the condition of the teeth and ... hygiene at home. If the child himself cannot cope with brushing his teeth at home, then you also need to visit a hygienist for professional teeth cleaning once every 1-3 months. If the baby has learned to thoroughly brush his teeth and he does not have a tendency to carious lesions, then it is enough to visit the clinic once every six months.

Parents can identify the first signs of caries themselves. Try to sometimes look into the baby's mouth - in the truest sense of the word. We saw changes in the color of tooth enamel - run to the doctor! After all, caries can already be hidden under pigmentation. The less started the process, the easier it will be to prevent its further development.

In addition, regular check-ups of the child at the dentist also allow you to track any changes in the bite. If the pathology of the bite is sufficiently pronounced, the teenage dentist himself can see, for example, a too narrow jaw, and a lack of space for permanent teeth, etc. We immediately refer such a patient to an orthodontist. However, we recommend visiting this specialist for all children without exception. What a therapist or surgeon does not see is certainly not hidden from the experienced eye of a bite specialist. And only in his power to prevent its incorrect formation in the initial "imperceptible" stages.

We also mandatory examine the baby for the presence of short bridles. For example, with untimely excision of the short frenulum of the upper lip, a diastema (gap between the teeth) may form. And this is an aesthetic defect that we are trying to prevent. To trim the bridles, a laser bloodless method is used without suturing. The wound heals itself within two weeks with appropriate antiseptic treatment and the use of ointments.

Peculiarities of communication with teenagers

Of course, finding a psychological approach to the baby is a separate art. It will be very difficult for a doctor who has not worked with children to see teenagers. There is a special line here - this little man seems to be still a child, but already "half-adult", you understand? There are children capricious, frightened, restless. It takes patience and the ability to choose the right words. It's easy for an adult to say, "Open your mouth!" With children, this does not always work.

There are children of 6-7 years old who have to be treated like very young children: for example, instead of “let's give an injection”, we say that “we will pour sleepy water on the tooth” or put a “snowflake”, etc. That is, we try to find alternative ways to explain to the baby what will happen to him, without scaring him. In a sense, such a half-truth.

There are children, do not believe it, frightened by their own parents. One wrong word can bring the baby "out of balance." Therefore, we often have to conduct "educational" conversations with parents before proceeding with treatment or even examination.

Difficult moments arise with children frightened by a bad visit to the doctor in the past.

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