Why do pediatric dentists as well as general dentists place so much emphasis on retaining milk teeth, till they fall in their natural span of time? The author will elaborate on the importance of the deciduous or milk teeth, and the role they play in the dental and physiologic development of the child.

What are milk teeth? 

Milk teeth (primary teeth) or deciduous teeth are the first set of teeth that a person gets in his/her lifespan. Typically, the milk teeth start erupting from the age of 5-6 months, starting from the lower incisors, and the last teeth to erupt are the primary second molars by the age of 3-3.5 years. The primary teeth total 20 in number. There is usually differing eruption trends from child to child, so delayed eruption of the primary teeth or late shedding should not be a matter of overt concern unless there is some underlying metabolic, or hereditary condition.

Eruption and shedding pattern of milk/primary teeth

When should care start?

 The home care should begin from the moment the teeth erupt in the mouth. It is very common to neglect the health and maintenance of the primary teeth, since the child may not be compliant towards oral hygiene maintenance, unlike an adult. Primary teeth, thus, are very prone and susceptible to early decay, which can spread very rapidly. Night feeds with sugared/un-sugared milk, bedtime snacks, sticky carbohydrates, processed foods like wafers, chips, bread, sweetened carbonated drinks, are equally prone to cause rampant decay in children, as does chocolates, sweets or pastries. Although it would be unfair to deny the child of these savouries, it is in the interest of the child's health, that an oral hygiene protocol is implemented, to make the child compliant towards the same. When the child is unable to brush their teeth on their own, the parent/s can use a muslin cloth dipped in clean water to wipe the teeth after a feed or use a finger stall brush with or without toothpaste to achieve the same results. It is imperative that brushing must be done twice a day, and the child must brush at night before sleeping, to reduce the risk of developing decay. Pooling of milk, or food, around the teeth following night feeds gives rise to the classic "baby-bottle syndrome", which causes rapidly progressing and destructive caries of the teeth.

Baby-bottle syndrome

If brushing the teeth immediately after eating a sticky carbohydrate/sweet/ savoury, is not possible, the child should be given water to drink, or should rinse thoroughly to remove whatever residue possible. Brushing in between meals need not always be with a medium like toothpaste, but even a moistened brush will achieve the same results. Nothing can be more distressing for the child or the parent, to suffer from the pain and discomfort associated with dental decay. When the decay is advanced, it often affects the nutrition of the child, as the pain often prevents them from eating, and they shun food. Repeated infections from carious teeth can severely affect the child's immunity and health. 

When should professional advice be sought?

As soon as possible! The child's first visit to the dentist should always be for a routine check-up, and when he/she is pain-free. This makes the child much more cooperative for dental procedures, if and when required. We often see that the child is brought to the office under duress, and then forced into treatment, which frightens them even more. Threats such as "doctor will give you an injection if you don't cooperate", or offering incentives like "I will buy you so and so, or let you do so and so, if you sit quietly", do not help appease the child's anxiety, and more than often, it boomerangs unfavorably. A child is actually unaware of the implications of treatment, and most fears are instilled by the parents' reaction to the dental visit. A happy child is probably the best patient that a professional can ask for, as they place implicit trust on their friendly doctors! A professional checkup at a regular interval also helps apprehend developing orthodontic or growth issues, early decay, malocclusion, and a host of other problems that can manifest in a child's mouth. Detailing all will not be within the scope of this article.

Is it necessary to carry out advanced treatment in children?:

In one word, yes! If advanced treatment like root canals, stainless steel crowns or aesthetic crowns for the front teeth, myofunctional appliances, serial extractions etc, are recommended, it is in the best interests of the child. The primary teeth form the biomarkers for the development, eruption and health of the succeeding permanent teeth, as well as the stable growth and development of the jaws. Premature loss of the milk teeth can result in the permanent teeth getting impacted, a shift in the teeth causes malocclusion and jaw development issues. More often than not, decayed front teeth can be a social stigma for the child. Unfortunate, but true, in today's society.

The maxim of prevention being better than cure is highly applicable when it comes to dentistry for children!