Pediatric Dentistry

This is a phase that can bring some discomfort to the baby and a lot of concern for the parents.

The most common symptoms, usually noticeable to parents, include red and sometimes swollen gums, loss of appetite, increased salivation, irritability, and changes in sleep patterns.

If there is a fever, vomiting, or diarrhea, the child should be seen by a pediatrician to assess any possible underlying cause.

Parents can ease their baby’s discomfort by cleaning the mouth with a wet gauze 2-3 times a day, applying a special gel for the gums available in pharmacies, or using teething rings available on the market.

In Portugal, according to the guidelines of the Directorate-General of Health (DGS), topical application should be done in the form of toothpaste for brushing, appropriate for different stages of growth.

Tablets and drops, which were commonly used in the past, are not recommended.

According to the DGS, from the eruption of the first tooth until the age of 3, brushing should be done by the parents twice a day, with brushing before bedtime being mandatory.

Parents can use a wet gauze, finger brushes designed for this purpose, or soft brushes with the appropriate size.

Between the ages of 3 and 6, gradually allow the child to brush on their own, but always with supervision and assistance.

Brushing should be done twice a day, one of which should be before bedtime, using age-appropriate toothbrushes.

From the age of 6, the guidelines remain the same, with the only change being the amount of toothpaste used.

According to the DGS, from 0 to 5 years of age, the toothpaste should contain a fluoride concentration between 1000 and 1500 ppm, and the amount to use should be about the size of the child’s little finger nail or equivalent to a grain of rice.

Always avoid having the child swallow the toothpaste, which can be difficult due to the appealing flavors.

From the age of 6, the fluoride concentration in the toothpaste should be 1500 ppm, and the amount to use should be similar to the size of a pea.

Ideally, this habit should be abandoned by the age of 3, which allows for any potential changes in the development of the dental arches to be mostly self-corrected.

Fissure sealants are a fluid resin applied to the occlusal surface of molars and premolars with the aim of sealing the pits and fissures. They are recommended after the eruption of the first permanent tooth. The goal is to prevent the development of dental cavities, as they act as a physical barrier, preventing bacteria from entering the fissures and pits, which are essential for the initiation and development of the cavity process.

When a dental trauma occurs, the child should be observed by a dentist. In the case of a fracture of a permanent tooth, it is important that, if the tooth is found, it is transported in a moist medium (saline solution or milk) to the dentist so it can be reattached.

In the case of an avulsion (complete loss of the tooth from the gum), if it is a baby tooth, there is no indication for reimplantation, but if it is a permanent tooth, it may be reimplanted in the same place. In these cases, the tooth should be transported in a moist medium, held by the crown, and cleaned with water or saline. The success rate of reimplantation is higher the shorter the time between the accident and the treatment.

This black pigmentation is not related to oral hygiene and tends to disappear over time. It can be removed superficially through scaling.

Children should be treated with their cooperation, gaining trust over time. If the child’s cooperation cannot be achieved, conscious sedation can be used to prevent the child from having a traumatic experience.

Conscious sedation is a superficial sedation, administered through inhalation of a gas mixture consisting of 50% nitrous oxide and 50% oxygen. This is one of the safest sedation methods, allowing the patient to return to their normal life immediately after the procedure. It is indicated for anxious or odontophobic patients, or children, and helps achieve a state of complete relaxation and calm while the patient remains awake, cooperative, and completely safe, thus facilitating dental treatment.

It is a safe, non-invasive analgesia method with a calming and relaxing effect, and a recovery time of about 5 minutes. It acts quickly and lasts for a short duration. It is particularly useful for non-cooperative children or adults with a fear of dentists.

Dental agenesis is one of the most common congenital anomalies in humans and is characterized by the absence of one or more teeth, confirmed by radiography. There are varying opinions regarding the frequency of agenesis in different teeth, but it is generally agreed that multiple agenesis cases are rarer.

Agenesis can affect any tooth in the dental arch, with the most common being third molars (wisdom teeth), followed by second premolars and upper lateral incisors. Regardless of the affected tooth, it may occur on only one side of the arch or bilaterally.

There are several possible treatments, and it is up to the dentist to assess each clinical case. The approach to dental agenesis is generally multidisciplinary:

• Orthodontics: The primary goal is to reposition the teeth, organize the spaces, close them, or open space for the missing tooth.
• Implantology or prosthodontics: Focuses on replacing the missing teeth after orthodontic treatment.