Kids' Dentistry Archives - Prosthodontist in Johannesburg
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Kids’ Dentistry

Why Snoring In Children Should Never Be IgnoredSnoring in children is the clearest symptom of obstructive sleep apnoea in children, a condition which presents differently in children when compared to adults. Even though sleep apnoea affects middle aged men more than any other demographic, it is often undetected amongst children. And that’s quite surprising when you consider that between 3 and 12% of children snore, and 1-3% of children have obstructive sleep apnoea.

If your child is going for dental check ups every six months, your family dentist probably has the best opportunities to inspect and screen your child for sleep apnoea.

What Are The Causes Of Sleep Apnoea In Children?

Sleep apnoea is common in children who have swollen, infected tonsils and adenoids, but it may also be caused by allergies and developmental defects.

Examples of developmental defects may include

  • Narrow air passages
  • Low muscle tone in the mouth or upper airway
  • Under-developed maxilla (upper jaw)

What Are The Symptoms Of Sleep Apnoea In Children?

The symptoms of sleep apnoea in children may present slightly differently to adults. Adults tend to put weight on because of the hormone fluctuations that take place. By contrast, children are more likely to present with poor physical development and may struggle to put weight on.

Some common symptoms of sleep apnoea in children include

  • Sleepiness and fatigue during the day
  • Pauses in breathing during sleep
  • Concentration problems
  • Breathing through the mouth
  • Short or poor attention span
  • Wetting the bed
  • Issues with behaviour
  • Poor physical development and difficulty with weight gain

As you may have observed many of these symptoms overlap with other conditions, or may have been misdiagnosed in the past. A thorough examination and monitoring is required to ensure an accurate diagnosis is made, and a sound treatment plan is developed. Managing sleep apnoea early on can help to prevent the development of chronic health conditions later in life.

To find out more about treatment options or screening for sleep apnoea in children, please contact our practice for the most convenient appointment: (011) 483 2281

Prevention Is Better Than Cure

Baby teeth are fundamentally important because they are an integral part of the growth and development of the mouth and jaws. The baby teeth are a precursor of the permanent teeth which start to appear in the mouth at about the age of 5 to 6.The permanent teeth erupt by causing the roots of the baby teeth to resorb. That is why the baby teeth become loose and it is so exciting for a young child to know that the mouse is on its way.

I see so many patients who have grown up without having the knowledge to look after the primary teeth and therefore the permanent teeth. The result is unnecessary tooth decay which needs to be treated with fillings. There is no filling in the world that will adequately restore the tooth to its original state and form. The reality is that teeth are designed to last for lifetime with proper care. The one problem that may develop is an orthodontic one in which the crooked teeth may have to be treated with definitive orthodontics. Here genetics also plays a factor.

The most important factor to emphasise to pregnant women in particular is the great advantage of breastfeeding and not the bottle. The reason for this is that the young baby’s mouth adapts to the shape and form of the mother’s breast. This close adaptation allows the muscles of the mouth to move in such a way that it enhances the normal growth and development of the jaws. This is a very important fact that most mothers don’t know about and should be greatly emphasised, certainly when the mother  is pregnant and not feeding yet. It is good to have the knowledge in anticipation.

Giving candy to a child should be a no-no. I know that this is very difficult to prevent. I see it with my grandchildren as well and they have developed cavities. The prolonged sucking of sugar sweet should be avoided. The limiting of time that the mothers exposed to sugar is important. Thus if possible after eating a sweet, the child should be encouraged to rinse with water.

Another important fact is that a young child should be watched to see that they are breathing through their nose and not the mouth. Mouth breathing is a potential problem in the growth and development of young child. An Ear Nose Throat (ENT) specialist should be consulted.

 All children love sweets. It is a fact of life. To keep them away from sweets is almost impossible. It’s part of being sociable with one’s little friends.

Let me share with you what happened to my grandson and great grandniece.

Both my daughter and niece called asking for help. They said that their children were kept up at night with toothache.

Both children are six years old, and a clinical examination on both of them revealed deciduous (baby) teeth ravaged by decay.

Deciduous teeth play a vital role in a child’s dental development. They are the precursor to permanent teeth and hold the space in the jaw for the permanent teeth to erupt from then on until the age of approximately 12. They are precious and need to be looked after appropriately.

That means regular brushing and fluoride treatment. The consumption of sugary sweets needs to be kept to a minimum. Parents have a responsibility.

Children need to be introduced to a dental office at an early age. It is suggested to bring them in regularly from the age of two just to have a ride in the chair and experience the fun. That takes the fear away and certainly encourages parents to look after their precious baby teeth.

 The only way to treat these children was with the help of conscious sedation. A specialist anaesthetist was brought into the rooms. He set up with all his dedicated equipment and was able to allow me, while each child was comfortable and sleeping, to work. I was able to do all the necessary restorative treatment to bring their mouths back to good health.

The purpose of conscious sedation is to produce a state of relaxation and pain relief using the appropriate medication to facilitate performing minor procedures.

Besides facilitating the necessary treatment, the child wakes up with no recall of the experience and no long-term fear of visiting a dentist in the future. How many people do you know who dread coming to the dentist because of being poorly handled as a child?

Both children now have healthy, decay-free mouths that need to be properly looked after from now on.

Perhaps you know of children who may need the service. Please feel free to call. We would love to help.

 

Dr Kaplan says, “I came across this charming poem in a pamphlet which was written in 1944”

by Dorothy Gray

I used to like the dentist very much,
He really seemed to be most awfully kind;
But since one dreadful day,
I’m afraid I must say
That I’m sorry, but I’ve had to change my mind.

I’ll tell you just exactly how it happened;
I’d only been to see him just once or twice,
And I loved to sit up there
In his funny high armchair;
And a visit to the dentist seemed quite nice.

But once I had a very wobbly tooth;
I’d tried to pull it out but I just couldn’t !
And I asked him not to touch
(Though it didn’t hurt me much)
And he shook his head and promised that he wouldn’t.

So I let him have a look inside my mouth,
That he would keep his word I had no doubt;
but in spite of what he said
He grabbed the tooth instead;
And though you won’t believe me, took it out !

Now it wasn’t that I minded what he did;
If he’d warned me I’d have been quite brave, I’m sure;
But they’ll never get me there,
In that silly high armchair;
And I’ll never trust a dentist anymore !

 

Our relationship with our patient is based on trust.

With good ongoing dental care, your teeth should last your lifetime.

Teething is a painful experience not only for the young child but certainly for the parents who have to endure watching the agony and helping to provide relief. One feel so helpless trying to relieve their pain and having to endure those awful sleepless nights.

They are many housewives remedies to see one through the “agony”. Some mothers suggest rubbing brandy or whiskey over the sore gums (just enough to not make the young child into an alcoholic!).

Another alternative teething ring or a hard rusk to bite on. The good thing is that the stage passes by in due course.

Like everything in child-rearing, everything depends on the parent from feeding, bathing, changing diapers, breaking wind and so on. And so it is with teeth as well. They are precious and need looking after. Baby teeth are not to be taken casually. They fulfil a vital function in growth and development of the child. Besides being used for eating and chewing and learning how to speak, they also are fundamentally important in maintaining space for the permanent teeth to erupt.

Baby teeth are also prone to decay. It is very important to avoid having the child go to sleep with a milk bottle. This causes rampant decay known as “baby bottle syndrome”.

Prevention is better than cure. It is the parents’ responsibility to look after these baby teeth from the moment they appear in the mouth. In the early stages of tooth eruption, they can be effectively cleaned by wiping them with a gauze swab. As more teeth come into the mouth with the growth of the child, they can then be introduced to a toothbrush. Monkey see monkey do. If the child watches the parents enjoy brushing their teeth, they will want to do the same. Toothbrushing can really be fun. Make it a game and sing some songs. Cultivate an appreciation for the preciousness of beautiful teeth from an early age.

The are many children’s toothbrushes on the market and children’s toothpaste which are pleasantly flavoured. There is no particular preference in their choice. Rather it is the conscientiousness and motivation of the parent to ensure that the teeth are properly looked after from the very beginning.

Dummy and thumb sucking may well affect the milk teeth by creating a widened space between the front teeth. I recall one of my teachers saying that it is inadvisable to stop a child from dummy or thumb sucking prematurely or forcibly. They are doing so because of an emotional need and will stop in due course. It is much easier to straighten teeth than to straighten the psyche.

All too often one hears from adult patients how they were traumatised in the younger years by the dental treatment that they receive then. They remember a painful injection; a very difficult extraction; being forced into the dental chair against their will; unsympathetic dentist and parent. All of these scenarios are part of crisis management which could have been avoided had the child been taken to dentist timelessly before any problem had occurred.

Dental caries is easily detectable and should be treated promptly. More importantly though, it can be prevented and avoided with a good home care by a responsible parent. It is believed that dental decay is an infection passed from parent to child. Therefore it is inadvisable to have the parent suck on the dummy before passing it on to the child.

The first visit to the dentist should be at roundabout age 2 to 3 at which time all that is needed is the experience of the fun to ride up and down on the dental chair. It is disastrous for the parents to show fear of the dentist because that fear is contagious. The whole experience should be one of fun and excitement. Regular dental visits should become routine and hopefully the child will be able to bounce out of the chair and exclaim “look, no cavities”.

Choosing a good dentist

Choosing anything be it a service or commodity can oftentimes be a daunting task.

A commodity is easier to choose.

You know what you want and you know what your price range is. You can actually feel and see the article that you are buying in making your choice. Finding the shop to go to is challenging. The lead may be an advert in a newspaper, magazine, radio advert or word-of-mouth. How far does one have to travel to reach the shop and what guarantee is there that the article is in stock? A telephone call can help.

Services are very different.                                                                                    

I know the story of somebody who entered into a business association based on an agreement that was drafted by an “experienced” lawyer. On presentation the agreement ostensibly covered all eventualities and was signed. The financial manager was duly appointed. Several years went past with the relationship based on the agreement working well until there was a takeover of the business. Now the new owner was faced with making staff changes. To his great surprise the financial manager found himself retrenched. The agreement was flawed. It had a loophole.

What is experience?

Is it perhaps doing the wrong thing year in year out? Sometimes it works, sometimes it doesn’t and when it doesn’t, the disappointment is real. Experience means knowledge and expertise. It doesn’t necessarily mean years on the job.

And what about fees for professional services? A patient once told me that his father said “whatever the professional asks for, just pay!”

How’s that for an undertaking. But there was a proviso. You have the right to choose the professional and once that choice has been made, relax with confidence.

So how do you go about choosing a good dentist?

  • Is it based on the appearance of the office?
  • The friendliness of the staff?
  • The way the telephone was answered?
  • The modernness of the equipment?
  • Whether an x-ray apron is used?
  • The location and adequate parking?
  • Good sterilisation of instruments?
  • The lightness of touch?
  • A painless injection?
  • Effective anaesthesia?
  • Good people skills?

All these are things that one can feel and see but dentistry is different. You cannot see what the dentist is doing. It is totally blind!

And so the question remains, how do you choose a good dentist?                      

Let me tell you another story which I’m sure you will enjoy.

The owl and the peacock were having an argument as to who was the most beautiful bird in the world. The owl said “I am” and the peacock said “I am “. They agreed to resolve the argument by consulting the first animal that they met in the forest and whoever won would bite off the other bird’s tail. Off they went and came upon the wild boar. They asked him to judge the case and eagerly awaited his opinion.

In my opinion said the pig, having thought for a while, “It is the owl”.  The owl rightfully bit off the peacock’s tail and the peacock ran out of the forest crying bitterly and uncontrollably.

The peacock then came across the wise old fox and she told him the story. Said the fox sagely and compassionately, “Look whose opinion you asked”. On what basis is word-of-mouth established?

I asked a periodontist colleague his valued opinion in choosing a good dentist and this is what his patients have told him: –

From the perspective of a layperson I think the primary motivation to select a dentist is the testimonials from other patients of the dentist. Another factor patients look at is the qualifications of the dentist and the institutions from which they were obtained. Affiliations to groups or bodies are also looked at. Patients also look at number of years in practice. If one has a website, patients like to look at photos of work done by the dentist.

Word-of-mouth is very powerful, but consider this…

In the South African Dental Journal March 2016,Vol71 Dr S Naidoo, senior professor and principal specialist, faculty of dentistry, University of Western Cape writes the following:-

The profession of dentistry has both benevolent and protective aspects with regards to duty of care to patients, to always try to do the best for patients and shall for the principles of non-maleficent’s – to do no harm. This principle expresses the concept that professionals have a duty to protect the patient from no harm.

General dentists are usually the first professional patients visit, seeking an evaluation of the oral and dental needs. The general dentist may then treat the patient or may refer the patient for speciality care depending on the conditions which have been assessed and diagnosed. This is because amongst general dentist there are differing levels of expertise, exposure to postgraduate training, and confidence in undertaking treatment of more advanced dental conditions. Whenever necessary, timely and appropriate referral is an ethical imperative which fulfils a professional duty to a patient.

The general dentist is expected to recognise when specialist care is more appropriate to the patient’s needs and completion of the treatment plan and should then refer appropriately.

Interestingly, general dental practitioners are entitled to carry out all dental procedures including those falling within the scope of specialists (provided they have the training).

Now, having made the choice of dentist by whatever criteria, are you satisfied that time has been spent on listening carefully to your past dental history?  Has the initial consultation included gathering of all the diagnostic records needed to formulate a comprehensive diagnosis and treatment plan?

Has a subsequent planning appointment taken place to empower you as the patient to make an informed decision and evaluate the possible treatment options?

The choice is yours… Choose wisely.

 

Dr Kaplan, who has been in practice for 45 years, has seen many dental disasters, which could have been prevented.

Because of this, he is passionate about educating parents about the role of children’s teeth in their development and the importance of good dental hygiene.

Parents need to have the knowledge to show their children how to take care of their teeth, from an early age.

Practised regularly and religiously many a dental disaster can be prevented.

Click the picture below to view this presentation with your child and start teaching good habits from a young age.

It is quite amazing how many people take their teeth for granted!

Everybody wants a beautiful smile with sound healthy teeth. That does not happen just by itself.

As I have written many times, the dental care starts from childhood with parental responsibility and guidance to the young child on how to look after their teeth. Effective brushing and plaque control together with a controlled sugar-free diet is a key to long-term dental health.

Unfortunately teeth sometimes do decay and a restoration is indicated.

What is the appropriate restoration to use?

There are choices of materials to use and each has their pros and cons. This decision needs to be made together with the dentist so that you as the patient can choose appropriately. No filling can last a lifetime but some materials are certainly better than others. The short-term expense should not be a consideration for long-term benefit. Cheap is expensive.

Dentistry is blind. The patient has no idea what the dentist is actually doing nor has the patient any control on the procedure being performed. Has there been a planning appointment designed to discuss and empower the patient prior to the commencement of treatment.

Once treatment has been completed:-

  • Has the appropriate material been chosen?
  • Has the tooth been adequately prepared?
  • Has the tooth been restored to its original anatomy or just filled?
  • Has the filling been properly placed?
  • Is there an open contact?
  • Is there post-operative sensitivity?
  • Is there an ill- fitting margin that will set the tooth up for recurrent decay
  • Is the technical work of the highest standard possible?
  • How many times will the filling need to be replaced in a lifetime?
  • Are the gums now in a healthy state ?
  • Can the restored teeth be adequately kept plaque free?

These are real questions that have an impact on long-term dental health.

So what can you do about it? Is it possible to check. The answer is yes.

It is suggested that you visit a prosthodontist for his assessment and evaluation. This is the way to possibly avoid unnecessary long-term problems the treatment of which may involve a commitment to time, effort and expense.

Have the work done right the first time. Please us a call. You will certainly be coming to the right place.