Dental Problems in Children

Childhood is an age of acute dental danger. Appetites are at their peak and pocket money finds easily access­ible sweets. Tooth decay is at its most insidious. And there are accidents with falls, balls, bats and fists impacting on the front teeth. So expensive treatment is best delayed if clinically possible. Add to this the possi­bility that the permanent teeth are crooked, overlapping or undershot, and that young people (especially girls) are starting to become concerned about the physical impression they make, and this becomes an age of many dental visits.


Problems with Appearance

Thumb sucking may continue until around puberty, pulling the upper teeth forward, necessitating remedial orthodontic treatment, but this does not generally preoccupy young people themselves until puberty strikes, when appearance suddenly can become every­thing. At this time, even an obvious fixed orthodontic appliance will be tolerated if it holds the promise of perfectly aligned teeth at a later date.


It is at this point in life that young people start to believe that they are ugly and their physical attributes not up to par. This includes the teeth. Many teenagers (by now not their parents) believe that their teeth are ugly and misshapen, even when they are not, or believe that their teeth are the wrong color. Much effort is expended in trying to clean the teeth to a whiter-than-white, or even trying to persuade the dentist to crown them to make them shapelier or whiter. But, of course, teeth are not pure white, they are various shades of creamy colors, and white permanent teeth look very strange indeed.


Remedial Treatment

Sometimes, however, youngsters are correct about their appearance. Teeth that have been struck hard, but not broken, most often die and turn a rather sinister shade of grey. There may also be fluoride or developmental mottling, while crooked, misplaced or missing teeth and lower jaws that stick out or recede can cause acute embarrassment.


Many of these procedures involve orthodontists, but treatment is unlikely to start until the onset of puberty, at around 11 or 12. This is because the growth spurt that starts at this point aids orthodontic treatment. It is also wiser to await the arrival of all the permanent teeth, so as to be able to assess how much space will be available for tooth movements. However, if there are obvious jaw misalignments some orthodontists may wish to start treatment somewhat earlier.



Some youngsters get many more decayed teeth than others. As we have already indicated, these are prob­ably the young people who do not clean their teeth adequately. This matters particularly if they are prone to decay. And whether they are prone to decay or not is probably a matter of luck. Different genes lead to differ­ent circumstances. One person may have a higher percentage of bacteria in the mouth, another may have less saliva, and yet another may have a tooth shape that both retains food and makes plaque deposits more diffi­cult to clean away. There is also that positive relation­ ship between the use of fluoride toothpaste and non-decayed teeth. Some young people use it; some do not.



Parents may become concerned at the appearance of a small, wobbly lump, especially on a child’s lower lip. It is almost certainly a mucocele, probably caused by a blow from a ball, or perhaps lip-biting. Although they have a habit of recurring, they are totally harmless. It is worth remembering that it is unusual in the extreme for any difficult lump to occur in the mouth until people are past their fortieth birthdays. Some teenagers become martyrs to aphthous ulcers. Regrettably there is very little they can do about them, except use a chlorhexidine mouthwash to aid healing.


Gum Disease

While the gums of young people may bleed when brushing, advanced gum disease is very rare among young people. However, it is probably starting at this time. The early signs of gum damage, and indeed loss of bone, can be detected in some teenagers, so it is import­ant for them not only to clean their teeth thoroughly but also to go to their dentist to get good oral hygiene instructions and regular monitoring. This is the age group when not only are dental check-ups at their most important, they should also be at their most frequent.

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