Mouth breathing is one of the most pressing problems in children: it points to many diseases and also provokes many pathologies, including in the mouth. What should we know about mouth breathing, why does black stain appear on teeth at an early age, should baby teeth be treated, and how do you keep restless children still in the dentist’s chair? These and other interesting topics were discussed on the program “Visiting the Doctor” by the founder and head of the Nino Beridze Orthodontic Center and President of the Association of Pediatric Dentists, Nino Beridze and pediatric dentist and orthodontist, Vice President of the Association of Pediatric Dentists, Elene Kharashvili.
Nino, I’d like to start with the Second International Congress of Pediatric Dentists. How important was this congress, and what were the main topics?
On November 4, the international congress of the Association of Pediatric Dentists was held. The congress had a big response, with more than 300 doctors taking part – from Georgia as well as Austria, Ukraine, Belarus, Kazakhstan and Armenia. The main topic was painless dentistry for children. The keynote speaker, Osman Werner, spoke on exactly this topic: “Hypnosis in pediatric dentistry” is a skill that makes it easier for a doctor to work and communicate with children, and as a rule it works well. We also discussed the use of nitrous oxide in pediatric dentistry and the restoration of baby teeth. As you know, not only parents but doctors too take baby teeth less seriously. It turns out that baby teeth have a very important function, including an aesthetic one. The congress also covered the management of dental diseases in pregnant women, and more.
Elene, speaking of mouth breathing – why might a child breathe through their mouth, and on the other hand, what complications and problems can this cause in the mouth?
Unfortunately, in Georgia, as around the world, the number of patients who breathe through their mouths has grown. It’s often considered just a habit, and we dentists discover during a visit that the child breathes through their mouth. Such children often have allergies, respiratory diseases, adenoids and enlarged tonsils. Mouth breathing belongs to the group of harmful habits. When the mouth is open for mouth breathing, the child can’t breathe through the nose. As a result, the jaws grow in the wrong direction. To put it more simply, the jaws are narrower, and both chewing and swallowing are disrupted. Disrupted swallowing causes the tongue to sit in the wrong position. This is exactly what makes the jaws develop incorrectly in children. It’s important to start orthodontic treatment early. To improve nasal breathing, we need to find the reason the patient breathes through the mouth. To find the cause, the patient is examined with X-rays and clinically, and only a comprehensive approach allows the right course of treatment to be chosen. A multidisciplinary approach with ENT specialists and allergists is important, and seeking help early is crucial.
Nino, what negative effects does using a pacifier until a later age, say until 3, have?
This habit affects the bite and deforms jaw growth, especially when the habit lasts a long time. If a child has a pacifier in their mouth for 5 minutes, it has no effect on the direction of jaw growth, but if a child has a pacifier in their mouth for several hours straight at night and sucks the pacifier – or even a thumb – it will definitely cause abnormal jaw growth. If a child has the pacifier habit until about a year and a half, the process self-regulates by age 3 and doesn’t need our help. If pacifier use continues past age 3, it’s best for dentists to get involved. In such cases, various appliances are made, and only after diagnosis do we decide what’s best for the patient – on the one hand so the child gives up the bad habit, and on the other so the jaws develop normally.
Elene, people say that black stain on teeth at an early age doesn’t need treatment and that cleaning it off can even damage the enamel…
Hygiene doesn’t damage enamel – what damages enamel is having neither personal nor professional hygiene. When a toothbrush says 0 to 3 years, it means it should be used during that period, not that we start caring about hygiene at 6 or 8. Black stain is caused by an excess of actinomycetes in saliva. It isn’t caused by a deficiency of any mineral. There are many myths about this – for example, it’s linked to worms. The medical name for black stain is Priestley’s stain, which becomes active in a particular age group because it coincides with teething. It must be removed, because bacterial plaque accumulates on this stain, and we get circular caries around it. The reason is that the stain has deprived the tooth enamel of its protection. Priestley’s stain and black stain tend to recur, but they must be removed every time. It’s also worth noting that each time there is much less of it. The idea that the stain doesn’t need to be removed is as false a myth as the one that baby teeth don’t need treatment.
It’s important for the first dental consultation to take place after the child’s first tooth erupts. In reality, this helps improve parents’ dental education, which means greater awareness of personal hygiene, nutrition and preventive visits. Parents are told how to protect their child’s mouth from caries and any other problems.
We warn them about harmful habits – in other words, the first visit is devoted to the dental education of the patient and parent. Professional and preventive visits are very important; during them the mouth is examined. This procedure is much more comfortable, because there’s no pain, and for the child the dental procedure becomes a positive experience rather than a negative one.
Nino, it’s interesting – is it necessary to treat caries when the tooth is going to be replaced anyway?
Nature gives people nothing by chance. The same goes for baby teeth, which have the following functions: biting, chewing, speech, swallowing, etc. Most importantly, baby teeth save space for the permanent teeth, so that they erupt physiologically and have ideal space in the dental arch. When a baby tooth is lost too early, the permanent teeth have no room and we get an orthodontic problem – and we deal with these problems for years. This is parents’ investment in their child’s health. We need to take care of baby teeth so that at 10-11 years old we have a healthy mouth.
It’s important that a child’s first visit to the dentist doesn’t coincide with pain.
Just as every parent chooses a pediatrician from birth, they should also choose a dentist for their child and go to them for recommendations and advice. As a result, the child may never need a visit because of pain. A lot depends on parents, and they should pay close attention to this. Today’s treatment isn’t associated with pain – anesthesia is used. Parents often have phobias and talk about how painful their dental visits were as children. In reality, a child who has never been to a dentist doesn’t know what it’s like and so isn’t afraid. It’s very important what mood we create for them before the visit.
Preventive visits and treatment are crucial. Improper hygiene is destructive and has a big effect even on patients who may have very good genetics.
Elene, if a child has caries at an early age, should we assume they’ll be prone to caries in their permanent teeth in the future?
That can’t be said unequivocally, but it’s important that permanent teeth don’t erupt into a caries-affected mouth. Often, when the permanent molar erupts behind the chewing teeth, parents think it’s still a baby tooth. As a result, permanent teeth that erupt into a caries-affected mouth are actively exposed to this flora at age 6-8 and decay through neglect. That’s why the permanent first molars often have carious lesions. This is exactly why treating baby teeth is important; the reason is that personal hygiene wasn’t considered important before age 5. The family decided that the child should start brushing at 6.
The first tooth begins to form in the womb. Infections the mother had during pregnancy and health problems before the child is 2 often affect the tooth buds. Toxic pregnancy and medications taken also have a bad effect on the hard tissues of the teeth. A frequent cause of early caries is the feeding routine: sweetened drinks and the amount of carbohydrates in the diet damage newly erupted enamel. At the first visit, when we educate the parent, we tell them not to give the child sweetened drinks from a bottle, especially at night. From 1.5 years, a child should be able to drink from a cup – after all, this also forms the standard swallowing pattern. Snacking between meals, biscuits, lollipops and chocolates are destructive. Taken together, hygiene can’t cope with all this. There are cases where, after evening hygiene, parents give children biscuits and sweetened dairy products.
Nino, is it advisable to remove loose baby teeth at home?
When a baby tooth’s root has resorbed, removing it at home isn’t a problem. When it’s only attached to the gum, it often comes out while biting or chewing hard food, and children easily lose such teeth. If a baby tooth’s root hasn’t resorbed, or has only half resorbed, it sits firmly in the socket and removing it at home is problematic – this is the doctor’s job. In this case, a normal extraction should be done under local anesthesia. The wound is deep and the likelihood of infection is very high.
Elene, which sweets are more harmful to teeth?
If we don’t put a newborn in the sun without sunscreen, why have we decided that a 2-year-old can be given a Chupa Chups, a hard caramel candy, jelly beans and sweets that stay in the mouth for quite a long time? That’s a little hard for me to understand.
When children suck a candy for 30 minutes, the concentration of carbohydrates becomes so high that the mouth’s pH can’t cope. Besides, children often bite candies, and you hear a sound that tells you they’ve chipped something. It’s a well-known international fact that dentists’ biggest sponsors are grandmothers and grandfathers who buy large amounts of candy. I think even one kind of sweet a day is a lot, but some children eat so much that I ask: how much is a little? The concentration needs to be neutralized, and if we see a child has been eating a candy for 20 minutes, we can at least neutralize it with water – in other words, it’s important for the little one to drink plenty of water. 80% of diet-related caries comes from eating too many carbohydrates. Children who come in with multiple caries have lots of lollipops in their diet. Parents think chocolate is worse, but chocolate is neutralized in the mouth much faster than lollipops. Sweets aren’t good for you, and pediatricians often say that the number of children and teenagers with diabetes has increased. This is because food is loaded with carbohydrates.
Nino, can caries appear even if all the rules are followed?
Of course, there is a genetic predisposition when the parents had frequent carious cavities. In this case, preventive measures can be taken – home hygiene alone isn’t enough. Parents should see a dentist, who will decide on and prescribe fluoridation, which strengthens the teeth and increases their protective function. This is a very good way to prevent caries. That’s why prevention is important: each patient should be assessed individually, and parents should be friends with dentists.
Nino, parents often avoid visiting the dentist because their child will find it hard to stay in the chair. What’s our answer for parents of restless, hyperactive children or children with behavioral problems?
We never start treatment at the first visit. It’s important that the first procedures are introductory, so the doctor gets to know the patient’s temperament and understands how to approach them individually. When a parent says everything you just mentioned in front of the child, that child will never sit still. It’s very important that negative information doesn’t reach the child – we even ask some parents to leave the room, they’re so emotional. At the first visit we may not even take the child into the treatment room, just get to know each other. As you know, ours is an orthodontic center, and patients with braces come to us once a month; we ask them to bring along a sister or brother to show that the process isn’t associated with any pain or unpleasant procedures. It’s quite common for a sibling who waits and watches to have great fun, make contact and have no fear of the procedure at all.
