TEETHING

The term “Teething Problem” in day-to-day usage means some problem, which are not entirely unexpected in the beginning of any endeavor. They usually subside on their own and are quit manageable and there is no need to get unduly worried regarding them.

Similarly, while actual teething also there may be some minor problem which resolve on their own. Teething is a new and unique experience for the child. It is the part of the growth of the child.
Teething is the natural eruption of the teeth by perforation of gums. It is characterized by stretching or thinning of gum tissue over the enamel of the teeth. It is a normal physiological process. The symptoms that accompany the process begin from the first to fifteenth month and may continue off and on into the third year of life.

The inflammation associated with the eruption of teeth is called as eruption gingivitis. Gums can become sore accompanied by the bleeding at the gum margin.

Teething can lead to intermittent localized discomfort in the area of an erupting tooth and subsequent irritability. Low grade fever will be associated with teething but this has not been established many children go through teething without any apparent problem, whereas have significant discomfort and irritation.

There is a tendency among some parents and doctors to attribute unexplained systemic treatment to teething which is true. Usually undiagnosed fevers and problems the cause of which are obvious to some doctors are passed of as due to teething .

Thus teething is rarely if ever responsible for some significant fever, rhinorrhea, rashes, or diarrhea.

It must be remember for the infant mouth is a window to world. Infants put anything that they fancy into their mouth. This because one of the first experience of the infant is sucking. The infant sees and explores the world with his mouth. The eruption of the teeth is a new experience for the infant. Since the infant has the tendency to put all the objects he sees into the mouth, this can result in inflammation of the gums, since the gums now get cut between the teeth and hard objects.

Therefore the normal appearance at the age of 4 months of oral exploration and consequent salivation and drooling is frequently attributed to, but rarely due to teething. The gum inflammation that occurs with the actual eruption of a tooth may produce an increase in this activity as well as periods of irritability. There is tendency to put figure or some other hard object in the mouth to counteract irritation of gums tissues.

There is no proven treatment, although rubbing swollen gums or giving the infant cold hard object such as an ice ring for the child to chew on may relive some discomfort. Gentle brushing for several days usually resolve the gum swelling. Messaging the gums with the solutions such as boroglycerin taken on a figure or with a Turkish towel may help.
Applications of commercially available topical analgesics at best provide limited and a very transient relief.
When discomfort and irritability clearly related to teething, which is very rare, aspirin and acetaminophen may be useful.

An incision of the gums is seldom required.

The only associated condition that has long-term consequence is the eruption of a tooth that is well out of alignment in the dental arch, which is also rare in the milk teeth. In such case either alignment of the tooth orthodontically or gum grafting can be considered.

The eruption of teeth usually means that the infant is now mature enough to take supplementary food and need not rely solely on breast-feeding alone. However eruption of teeth should not be taken as an indication to stop breast-feeding. Eruption of teeth obviously might cause discomfort to the nipples while breast-feeding. Even after the eruption of milk teeth the infant is not completely ready to start on semi-solid diet. Breast-feeding, in most of the cases, has to continue for some time after the teeth start erupting. Cessation of breast feeding should be depend upon the advise of the pediatrician or the nurses.

The eruption of teeth means that now parents now have to initiate dental hygiene fro the child. Usually simple cleaning and removal of food debris is sufficient by finger or by Turkish towel. A baby toothbrush with or without little toothpaste may be used for the older infant. The most important precaution is that parents should stop putting the child to sleep with the milk bottle in the mouth as this can leads to severe dental problems.

Care of teeth is very important now a day since the consumption of refined foods and sweets and chocolates has increased considerably. Sweets and chocolates should not be used as bribe to silence a crying child. Sleeping with a milk bottle in the mouth can cause severe form of dental decay known technically as BBTD (Baby Bottle Tooth Decay). This is discussed later on in the article.

Usually the fronts of teething in the lower jaw are the first to erupt. They erupt by the age of six months. Even if there is a delay for few months it does not indicate any pathology. The time eruption may vary widely. The eruption of primary teeth over by about two years of age. Usually the tooth in the lower jaw erupts first then it corresponding tooth in the lower jaw. Teeth erupt faster and earlier in the healthy infants than in undernourished or malnourished one. See table for details. However it must be remembered that the displays only averages.

Delayed eruption of all teeth may indicate systemic or nutritional disturbance such as hypopituitarism, hypothyroidism, cleoidocranial dysostosis, Gardner syndrome etc. Failures of eruption of small and single group of teeth usually arise from such local causes such as malpositioning of teeth, cysts, or retained primary teeth. If entire dentition is advanced for age and sex, precocious puberty or hyperthyroidism should be considered.

Natal teeth are those, which are present at birth. There are several superstitions surrounding natal teeth. Occasionally natal teeth are a source of curiosity, embarrassment and sometimes ever derision for the parents. There is nothing pathological about natal teeth. Natal teeth are observed in approximately 1:2000 newborn infants; usually there are in the position of lower central incisors. Natal teeth are present at birth, whereas neonatal teeth erupt in the first month of life. Eruption cysts may precede neonatal teeth. Attachment of natal teeth is generally limited to the gum margin, with little root formation and bony support; such teeth should not be considered to be extra teeth until so identified by radiograph. A natal tooth may be the prematurely erupted primary tooth, in which cases early dental eruption may be expected. Natal teeth are associated with cleft palate, Pierre robin syndrome, Ellis-van creveld syndrome, Hallerman-streiff syndrome and other anomalies. A family history of natal teeth or premature eruption is present in 15-20% of effected children.

Natal teeth may resulting pain and refusal to feed secondary to looseness and movement, and may produce discomfort due to abrasion or biting of nipple during nursing. There is danger of detachment with aspiration of tooth. Because the tongue lies between the alveolar process during birth, it may become lacerated, and occasionally the tip is amputated (Riga-fede disease).
Usually natal teeth are of no significance except they might cause discomfort to the mother while breast feeding and should be left alone. Decision regarding extraction prematurely erupted primary teeth must be made on an individual basis.

BBTD: This is an extensive form of tooth decay occurs from sleeping with nursing bottle. Even in U.S.A it is relatively common, occurring in about 15% or more in some Native American groups, there are no studies carried out for the Indian population but the prevalence in the Indian population is much more. BBTD is seen very common in private dental clinics.

BBTD occurs before 18 months of age, at a time when many children have not visited a dentist, but when many children visited pediatrician. This presents the pediatrician with the opportunity to link counseling on nutrition and dental hygiene. Breast-feeding or water bottle at night greatly reduces the occurrence of BBTD.

It is the only severe dental disease common in children less than 3 yrs of age. Furthermore, children with BBTD are more likely to continue to develop additional cavities on smooth surfaces of teeth. The elimination of major dental problems in toddlers and less decay in later childhood. Children less than 1 yr of age who sleeps with the bottle should be referred for treatment.
Eruption of teeth in an infant might present some transient problems both to the parent and to the child. They are very minor and are a part of the growth process of the child. For, the infant it is a unique experience and he may get excited about it. For the parents it is time to start supplementary diet after consulting the pediatrician more important is the initiation of good dental hygiene procedures fro the child so that the milk teeth last well and subsequently the permanent teeth take up their positions.

Good dental habits are formed early in life. Parents must remember that all teeth begin the same way. It is the care that makes the difference later in life.

Exfoliation failure occurs when a primary tooth is not shed prior to eruption of its permanent successor. The primary tooth should be extracted if the permanent tooth becomes visible. This occurs mostly in the mandibular incisor region.
Similarly manifestation can also arise when the first permanent molars erupt at the age of about 6 years. They are the largest teeth to penetrate mucosa and during the mucosal rearrangement to allow the eruption of the tooth; the gums can become very sore. Parents say that the child has a toothache.