Pediatric Dentist (Pedodontics) İstanbul

Scientific editor: Specialist in Pediatric Dentistry (Pedodontics)
Multidisciplinary editor: Prof. Dr. Mehmet Oğuz Öztoprak – Specialist in Orthodontics and Dentofacial Orthopedics
Last updated: 23 July 2026

Pediatric dentistry, or pedodontics, is the dental specialty concerned with protecting children’s oral and dental health, diagnosing their diseases and treating them from infancy to the end of adolescence.

A pediatric dentist is not only a dentist who fills decayed milk teeth. The eruption of the child’s first teeth, decay risk, oral care habits, dietary pattern, milk and permanent tooth development, gum health, jaw growth, tooth eruption sequence, oral habits, dental trauma, dental fear and systemic and special health needs are evaluated together.

Children’s tooth structure, mouth size, way of communicating, fears, response to pain and medical needs are different from adults. Therefore, the examination and treatment plan should be prepared not only according to the child’s tooth, but according to their age, development, temperament, previous experiences and family structure.

At the center of the current pediatric dentistry approach is reducing decay risk before treating decay. Nevertheless, no fluoride application, fissure sealant or regular check-up definitively prevents all decay. Preventive success depends on the joint management of home brushing, fluoride toothpaste, dietary habits, check-up frequency and the child’s individual risks.

The American Academy of Pediatric Dentistry (AAPD) recommends establishing a “dental home” within six months after the first tooth erupts and by 12 months at the latest; at this visit, decay risk, oral care and nutrition are evaluated.

At Dentapolitan, pediatric dentistry is handled not as a treatment area consulted only when there is pain, but as a preventive and developmental follow-up process continuing from the baby’s first tooth to the end of adolescence.

What is pedodontics?

Pedodontics is the specialty concerned with the oral and dental health of infants, children, adolescents and individuals with special health needs from childhood onward. Its main working areas include the first dental examination, decay risk assessment, oral care education, dietary counselling, fluoride applications, fissure sealants, milk and permanent tooth fillings, milk-tooth pulp treatments, root canal treatment, milk-tooth extractions, stainless-steel crowns, space maintainers, eruption follow-up, evaluation of oral habits, treatment of dental trauma, athletic mouthguards, dental fear and behaviour guidance, sedation and general anaesthesia evaluation, treatment of children with special health needs and oral and dental health in adolescents.

Who is a pediatric dentist?

The term “pediatric dentist” can be used in everyday language for dentists who work with children. A pedodontist or pediatric dentistry specialist is a dentist who, after dental education, has completed specialty or doctoral training in pediatric dentistry. Their training particularly covers the treatment of milk and developing permanent teeth, pain and infection management in children, child-specific communication, behaviour guidance techniques, local anaesthesia in children, trauma treatment, decay risk assessment, growth and development, special health needs and the evaluation of the need for sedation and general anaesthesia.

Specialist treatment may not necessarily be needed for every child. However, when there is very young age, widespread decay, intense fear, trauma, special health needs or an advanced treatment need, pedodontic expertise can be important.

When should children have their first dental examination?

The first dental examination should be done within six months after the first milk tooth erupts and by around one year of age at the latest. Current AAPD policy recommends performing a decay risk assessment together with the first tooth and establishing a continuous dental follow-up relationship by 12 months at the latest.

The aim of this first visit is mostly not to place a filling. The aim can be to check erupted teeth, determine decay risk, show the brushing method, explain the correct toothpaste amount, evaluate nutrition and night feeding, discuss pacifier and thumb-sucking habits, inform the family about dental trauma and get the child positively used to the clinical environment.

Why is an early examination needed if the child has no complaint?

Early childhood decay may not create pain at first. When the first white enamel changes are noticed, brushing can be regulated, dietary frequency can be changed, fluoride support can be planned, the progression of decay can be slowed and the need for more comprehensive treatment can be reduced. If the child’s first dental experience occurs during pain, an abscess or an emergency extraction, the risk of developing fear can increase.

What is done in the first child dental examination?

The first examination can be kept short and simple according to the child’s age. In the evaluation, the medical history, pregnancy and birth history, medications used, allergies, feeding method, night feeding, bottle use, breastfeeding pattern, brushing, toothpaste use, fluoride sources, thumb-sucking and pacifier, tooth eruption sequence, mouth breathing, snoring, trauma history and the family’s dental health habits can be questioned. The child’s teeth, gums, tongue, palate and intraoral tissues are examined. An X-ray does not need to be taken at every first visit.

In small babies and children, the “knee-to-knee” examination method, in which the mother or father and the dentist sit facing each other, can be used. While the child remains on the parent’s lap, their head is extended towards the dentist; this method can help the child feel safe, help the dentist see inside the mouth and help the parent learn the brushing method.

How often should children go to the dentist?

An automatic six-monthly check-up is not suitable for every child. The follow-up interval is determined according to decay risk, age, new tooth eruption, oral care, nutrition, previous decay experience, fluoride exposure, orthodontic appliances and special health needs. A more frequent check-up can be planned for a child with high decay risk, and check-ups at longer intervals for a low-risk and healthy child. The check-up interval is personalized for each child according to decay and developmental risk.

Why are milk teeth important?

Although milk teeth are temporary, they are not unimportant. Their functions are to help chewing, support speech development, provide support to the lip and facial tissues, protect the child’s social appearance, hold space for the permanent teeth, guide the eruption of the permanent teeth and contribute to jaw bone and muscle function.

Milk teeth are lost at different ages. Some milk molars can remain in the mouth until about 10–12 years. Therefore, leaving a tooth that will be used for years untreated with the thought that “it will fall out anyway” is not correct.

Should milk-tooth decay be treated?

Not every milk-tooth decay is treated with the same method. In making the decision, the child’s age, the time remaining until the tooth falls out, the depth of decay, pain and infection, the restorability of the tooth, its effect on the permanent tooth, the child’s cooperation, the general decay risk and alternative treatments are evaluated. The treatment options can be fluoride and close follow-up, applications aimed at stopping the progression of decay, minimally invasive restoration, composite or glass-ionomer filling, stainless-steel crown, pulp treatment, root canal treatment and extraction. Just as not every small lesion immediately requires a large filling, it is also not appropriate to only monitor an advanced and infected milk tooth.

What is early childhood caries?

Early childhood caries is a clinical condition describing decay seen in the milk teeth of children under six years. This decay can begin especially in the upper front teeth, the milk molars and at the gum margins. The AAPD defines early childhood caries as an important chronic disease that develops over time with the disruption of the balance between protective and risk-increasing factors.

“Bottle caries” is an old and limiting expression, because early childhood caries does not arise only from the bottle. The factors that can increase the risk can be frequent consumption of sugary liquids throughout the night, not cleaning the teeth after milk or formula, frequent snacking, sugary drinks, fruit juice and sweetened milk, insufficient fluoride, not brushing regularly, insufficient parental support, previous decay, enamel development defects, dry mouth and some systemic diseases. Breast milk alone should not be evaluated as “causing decay”; the risk should be determined by evaluating together the feeding frequency after the teeth erupt, night exposure, other carbohydrates and oral care.

How is decay detected in children?

In the early period, a matte white line at the gum margin, a chalky white spot, colour change and surface roughness can be seen. When it progresses, a yellow or brown area, a cavity in the tooth, food accumulation, cold or sweet sensitivity, chewing pain, night pain, facial or gum swelling and an abscess can occur. Decay does not have to be black; white lesions can be the early stage of decay.

Decay risk assessment in children

Decay risk assessment is not just looking at the child’s existing teeth. The risk-increasing factors can be previous decay, plaque accumulation, frequent sugar consumption, night feeding, not using fluoride toothpaste, enamel development disorder, dry mouth, orthodontic appliances, special health needs, the sugar content of medications, an intense family history of decay and the absence of regular dental follow-up. The protective factors can be brushing with fluoride toothpaste twice a day, parental support, regular risk-based check-up, professional fluoride when needed, reducing the frequency of sugary consumption, fissure sealants, sufficient saliva and early treatment.

When and how should children’s teeth be brushed?

Brushing should begin as soon as the first tooth is visible in the mouth. Wiping the inside of the mouth with a clean cloth before the tooth appears can get the family used to care; but after the tooth erupts, the main protective method is a toothbrush and a suitable fluoride toothpaste. The AAPD supports brushing twice a day with an age-appropriate amount of fluoride toothpaste in all children.

Small children’s manual skill is not sufficient to clean all tooth surfaces effectively. Generally, the parent should brush in infancy and preschool, the parent should check even if the child brushes in the primary-school period, and independent care should be determined according to manual skill and level of responsibility rather than age.

Fluoride toothpaste and fluoride applications in children

Fluoride toothpaste is one of the main methods of protection against decay. According to the AAPD, fluoridated water and brushing with fluoride toothpaste twice a day are among the main methods that reduce decay prevalence in children. The amount of toothpaste should be adjusted according to age: a very small amount, a rice-grain or thin smear, in children under three; an amount not exceeding a pea size between three and six years; a suitable amount in older children who have learned to spit. The fluoride concentration and amount of the toothpaste should be recommended by the pediatric dentist according to the child’s decay risk.

Fluoride, with the right product, dose and manner of use, helps protect against decay. The risk can increase, especially at the young ages when the teeth are developing, with the continuous and excessive swallowing of fluoride products; this can lead to dental fluorosis. Therefore, the toothpaste amount should be limited, brushing should be done under parental supervision, the toothpaste should be kept out of the child’s reach, fluoride tablets should not be used haphazardly and drinking water and other fluoride sources should be evaluated.

What is fluoride varnish?

Fluoride varnish is a professional product that contains a high concentration of fluoride and is applied in a very small amount to the tooth surface. The aim can be to strengthen the enamel, slow the progression of early enamel lesions, reduce the risk of new decay and control sensitivity. Fluoride varnish does not automatically heal a decayed tooth, does not fill an existing large cavity, does not replace brushing and the dietary pattern, and is not applied at the same frequency in every child. The application frequency is determined according to decay risk.

What is silver diamine fluoride?

Silver diamine fluoride is a topical agent that can help stop the progression of selected decay lesions. It can be used for temporary or disease-control purposes especially in very young children, patients with limited cooperation, those with many decayed teeth, situations where treatment must be postponed and children with special health needs. Its most important disadvantage is that it can permanently turn the active decay tissue a dark or black colour. This application does not correct the shape of the decay cavity, is not suitable for every tooth, does not always eliminate the need for definitive restorative treatment and requires family consent.

What is a fissure sealant?

A fissure sealant is a thin protective material applied especially to the deep grooves on the chewing surface of the molars. These grooves can be too deep for the toothbrush to reach. A fissure sealant can reduce bacteria and food accumulation, lower the risk of groove decay and help stop the progression of selected initial-level decay. The joint clinical guideline of the AAPD and ADA supports the use of fissure sealants to prevent decay on the chewing surfaces of milk and permanent molars in children and adolescents.

Most often, milk molars, six-year molars, twelve-year molars and premolars with deep grooves are evaluated. It does not need to be routinely applied to every molar; the eruption status of the tooth, the groove structure, the possibility of isolation and the child’s decay risk are taken into account. A fissure sealant does not completely prevent decay; it only protects the chewing groove to which it is applied, and decay can develop on the interproximal surfaces or other surfaces of the teeth. It can also wear, partly come off or need to be renewed over time; therefore, it should be checked.

Tooth fillings, the Hall technique and stainless-steel crowns in children

A filling is the repair, with a suitable material, of tooth tissue lost due to decay or trauma. The materials that can be used can be composite resin, glass-ionomer cement, resin-modified glass ionomer and temporary restorative materials. The material selection is made according to whether the tooth is a milk or permanent tooth, the size of the decay, moisture control, the child’s cooperation, the time the tooth will remain in the mouth and the bite force. In very extensive substance loss, a crown may be needed instead of a filling.

The Hall technique is a minimally invasive method in which selected decayed milk molars are covered with a stainless-steel crown without the decay being completely cleaned. The aim is to control the progression of the disease by cutting off the food source of the bacteria that cause decay. This method mostly may not require local anaesthesia, intensive tooth grinding and the complete removal of decay; however, not every tooth is suitable. It may not be suitable in spontaneous pain, abscess, pulp disease, the tooth being too broken down to restore, very little time remaining until the tooth falls out and anatomical situations preventing the crown from seating.

A stainless-steel crown is a durable restoration that completely covers a milk molar with advanced substance loss. It can be considered in multi-surface extensive decay, a milk tooth that has had pulp treatment, an enamel development defect, filling-fracture risk, high decay risk and comprehensive treatment under general anaesthesia. It protects a large tooth, can be more durable than a filling and can help the tooth continue its function until it falls out. Its disadvantage is the metal appearance; different aesthetic crown options can be evaluated in the front region.

What is milk-tooth root canal treatment?

In milk teeth, “root canal treatment” is used as a general expression; however, different treatments can be applied according to the condition of the pulp. Pulpotomy is the removal of the diseased pulp tissue in the crown part of the tooth and the preservation of the living tissue within the root; it can be considered if the decay has reached the pulp, the root tissue is alive and controllable, there is no abscess or advanced root infection and the tooth is restorable. Pulpectomy is the cleaning of the infected or non-vital tissue in the root canals of the tooth and filling it with a material suitable for a milk tooth; it can be considered if the pulp has lost its vitality, the infection has progressed to the root canals and the tooth is worth keeping in the mouth and is restorable. The material used in milk-tooth root canal treatment can be different from permanent-tooth root canal treatment; because the milk-tooth roots need to naturally dissolve to make space for the permanent tooth.

Milk-tooth pulp treatment done with correct diagnosis and suitable technique aims to keep the tooth in the mouth and control the infection. However, no treatment is completely without risk; the persistence of infection, loss of the filling or crown, a lesion around the root, renewal of the treatment, extraction of the tooth and the effect on the underlying permanent tooth germ can occur. An untreated infected milk tooth can also create a risk for the developing permanent tooth.

Milk-tooth extraction and space maintainer

Extraction can be considered if the tooth cannot be restored, if there is advanced infection, in situations where the root canal treatment has failed, if the roots of the tooth have dissolved to an advanced degree, if it prevents the eruption of the permanent tooth, if there is serious displacement after trauma, if the orthodontic or eruption plan requires it and if there is a pathological formation. A milk tooth should, if possible, be protected until the natural time of falling out; however, leaving an infected and untreatable tooth in the mouth just to hold space is not correct.

When a milk tooth is lost before the normal time of falling out, the appliance used to reduce the drifting of the neighbouring teeth into the space is called a space maintainer. A space maintainer can be fixed, removable, one-sided or two-sided. A space maintainer is not needed after every early milk-tooth extraction; the decision is affected by the lost tooth, the child’s age, the eruption time of the permanent tooth, the amount of space, the position of the neighbouring teeth, crowding, jaw development, oral hygiene and the child’s cooperation. Regular check-ups are needed after a space maintainer is placed; the appliance can loosen, break or create gum irritation or plaque accumulation.

The six-year molar and the eruption of permanent teeth

The six-year molar is the first permanent molar that erupts behind the milk molars at around six years of age. Since it does not erupt in place of a milk tooth, families may mistake this newly erupted tooth for a milk tooth. This tooth is important for chewing function, the closure of the teeth, orthodontic anchorage and the development of the permanent dentition. Because of its deep grooves and the difficulty of cleaning during the eruption period, the decay risk can be high; in this period, the evaluation of brushing, fluoride and a fissure sealant is important.

Eruption times can vary from person to person. In general, the first permanent molars and front incisors can erupt at around 6–8 years, the premolars and canines in the later school period, the second molars at around the beginning of adolescence and the wisdom teeth at more advanced ages. A tooth not erupting at a certain date does not mean disease on its own; however, a marked delay between the right and left sides or a milk tooth remaining for a long time should be evaluated.

Tooth eruption problems in children

Evaluation may be needed in situations of a tooth erupting much later than its counterpart on the other side, a milk tooth not falling out, a permanent tooth erupting from a different place, a tooth erupting on the palate or cheek, an impacted tooth, an extra tooth, a missing tooth, an eruption cyst, the tooth being attached to the bone, lack of space and early or delayed tooth loss. When necessary, the pediatric dentist, the orthodontist and the oral and maxillofacial surgeon can work together. Not every impacted canine can be prevented; however, if the eruption path, the condition of the milk canines, crowding, upper jaw constriction and the radiological position are evaluated during childhood, some risky situations can be noticed earlier. In selected patients, extraction of the milk tooth or orthodontic space opening can help the eruption of the permanent canine.

Is a dental X-ray safe in children?

Dental radiographs, when needed, can provide important information for diagnosis. With an X-ray, interdental decay, root development, infection, missing or extra teeth, impacted teeth, trauma damage and the position of the permanent teeth can be evaluated. A routine X-ray does not need to be taken every year in every child; the imaging decision is made according to the clinical examination, decay risk, age, contact of the teeth, trauma, an eruption problem and previous images. In children, the lowest suitable radiation dose possible, the correct device and protective protocols should be used.

Dental trauma in children

Falls, impacts and sports injuries can be common in children. As a result of trauma, tooth fracture, loosening of the tooth, sideways or inward movement of the tooth, complete avulsion of the tooth, lip and gum injury and jaw bone damage can occur. The treatments of milk and permanent tooth trauma are different from each other. The IADT guidelines state that milk-tooth injuries require special evaluation because of their proximity to the developing permanent teeth.

What should be done if the child’s tooth is fractured?

The child should be calmed, the mouth should be checked for bleeding and foreign bodies, if the fractured piece is found it can be stored in clean milk or saline, cold can be applied externally to the area and a dentist should be consulted in a short time. If there is loss of consciousness, vomiting, dizziness or serious facial trauma, an emergency medical evaluation should be made. The fractured piece can be reattached in some cases.

What should be done if a permanent tooth is completely avulsed?

The complete avulsion of a permanent tooth is a serious dental emergency; rapid and correct intervention can affect the probability of preserving the tooth. Under suitable conditions, the tooth should be held by the crown part, the root part should not be touched, if dirty it should be cleaned gently for a short time, in a conscious and cooperative child the tooth can be replaced in its place, if it cannot be replaced it should be transported in milk or a suitable storage solution, the tooth should not be left dry and a dentist should be consulted urgently. If a milk tooth is completely avulsed, it should not be replaced; there is a risk of damaging the developing permanent tooth.

Even if the tooth looks normal after trauma, this does not mean there is no problem. After trauma, the tooth can lose its vitality, change colour, root development can stop, it can develop an infection, root resorption can occur and an eruption disorder can develop. Therefore, after trauma, a clinical and, when needed, radiological follow-up is done at certain intervals.

Dental fear and behaviour guidance in children

Dental fear can develop because of a previous painful experience, the family’s fearful narrative, stories heard from the surroundings, fear of needles or blood, a feeling of loss of control, age-related development, sensory sensitivity, general anxiety and long and difficult appointments. Labelling a frightened child as “stubborn” or “spoiled” is not correct. The aim is not to treat the child by force, but to create a safe behaviour plan suitable for the child’s development.

Behaviour guidance is the whole of the communication and support methods used so that the child understands the dental treatment, develops trust and can safely complete the procedure. According to the AAPD, behaviour guidance should be child-specific and family-centered; when selecting a technique, the medical history, temperament, pain, treatment need, previous behaviours, alternatives and informed consent should be taken into account. The main techniques that can be used can be tell–show–do, positive language, age-appropriate explanation, positive reinforcement, distraction, modelling, gradual acclimatization, breathing and relaxation methods, short appointments and offering the child limited choices. The AAPD’s 2023 clinical guideline shows that the overall effect of basic non-pharmacological methods can be small; therefore, no technique gives the same result in all children.

In the tell–show–do technique, the dentist first explains the procedure in words appropriate to the child’s age, then safely shows the instrument or application and then performs the procedure. The aim is not to deceive the child, but to simplify frightening technical language.

Should the parent be in the treatment room?

There is no single correct answer. The decision is made according to the child’s age, anxiety level, the parent-child relationship, the type of treatment, the clinic’s approach and safety. Some children are more comfortable with the parent nearby, while others can be affected by the parent’s anxiety. If the parent is in the room, they should not distract the child, should not give contradictory instructions to the dentist, should not use frightening words and should not turn the treatment into a reward or punishment tool.

Families should describe the visit briefly and positively, should not give guarantees such as “it won’t hurt,” should not emphasize words such as needle, extraction, blood and pain in advance, should not tell their own bad experiences in front of the child, should not present the treatment as a punishment and should not force brushing by frightening the child. A suitable expression: “The dentist will count your teeth, clean them and help them stay healthy.”

Local anaesthesia and sedation

Local anaesthesia provides pain control by temporarily numbing the tooth and surrounding tissues. The dose should be calculated according to the child’s weight, age, medical condition, the anaesthetic agent used and the number of procedures. The possible risks can be biting the lip or cheek, temporary swelling, injection pain, a feeling of palpitation, allergic reaction and overdose toxicity. After treatment, supervision is needed so that the child does not bite their lip or cheek until the numbness wears off.

Sedation is a pharmacological behaviour guidance method used to reduce anxiety and movement and to enable the treatment to be done safely and in a more tolerable way. The levels of sedation are different: minimal sedation, moderate sedation, deep sedation and general anaesthesia are not the same applications. The sedation decision should be made by evaluating the child’s age, anxiety, cooperation, the scope of the treatment, medical condition, airway, alternative behaviour methods and the postponability of the treatment. The AAPD classifies sedation and general anaesthesia as advanced behaviour guidance methods; it recommends that the decision be made with alternative methods, medical condition, development, treatment need and the risk–benefit balance.

A mixture of nitrous oxide and oxygen is a minimal or moderate sedation method applied with a nasal mask. The child is mostly awake, can speak, can respond to commands and can feel relaxation and lightness. Nitrous oxide may not replace local anaesthesia; it may not be suitable in nasal congestion, some respiratory tract diseases, inability to communicate, refusal of the mask and some metabolic or medical conditions.

Children’s dental treatment under general anaesthesia

General anaesthesia is an advanced anaesthesia method in which the child is unconscious and their protective reflexes are suppressed. It can be considered in the situations of a widespread treatment need at a very young age, intense fear and inability to establish cooperation, special health needs, many painful or infected teeth, urgent and comprehensive treatment, special situations where local anaesthesia is not sufficient and surgical procedures. According to the AAPD, general anaesthesia should not be used routinely in a healthy and cooperative child with a minimal treatment need; the decision should be based on age, treatment need, alternatives, medical condition and the risk–benefit balance.

General anaesthesia is not without risk; nausea and vomiting, sore throat, respiratory problems, drug reactions, agitation during the waking period and rare serious anaesthesia complications can occur. For safety, a suitable health facility, an authorized anaesthesia specialist, monitoring suitable for the child, airway management, emergency intervention equipment and discharge criteria are required. The AAPD’s current guideline states that deep sedation and general anaesthesia providers should have appropriate licensing, authorization and pediatric life-support competence.

Dental treatment in children with special health needs

Children with special health needs may require a personalized approach because of autism spectrum disorder, Down syndrome, cerebral palsy, attention deficit and hyperactivity, differences in mental development, epilepsy, heart diseases, bleeding disorders, immune system problems, oncological diseases, rare syndromes and sensory processing difficulties. Before treatment, medical diagnoses, medications, allergies, communication style, sensory triggers, movement capacity, seizure history, nutrition and swallowing and aspiration risk are evaluated.

The methods that can be used can be getting to know the clinic in advance, visual stories, short and gradual appointments, a quiet or sensory-adapted environment, continuing with the same team, parent and caregiver support and sedation or general anaesthesia. The AAPD recommends the individualized evaluation of sensory-adapted environments, visual communication systems, breathing methods and, when needed, pharmacological options in anxious children and those with special health needs. In special situations where uncontrolled movement creates a risk of harming the child or the treatment team, the temporary limitation of movement (protective stabilization) is not a punishment or a routine behaviour method; it should not be applied without parental consent, should be used after alternatives are evaluated and only as part of the general behaviour plan.

Oral habits in children

Some habits that continue for a long time can affect tooth and jaw development: thumb-sucking, pacifier use, tongue thrust, lip sucking, nail biting, mouth breathing, incorrect swallowing and pen biting. The degree of effect depends on the duration of the habit, its daily frequency, the force applied, the child’s age and their growth structure.

A pacifier can help calming in infancy; but long-term and intense use can increase the risk of anterior open bite, forward inclination of the upper front teeth, posterior crossbite and a change in palate shape. The definite time of stopping is not the same for every child; reducing use as age advances and ending it in the preschool period is generally aimed. Sugar, honey or a sweet substance should not be applied to the pacifier.

Thumb-sucking seen for a short time and at a young age can be stopped spontaneously. If the habit lasts a long time, anterior open bite, forward inclination of the upper front teeth, backward inclination of the lower front teeth, upper jaw constriction and crossbite can occur. Treatment starts first with the child’s desire and behavioural support; punishment, shaming or using bitter products is not appropriate. When necessary, the pedodontist and orthodontist can plan an appliance together.

Mouth breathing, snoring and teeth grinding

Mouth breathing can be related to nasal congestion, allergy, adenoids, tonsils, structural nasal problems, habit and jaw constriction. In mouth-breathing children, dry mouth, gum inflammation, increased decay risk, difficulty in lip closure, a narrow palate, sleep disorder and snoring can be seen. The pediatric dentist can notice intraoral findings; but does not diagnose and treat nasal and airway diseases alone. When necessary, a pediatric, ENT, sleep medicine and orthodontic evaluation should be made.

Not every snoring is sleep apnea. However, regular and loud snoring should be evaluated if it is together with breathing pauses at night, sleeping with the mouth open, restless sleep, sweating, difficulty waking in the morning, attention problems, behaviour changes and growth problems. The dentist can notice accompanying findings such as lower jaw retrusion, a narrow palate, mouth breathing and clenching; the definitive sleep diagnosis is made by the relevant medical branches.

Teeth grinding during sleep can be seen in children and can change with age. The possible relationships can be sleep development, stress, some medications, snoring and respiratory problems, neurological conditions, tooth eruption and behavioural factors. A night guard is not needed in every child; the need for treatment increases in the situations of pain, advanced tooth wear, tooth fracture, limitation of jaw movement, sleep disorder and daytime loss of function. Since the child continues to grow, uncontrolled and long-term guard use can affect tooth eruption or jaw development.

Early orthodontic evaluation in children

The pediatric dentist follows tooth eruption and jaw development; when deemed necessary, they refer the child to an orthodontist. Early evaluation is important in situations of a lower or upper anterior crossbite, the jaw shifting to the side when closing, upper jaw constriction, the lower jaw appearing markedly forward or back, the permanent teeth being unable to erupt, early milk-tooth loss, impacted-tooth risk, thumb-sucking, mouth breathing, advanced crowding and the front teeth being very forward. An early examination does not mean that an appliance or braces will be started immediately in every child; some children are only followed up.

Gum, bad breath and enamel problems in children

In children too, gum bleeding, redness, swelling, bad breath and plaque and tartar can be seen. The most common cause is insufficient oral care; but hormone changes, mouth breathing, orthodontic appliances, medications, systemic diseases and immune problems can also play a role. Advanced periodontal disease is rare in children; however, if rapid gum and bone loss is seen, a systemic evaluation may be needed. The possible causes of bad breath can be insufficient brushing, accumulations on the tongue surface, decay, gum inflammation, dry mouth, mouth breathing, tonsil and adenoid problems, reflux and a foreign body in the nose; using only mouthwash may not solve the underlying cause.

Aphthae mostly heal spontaneously. However, an evaluation is needed in situations of lasting longer than two weeks, recurring very frequently, fever and general condition disorder, weight loss, a sore in the eye or genital area, many lesions, preventing eating and drinking, an immune system disease and medication use. Some teeth can be white, yellow, brown, rough, sensitive or easily fractured while erupting; the possible conditions are hypomineralization, hypoplasia, fluorosis, trauma-related development disorder and genetic enamel diseases. Molar-incisor hypomineralization, seen especially in the six-year molars, can create cold sensitivity, difficulty brushing, rapid substance loss, difficulty with local anaesthesia and increased decay risk; the treatment can include options such as fluoride, sensitivity control, fissure sealant, filling or crown.

Front-tooth aesthetics and athletic mouthguards in children

Decay, fracture, colour change, shape disorder and enamel development defect can be treated in milk or permanent front teeth. The options can be composite bonding, a strip crown, an aesthetic child crown, reattachment of the fractured piece, temporary restoration and more advanced restorative treatment in permanent teeth. Since the child continues to grow, permanent and irreversible aesthetic procedures should be planned carefully. Colour change in a tooth can occur due to trauma, decay, loss of pulp vitality, a developmental disorder, medications, fluorosis and internal or external stains; a milk tooth that turns grey after trauma is not necessarily extracted immediately, pain, infection, radiological findings and the change over time are evaluated.

In sports with a risk of contact and impact, the use of a mouthguard can help reduce tooth fracture, lip and cheek injury and displacement of the tooth. Custom mouthguards can provide better fit and protection than ready-made products. In children undergoing orthodontic treatment, a special guard that allows tooth movement may be needed.

Pediatric dentistry in adolescents and medication use

Risks can change in adolescence; orthodontic appliances, sugary and acidic drinks, energy drinks, insufficient brushing, uncontrolled use of whitening products, sports trauma, cigarettes and nicotine products, oral piercings, eating disorders, reflux and clenching should be evaluated. It is important that the adolescent participates in treatment decisions in an age-appropriate way and that their privacy and autonomy are respected.

Not every toothache or decay requires an antibiotic. An antibiotic does not clean decay, does not treat the infected pulp in the tooth and does not eliminate the abscess source. An antibiotic can be considered in situations of spreading facial swelling, fever, general condition disorder, lymph node findings, systemic infection risk and immune system problems; the tooth itself may need a filling, pulp treatment, drainage or extraction. Unnecessary antibiotic use increases the risk of resistance and side effects. The painkiller dose should be calculated according to the child’s weight; the parent should not give an adult medication haphazardly by dividing it, should not use two medications containing the same active substance together, should not use aspirin in children without consulting a doctor and should not exceed the prescribed dose.

What should be paid attention to after children’s dental treatment?

The recommendations vary according to the procedure. In general, the lip and cheek should not be bitten until the local anaesthesia wears off, very hot foods should be avoided, the child should not be allowed to disturb their mouth, the prescribed medications should be used at the suitable dose, the recommended pressure should be applied if there is bleeding, hard and sticky foods should be limited according to the type of procedure and oral care should not be completely abandoned. If there is severe pain, increasing swelling, fever, bleeding that does not stop or allergic findings, contact should be made with the clinic.

According to the type of treatment, temporary pain and sensitivity, biting the lip or cheek after local anaesthesia, breakage or loss of the filling, the crown coming off, failure of the pulp treatment, persistence of infection, need for tooth extraction, breakage or loosening of the space maintainer, gum irritation, increase in the child’s anxiety, sedation or anaesthesia complications and additional treatment need can occur. A lifelong success guarantee should not be given for any filling, root canal treatment, crown or trauma treatment.

Why do children’s dental treatment prices vary?

“Children’s dental treatment” is not a single procedure. The factors that can affect the fee can be the examination and risk assessment, the need for an X-ray, fluoride application, the number of fissure sealants, the scope of the filling, whether it is a milk or permanent tooth, pulp or root canal treatment, crown, tooth extraction, space maintainer, trauma treatment, the need for behaviour guidance, sedation, general anaesthesia and hospital conditions and the check-up and follow-up process.

Families should evaluate not only the procedure price but also the following questions: Will the treatment be done by a dentist experienced in pediatric dentistry? Will decay risk be evaluated? Will a preventive program be prepared? Will alternative treatments be explained? Are sedation or general anaesthesia really necessary? Is there a follow-up plan after treatment? What is the crown or filling material to be used? Are space-maintainer check-ups included in the price? Will long-term follow-up be done after trauma?

Pediatric dentistry approach at Dentapolitan

At Dentapolitan, pediatric dentistry is handled not as a treatment area consulted only when there is pain, but as a preventive and developmental follow-up process continuing from the baby’s first tooth to the end of adolescence. Reducing decay risk before treating decay, personalizing the examination and treatment plan according to the child’s age, development and temperament, monitoring tooth eruption and jaw development, working together with orthodontics, oral and maxillofacial surgery and the relevant medical branches when needed and informing the family about preventive care form the basis of our approach. Dentapolitan serves in Istanbul through its clinics in Ümraniye and Pendik.

This content has been prepared for general health information purposes. It does not replace an examination, diagnosis or a personalised treatment plan.