REMOVAL OF MILK TEETH IN CHILDREN: INDICATIONS, PROCEDURE, CONSEQUENCES, COMPLICATIONS.
Extraction of teeth of a milk or permanent bite is possible only according to strict indications. Many parents are sure that there is no particular value in the baby’s milk teeth, and often insist on removal, not treatment. But this practice leads to the formation of serious complications that affect the whole body: from posture to work of internal organs.
Table of contents:
- Importance of deciduous teeth – Chewing function – Preservation of space
- Indications for the extraction of milk teeth in children – Diseases of the teeth – Anomalies and malformations of the teeth – Injuries – Orthodontic indications
- How is the removal going?
- Possible complications – Syndrome of a dry tooth socket – Alveolitis – Bleeding
- The consequences of premature extraction of deciduous teeth.
VALUE OF MILK TEETH
There are 20 teeth in the milk bite: 8 incisors, 4 canines, 8 molars.
Each has its purpose, anatomical shape, terms of eruption and loss. It is this purpose that determines all the consequences for the body, as well as to some extent indications for removal.
This function in itself is important, because children’s nutrition is changing rapidly. It is not in vain that the introduction of complementary foods coincides with the appearance of the first teeth, and a change in the diet towards “adult” food is associated with the appearance of chewing teeth. But not only this is important.
Chewing stimulates the full growth of the jaws, their proper development. Therefore, it is imperative that the child’s diet contains foods that require thorough chewing and that children can chew. Diseases of the teeth and their absence affect the ability to chew, therefore, the growth processes of the jaws may be impaired, which creates the prerequisites for the formation of occlusion pathologies.
SAVING A PLACE
Milk teeth save room for permanent teeth. In the thickness of the jaw, the rudiments of the permanent teeth are somewhat offset from their milk “ancestors”, and when they erupt, they are shifted to the side.
If during their eruption they do not encounter resistance, they will begin to erupt in the wrong place, taking up too much space, interfering with the eruption of the remaining teeth. If there is no space left, then others appear outside the dentition, which is called dystopia – this is already a malocclusion, which over time leads to even more serious problems and even to facial deformation.
70% of the world’s population needs orthodontic treatment, but most of this number does not even realize such a need, because symptoms can occur only at an older age.
INDICATIONS FOR REMOVING MILITARY TEETH IN CHILDREN
All indications for the extraction of milk teeth can be divided into those that are associated with diseases, functional and anatomical features of the body. All of them have their own characteristics, and they should be strictly followed, otherwise the problems will not take long.
One of the most common causes of extraction of primary teeth in primary school age is advanced caries and its complications.
Caries is a pathological process of tooth decay, which in childhood has its own characteristics. First of all, this is a significant tooth decay, often during caries in children, the teeth literally crumble, only “black stumps” remain. If caries cannot be cured in a timely manner, it quickly goes into complications – pulpitis.
Already with a deep form of caries in children in the pulp (“nerve”) of the tooth there are first pathological changes.
Pulpitis means only one thing – inflammation and bacteria passed from the carious cavity into the tooth into the root canal, and then spread beyond it to the surrounding tissues.
Milk teeth in children appear in the oral cavity, without roots, this process continues for several years from the growth zones. Closer to the period of the natural shift, the root begins to absorb from the top, which is called resorption. It is this process that explains the loosening of teeth and their independent loss. If the root is not formed or resorbed, then the infection spreads rapidly to the periodontium, which has a dense network of blood vessels.
It is dangerous not only the presence of infection, which can spread throughout the body and provoke diseases, but also the fact that it can affect the germ of a permanent tooth. The closer it is to the edge of the alveolar ridge of the jaw, that is, teething, the more vulnerable it is to face infection, since it is deprived of its natural protective membrane.
In the course of scientific research, the relationship between pyelonephritis, gastritis and a number of other diseases of internal organs and the presence of caries and its complications was proved.
The presence of caries is not always a reason for removal, but only in case of significant destruction of the crown of the tooth and if there is a threat to serious complications that pose a threat to the health and life of the child.
Absolute indications for the extraction of primary teeth will be:
- pulpitis of teeth with resorbed roots more than half;
- purulent forms of periodontitis;
- cyst, granuloma and cystogranuloma of the tooth;
- the threat of defeat the tooth germ;
- the impossibility or ineffectiveness of therapeutic treatment.
ANOMALIES AND DAMAGES OF TEETH DEVELOPMENT
20 primary teeth are the main set of teeth, but there are also supernumerary teeth. Until recently, the exact reason for their appearance, both in the milk and in the permanent bite, was not known. Recent studies have shown that it is about genes. In the appearance of supernumerary teeth, the heredity factor also plays a role.
Supercomplete teeth can have the correct anatomical shape, fulfill their anatomical purpose, but can have little in common with the teeth: they look like spikes, dental processes.
Super-complete teeth must always be removed, even if they have the correct anatomical shape. But dentists often have difficulties: which tooth from the main set, which one is not, is not easy to figure out.
Superficial teeth are far from always cutting through the oral cavity. A case of teething in the nasal cavity is known, which has caused chronic bleeding. In India, several boys, but in different years, removed about 200-230 super-complete teeth, which were irregular in shape and resembled spikes.
Children are restless and in their desire to know the world can commit rash acts. According to the data, under the age of 3 years, tooth injuries are most often associated with falls, bumps and careless handling of objects. In children of preschool and primary school age, sports games, fights and skirmishes on the street cause injuries.
Indications for the removal of primary teeth will be:
- enamel chips with enamel affecting teeth with absorbable roots;
- a dislocated dislocation when the tooth goes inside the jaw. Thus, the prerequisites for trauma to the rudiment of a permanent tooth are created, and treatment may prove inappropriate and be associated with serious complications;
- complete dislocation – when the tooth is literally knocked out of the tooth socket. Of course, this way the tooth can be restored, it is enough to install it in place within 2 days. But not always such an operation can be carried out. In a milk bite, teeth often do not recover.
- fracture of the jaws. Of course, this is a rather serious injury, which is not common in children, but all teeth that are in the fracture line should always be removed.
In case of serious malocclusion, it is advisable to deal with treatment in childhood. The dentition in children is more malleable; correction is easier and faster. Recently, orthodontic dentists refuse to remove “extra” teeth, if we are not talking about supernumerary teeth.
It is necessary to remove milk teeth if the constants have already erupted. Recall that the tooth is considered erupted if at least part of the tubercle or incisal edge appears in the oral cavity. Sometimes the process of resorption of teeth is disturbed, or even does not occur at all, but this does not interfere with the eruption of constants. If milk teeth are not removed in a timely manner, complications are formed – pathology of the bite.
Despite the availability of indications, only the dentist can take them into account and say about whether it is possible to leave a tooth and what consequences threaten if you refuse to remove.
HOW DOES THE REMOVAL PASS?
The procedure for removing teeth occurs according to a certain algorithm, and its complexity depends on the age of the child and the degree of root resorption. Of particular interest is around pain relief.
Modern dentistry, especially children’s dentistry, is aimed at the comfort of a small patient, and even if it is a difficult removal, when the roots of the tooth do not resolve and tooth mobility is absent. In this case, the dentist may suggest removal using sedation.
Sedation and anesthesia are different techniques, although the line between them is quite thin.
In most cases, anesthesia is enough, the drug is selected individually, taking into account the peculiarities of the body, the possibility of developing allergic reactions, etc. Modern anesthetics are free of side effects, and with proper selection they will not cause harm. If we are talking about the removal of moving teeth, especially with simultaneous eruption, then often only surface anesthesia is enough.
Removal occurs with the help of forceps selected for each group of teeth separately.
When milk teeth are removed, complications rarely form, and the use of additional tools is required.
Children with such diagnoses as Down syndrome, cerebral palsy, autism spectrum disorders, heart defects, immunodeficiencies, etc. require a special approach to removal. Features relate not only to the choice of anesthetics, but also to the manipulation itself. Sometimes treatment under sedation and even anesthesia is indicated in the walls of the hospital for maxillofacial surgery or specialized centers.
Tooth extraction is a surgical procedure that can be associated with a number of complications. These include dry hole syndrome with the subsequent development of alveolitis, bleeding, etc. Their appearance is always an occasion to visit a doctor again.
DRY HOLE SYNDROME SYNDROME
After removal, a clot forms in the well for several hours, protecting the underlying tissues from infection. If a clot does not form, then dentists talk about dry hole syndrome.
The syndrome can form only if the roots of the teeth are long enough. When removing teeth with resorbed roots, such a diagnosis is not made.
The dentist can diagnose the syndrome after a visual examination and in the presence of appropriate complaints: aching pain, halitosis, enlarged submandibular lymph nodes. If there is no treatment, then inflammation – alveolitis joins.
Inflammation of the hole in the extracted tooth is manifested by the following symptoms:
- pain in the area of the extracted tooth;
- an increase and soreness of the lymph nodes;
- increase in body temperature – in insignificant limits up to 38.5º С;
- Bad breath, which becomes pronounced, putrid;
- the hole of the extracted tooth is covered with a gray, dense coating.
Treatment always requires an integrated approach and involves surgical intervention, as well as the appointment of drugs: local antiseptics, antibiotics, anti-inflammatory drugs.
Most often, such complications form in children with concomitant diseases and against a background of reduced immunity.
Bleeding from a hole in a removed tooth can form immediately after the procedure or after a few hours later. The reason to re-visit the doctor after removal will be the appearance of blood clots, a sense of its taste.
Seek medical help immediately, that is, go to the nearest hospital for maxillofacial surgery, if there is obvious bleeding from the hole of the extracted tooth. First aid and treatment will depend on the severity of bleeding, as a rule, this is the use of hemostatic sponges, as well as the imposition of surgical sutures.
CONSEQUENCES OF PREMATURE REMOVAL OF DAIRY TEETH
Removal of primary teeth is considered premature if it occurred more than a year before the appearance of permanent teeth. But such a definition is fundamentally difficult, because each child is individual. Of course, there are average periods of natural change of dairy and teething constants, but this does not mean that they are strictly applicable to a particular child. Sometimes tooth extraction, even six months before the eruption of permanent teeth, leads to complications.
The most common complication of premature extraction of deciduous teeth is teething permanent outside the dentition (dystopia).
This is due to a number of consequences:
- Impaired chewing function. Even one incorrectly located tooth is associated with impaired chewing function, what can we say if there are several dysfunctioned teeth.
- The phenomenon of Popov-Gadon. Nature does not tolerate emptiness, and the teeth in children begin to shift towards the missing site. For example: there is no chewing tooth on the lower jaw, adjacent teeth begin to move toward each other, and the upper tooth, which should come into chewing contact with the missing one, begins to extend. If this situation persists, over time it leads to deformation of the entire dentition. But, in fairness, it is worth noting that such complications are more often formed in a permanent bite.
- Pathology of the bite. Dystopia is already a malocclusion that requires treatment. Tactics are determined individually, depending on the age, dental formula of the child, as well as his individual characteristics.
It is possible to avoid all the possible consequences of premature tooth loss by prosthetics immediately or soon after removal. After the examination, the dentist can offer several options, but more often preference is given to implant prostheses, which, according to the principle of operation, resemble clothespins. Despite the lightness of the design, the prosthesis allows you to save space for eruption of a permanent tooth.
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