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What is a Paediatric Dentist?

A paediatric dentist is a specialist dedicated to the oral health of children right from their birth, infancy till adolescence or teen years. A paediatric dentist is a highly qualified doctor, with specific qualifications to treat conditions affecting the children’s teeth, gums, and mouth through the different stages of their growth. 

Generally, children begin to grow teeth during the first 6 months after birth. Typically, most children, also tend to lose their first set of teeth (milk teeth) by the age of 6 or 7 years. They then grow their permanent set of teeth, which last for life. During these stages, children tend to be prone to developing a cavity, gum problems, oral hygiene issues, bad breath, oral decay, and other oral diseases, which can cause pain, make them uncomfortable and often hamper the general quality of life. Hence, it is important to get frequent consultations from a qualified paediatric dentist to maintain good health in children. Dental issues are more common in children as compared to hay fever and asthma. 

Training of Paediatric Dentist

Generally, paediatric dentists are trained like other dentists. However, after completion of their general dentistry course, a paediatric dentist is also provided additional training in dentistry for infants, children, teens, and other children with special needs. 

Paediatric dentists are well trained to handle children during dental procedures and examinations. A paediatric dentist is more patient, subtle and considerate in his/her approach in treating children and making them comfortable. Moreover, they also use specific equipment that has been designed for children. 

Types of Treatment Offered by Paediatric Dentist

A paediatric dentist is well-equipped to provide comprehensive oral care for children. This includes diagnosing and treating oral problems and diseases. Some of the most common treatments offered by a paediatric dentist include:

  • Oral health exams for infants, including the mother
  • Preventive dental health procedures such as cleaning, fluoride treatment, and healthy diet and oral nutrition advise
  • Habit therapy for children that are addicted to thumb sucking, pacifiers, etc.
  • Assessing and correcting disfigured teeth and improper bite, also known as orthodontics
  • Treating tooth cavities and defects in the teeth
  • Treatment of dental injuries and trauma such as fracture, displacement, knocked-out teeth, etc.
  • Curing gum diseases and problems such as bleeding gum, ulcers, bad breath, mucoceles, and others.
  • Diagnosing and treating dental problems caused because of health issues such as diabetes, congenital heart issues, asthma, hay fever, and others

Symptoms of Oral and Dental Issues in Children

Some of the most common symptoms of oral and dental issues in children include:

  • Ulcers, sores or extremely tender areas in the mouth, which cause a problem in consuming food
  • Extremely bad breath
  • Pain in chewing or biting
  • Declining gums
  • Losing teeth
  • Extreme sensitivity to cold or hot food, beverages or overall temperature
  • Bleeding or swelling in the gums, usually noticeable upon brushing teeth or flossing
  • Pain in the jaw while biting or chewing
  • Toothache and cavities
  • Wisdom toothache
  • Swelling in the face and cheek
  • The clicking of the jaw
  • Dry mouth
  • Broken teeth
  • Teething problems
  • Misaligned teeth

In case, in of these symptoms are accompanied by high fever or swelling in the face or neck, parents should immediately take the child to a paediatric dentist for a consultation. 

Diagnostic Tests Used by Paediatric Dentists

Most of the diagnostic tests and procedures used by a paediatric dentist are similar to that of a general dentist. These include dental exams, X-rays, CT scans, etc. to understand current and also help with future oral problems in children. 

Benefits Offered by Paediatric Dentists to Children

Some of the most significant benefits offered by a paediatric dentist to children include:

  • Prevention and treatment of all oral and dental concerns
  • Educating children and parents on oral hygiene and prevention of dental issues
  • Calming children during dental and oral procedures to maximize efficiency
  • Advising on preventive dental health measures
  • Providing therapy for issues including teething problems, etc.

Reasons to visit a Paediatric Dentist

Parents should take their children to visit a paediatric dentist for the below reasons:

  • Get consultation for new or ongoing oral health issues in the child
  • Get an early risk assessment for dental and oral diseases and problems
  • Seek advice to stop unhealthy oral habits such as using a pacifier, thumb-sucking, etc.
  • Get preventive treatment for issues such as sealants, fluorides and more
  • Seek advice on the dental and oral health development of the child, including the growing, breaking and replacement of the milk teeth. 

Difference between a Paediatric Dentist and General Dentist

On a broad level, both specialists – paediatric dentist and general dentist diagnose and treat oral and dental issues. However, the detailed role of each is different. 

  • A paediatric dentist is trained as a general dentist with additional training of treating dental issues in children of all ages. That said, a general dentist is only trained to treat oral and dental issues in people of all ages, without any special training to treat children.
  • A paediatric dentist is limited to treating only children and does not deal with adult patients. However, a general dentist mostly treats adults but can treat children, in case of emergencies. 
  • A paediatric dentist covers more oral and dental health issues such as baby bottle tooth decay, teething issues, and more. On the other hand, a general dentist does not deal with such issues.
  • Paediatric dentists are specifically trained to manage children during dental and oral procedures, provide anaesthesia and also manage their growth and development. However, a general dentist can manage adults but is not specifically trained to take care of children.

Overall, a paediatric dentist is a specialist that can provide superior care for the oral and dental problems of children of all ages.

Vaccination chart for infants in India

Vaccinations, also known as immunizations are very important in protecting infants from a multitude of preventable diseases. Vaccines help to save millions of lives, as well as prevent many more from being hospitalized. In all immunizations can help prevent 2-3 million deaths every year from diseases such as diphtheria, measles, whooping cough, tetanus, hepatitis, pneumonia, polio, diarrhoea, etc. Even then over 22 million infants are not immunized completely with necessary vaccines. 

In India, even after so many efforts by the government and doctors to educate people towards getting their child vaccinated early on, more than 1.2 million children still die each year before reaching the age of five. Thus, there is a clear need to educate more people and reach as many parents as possible to make them aware of the vaccinations required by their infant. 

Below is the vaccination chart for infants in India as suggested by the Indian Academy of Paediatrics (IAP).

Reference: IAP-ACVIP Recommended immunization schedule for children aged 0-18 years (2018-19)

VaccinesDosesContent Tag
BirthBacillus Calmette–Guérin (BCG)1BCG
Oral Polio Vaccine (OPV 0)1OPV
Hepatitis B (HB 1)1Hep -B
6 weeksDiptheria, Tetanus and Pertussis vaccine (DTP 1)1DTP
Inactivated Polio Vaccine (IPV** 1)1IPV
Hepatitis B  (HB 2)1Hep -B
Haemophilus Influenzae Type B (HiB 1)1HiB
Rotavirus 11Rotavirus
Pneumococcal Conjugate Vaccine (PCV 1)1PCV
10 weeksDiptheria, Tetanus and Pertussis vaccine (DTP 2)1DTP
Haemophilus Influenzae Type B (HiB 2)1HiB
Inactivated Polio Vaccine (IPV** 2)1IPV
Hepatitis B  (HB 3)1Hep -B
Rotavirus 21Rotavirus
Pneumococcal Conjugate Vaccine (PCV 2)1PCV
14 weeksDiptheria, Tetanus and Pertussis Vaccine (DTP 3)1DTP
Haemophilus Influenzae Type B (HiB 3)1HiB
Inactivated Polio Vaccine (IPV** 3)1IPV
Hepatitis B  (HB*4)1Hep B
Rotavirus 3****1Rotavirus
Pneumococcal Conjugate Vaccine (PCV 3)1PCV
6 monthsTyphoid Conjugate Vaccine (TCV#)1TCV
9 monthsMeasles, Mumps, and Rubella (MMR 1)1MMR
12 monthsHepatitis A (Hep A1)1Hep -A
Influenza (Yearly)******1Influenza
13 monthsInfluenza (Yearly) ******1Influenza
15 monthsMeasles, Mumps, and Rubella (MMR 2)1MMR
Varicella 11Varicella
Influenza (Yearly)******1Influenza
PCV Booster 11PCV
16 to 18 monthsDiphtheria, Perussis, and Tetanus (DTP B1)1DTP
Inactivated Polio Vaccine (IPV*** B1)1IPV
Hepatitis A (Hep A2*****)1Hep – A
Haemophilus Influenzae Type B (HiB B1)1HiB
4 to 6 yearsDiphtheria, Perussis, and Tetanus (DTP B2)1DTP
Varicella 21Varicella
Measles, Mumps, and Rubella (MMR 3/MMRV)1MMR
9 to 14 yearsTdap1Tdap
Human Papilloma Virus (HPV 1 & 2)1HPV
15 to 18 YearsTd1Tdap
Human Papilloma Virus (HPV 1, 2 & 3)1HPV

*Fourth Dose of Hepatitis B permissible for combinations vaccine only

**In case IPV is not available or feasible, the child should be offered bOPV (3 doses). In such case give two fractional doses of IPV at 6 wk and 14 wk

***b-OPV, if IPV booster (standalone or combination) not feasible

****Third dose not required for RV 1. Catch up to 1 year of age in UIP schedule.

*****Live attenuated Hepatitis A vaccine: Single done only

******Begin influenza vaccine after 6 months of age, about 2-4 weeks before the season, give 2 doses at the interval of 4 weeks during the first year and then single dose yearly till 5 years of age

Vaccines recommended for high-risk children/area include:

  • Meningococcal (MCV)
  • Japanese Encephalitis (JE)
  • Cholera
  • Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Tdap; Td)
  • Human Papillomavirus (HPV)

A few examples of a high-risk category of children include:

  • Congenital or acquired immune deficiency
  • Liver disease
  • Diabetes
  • Chronic cardiac, liver, renal, or hematologic disease
  • Frequent travellers
  • Children with long-term exposure to radiation therapy, steroids, etc.
  • Children with hyposplenia
  • Children undertaken a cochlear implant surgery
  • Malignancies

Please note: Vaccinations may vary as per the geographical location and exposure of the infant; hence a medical consultation is very necessary. In any case, it is always advisable to consult a paediatrician before getting your infant immunized. 

Some other important things that parents must remember about their infant’s vaccination are:

  • Follow the vaccination schedule religiously and do not skip any vaccination
  • In case you miss a vaccination, consult your paediatrician and know the best recourse
  • Do not get the child vaccinated if he/she has an ongoing fever
  • Evaluate properly your choice between painless and painful vaccination for the child. Painless vaccination has a higher chance of decreasing immunity.
  • Mild fever post-vaccination is normal
  • Comfort your child during the vaccination
  • Do not panic or cry while the child receives the vaccination, it can cause the child to be hysteric.

Common health issues in children

Health conditions of children and adults vary not just in their type but also their intensity and overall symptoms. As parents, it is very necessary to understand some of the common health issues in children, their causes and effective treatment to ensure the safety of children. 

Some of the common health issues that mostly affect children include:

Sore Throat: Sore throats are very common in children and can often be very painful, if not treated adequately. The problem is caused by a virus and lasts for about 7-10 days, but in cases where the infection is more severe, the problem can intensify to cause a strep throat which is an advanced bacterial infection that makes the throat feel sore and scratchy. If not treated well in time, the bacterial infection can worsen to affect the kidneys and cause rheumatic fever. Babies and toddlers are at very low risk of getting a strep throat unless they are in close contact with someone who has the illness.

Ear Pain: Another very common health issue in children is ear pain, which has no definitive cause and could be because of multiple factors such as ear infection, swimmer’s ear (which impacts the ear canal). sinus infection, pressure on-ear because of cold, teeth pain travelling to the ear, fluid behind the eardrum, allergy, etc. Children under 5 years of age are at a higher risk of contracting ear infections, especially after an upper respiratory infection such as a cold. Earaches can be easily treated with antibiotics and usually do not become severe enough to cause more problems. 

Urinary Tract Infection (UTIs): Urinary tract infections occur when the bacteria enter the bladder or the kidneys of the child causing problematic symptoms such as pain and urgency in urination, blood in urine, pelvic pain, abdominal discomfort, fever, vomiting, bedwetting, etc. Children suffering from UTIs can also experience excessive mood swings and tend to get extremely fussy. These infections mostly impact children between their teens and adulthood. They are easily treatable with shorter drug courses.

Respiratory Syncytial Virus (RSV): A RSV is a common health condition in children in which the airways become infected. The problem is not serious unless the child is under 2 years of age or has a weak immune system or a health condition affecting the lungs and heart. In the latter, an RSV causes inflammation of the lungs, which can lead to pneumonia. Some symptoms include runny nose, nasal congestion, cough, breathing problem, irritability, etc. 

Fifth Disease: This disease is common amongst children of ages between 5 to 15 years. However, the problem is highly common and contagious, leading to a prominent face rash. The rash appears as if the cheeks were slapped and can spread throughout the body. Sore throat, low fever, upset stomach, headache, weakness, itching, joint pain, swollen joints, etc. are some of the common symptoms of the problem. The condition is usually benign unless the child has sickle anaemia disease or a weak immune system, in which case, the problem can intensify to cause problems.

Hand, Foot and Mouth Disease: Children under the age of 5 years usually contact the common disease through saliva, fluid from blisters, or a viral shredding through stool. Symptoms include fever, sore throat, lack of appetite, painful sores, skin rash on the palms and soles, among others. The condition usually resolves on its own in 7 to 10 days, without any treatment. However, in the case where the condition develops severely, medical treatment may be required. 

Croup: Croup is a condition which affects the windpipe and voice box, and is mostly caused by viruses that last for a week or a lower period. Symptoms usually include runny nose, fever, cold-like symptoms, barky cough, stridor, etc. The sings tend to get worse at night and can be benefitted with inhaling of moist air through streamer. In case, the breathing difficulties intensify or eating or drinking issues persist, the child might need immediate medical care, to reduce the swelling in the airways.

Scarlet Fever: Once a deadly disease, scarlet fever is caused by a bacterial infection of group A strep. The condition is now easily treatable and has symptoms such as sore throat, scarlet-coloured rash around the neck or face, which can spread across the body. 

Impetigo: A type of skin infection which usually affects the mouth, nose and hands, though can affect any other area of the body. Impetigo is caused when strep bacteria has a cut, scratch or a bite; the disease is more common in young children; however, it can impact children of all ages. Symptoms include tiny blisters that burst easily, oozing out a fluid which forms a crust that appears like a coat of honey. Touching the affected impetigo area can spread the blisters to other parts of the body and also can be very itchy. The treatment is simple and generally involves antibiotic ointments or oral medications. 

Kawasaki Disease: In this disease, the blood vessels of the entire body are inflamed due to an identified cause. The condition is rare; however, it is more likely to impact Asian or Pacific Island boys under the age of 5. In cases, where the condition is not timely or adequately treated, it can start to affect the arteries of the heart, which can lead to severe complications and long-term effects. Some of the common symptoms include long-lasting fever, red eyes, rash or redness on the hands and feet, rashes on the body, swollen lymph nodes, red lips or tongue. Kawasaki disease cannot be prevented but can be effectively treated provided it is diagnosed timely before complications start to impact the child. 

Apart from these, there are several other medical health conditions which can commonly impact children. But these conditions are easily treatable provided they are diagnosed with timely and effective medical care is received. 

Brain Tumors in Children: Symptoms, Causes and Treatment

Brain tumours in children or medically called pediatric brain tumours are abnormal masses or growth of cells which occur in the brain of the child or the tissues and structures near the brain. There are many types of pediatric brain tumours; some are cancerous or malignant while others are non-cancerous or benign.

The treatment and the recovery of the tumour depend on the kind of tumour, area in the brain, aggressiveness of the tumour, general health and age of the child. This is a very widely studied area; hence, multiple treatment options are available for the treatment of children with brain tumours.

The brain is composed of nerve cells and tissues and has three parts: brain stem that controls the activities of the body, cerebellum which indicates function such as walking and cerebrum that controls senses such as memory, emotions, thoughts and personality. Primary brain tumours either malignant or benign occur in the brain tissue first; however, it can spread to other parts of the tumour is cancerous. When the tumour spreads these tumours are known as secondary or metastatic brain tumours.

Some facts about brain tumours are:

  • Brain tumours can occur at any age
  • The exact cause of brain tumour cannot be identified
  • Factors such as exposure to radiation and family history are likely to make one at more risk of developing tumour
  • Signs and symptoms of a brain tumour depend on the type of tumour, location of the tumour, size of the tumour

Symptoms of Brain Tumor in Children

As mentioned, the signs and symptoms of a brain tumour in children depend on the type, size and the location of the tumour. It is also affected by the rate of growth. However, some symptoms may not be easily detected since they are similar to other conditions:

Some of the common symptoms of a brain tumour in children:

  • Headaches those become more frequent and severe
  • Feeling intense pressure in the head
  • Nausea
  • Vomiting
  • Vision problems
  • Double vision

Some other symptoms depending on the location of the brain tumour include:

  • Problem with balancing
  • Weakness or sensation in arm or leg
  • Weakness or drooping on one side of the face
  • Changes in behaviour or personality
  • Hearing issues
  • Memory problems
  • Trouble in walking
  • Slurred speech
  • A fuller spot is known as fontanel on the skull
  • Seizures
  • Abnormal eye movement
  • Swallowing trouble
  • Loss of appetite
  • The problem in feeding in infants
  • Confusion
  • Irritability

Causes of Brain Tumor in Children

In most cases, the exact cause of brain tumour in children cannot be determined. Most of the brain tumours in children are primary tumours and hence, begin in the brain or the tissues near it. These types of tumours start when the normal cells have abnormal mutations in their DNA, allowing the cells to grow and divide at an increased rate and continue to live even beyond their normal life span. This causes a mass of abnormal cells, which forms a tumour. A tumour can, however, be cancerous or non-cancerous.

Risk Factors of Brain Tumor in Children

The most common risk factor that makes children more probable to develop a tumour is a family history of genetic syndromes or a family history of brain tumours. Also, children who are more exposed to ionizing radiation are at a higher risk of developing tumours.

Diagnosis of Brain Tumor in Children

Based on symptoms per case, the doctor might suggest a few diagnostic procedures to study the conditions. The diagnosis methods for brain tumour include:

  • Neurological exam
  • Imaging tests
  • CT or PET scan
  • Biopsy
  • MRI scanning

Post diagnosis, depending on the size, location and growth of the tumour – the doctor will suggest a treatment method including surgery, radiation therapy, radiosurgery, chemotherapy and targeted drug therapy. However, in most cases, surgery is the primary mode of treatment of brain tumour.

Treatment of Brain Tumor in Children

The type of treatment for a brain tumour depends on the kind of tumour, location, size, and aggressiveness of the tumour, as well as the general health and age of the child. Some of the treatment options include:

Surgery: Brain tumour surgery is primarily used in treating malign tumours and in the case of malignant tumours – are used in combination with other treatment options such as radiation and chemotherapy. The basic goals of brain tumour surgery include:

  • Remove all or most of the tumour
  • Relieve symptoms caused by the tumour and enhance the quality of life
  • Relieve the intracranial pressure created by the tumour
  • Remove a part of the tumour to slow the growth
  • Drain any build-up of fluid in the brain
  • Make other treatments such as chemotherapy accessible
  • Help diagnose a brain tumour

The type of surgery and surgical method varies per case. However, brain tumour surgery is performed only when the tumour is located in a place which is accessible easily. The basic surgery is performed to remove as much of the tumour as possible and relieve symptoms. This type of brain tumour surgery is called Craniotomy. ‘Crani’ implying skull and ‘otomy’ meaning cutting into; therefore a craniotomy involves cutting into the skull to remove the tumour. A craniotomy is performed while keeping the patient under the influence of general anaesthesia. Then a portion of the scalp is shaved to make an incision to enter the skull and remove a piece of bone to access the area of the brain over the tumour. The surgeon opens the outermost layer of the brain tissue, locates the tumour and then removes/resects it. Once, the tumour is removed, the surgeon replaces the part of the brain or bone; this is called a flap which is secured with small metal brackets. Once, this is replaced, the surgeon stitches the scalp.

Radiation: Radiation therapy involves usage of high-powered energy cells directed to kill the cancer cells. Radiation therapy for a brain tumour can be delivered in two ways:

  • External beam radiation: Involves using high-power energy beams directed at the brain tumour from outside the body to help shrink the tumour size or eliminate the cancer cells.
  • Brachytherapy: In this form of radiation therapy, rice-sized radioactive seeds are placed in the brain tissue to kill the cancer cells. These radioactive seeds emit low doses of radiation over time and eventually stop emitting.

Proton Beam Therapy: This is an advanced treatment for brain tumours in children and is available only selectively. In this therapy, high doses of radiation are delivered to the targeted brain tumour, thus, minimizingthe impact to the nearby healthy tissues.This is most effective for growing children since it prevents the developing brain of the child to be negatively impacted by the radiation.

Radiosurgery: In this type, multiple beams of radiation are used to provide highly focused radiation treatment to destroy the tumour cells in the brain of the child. Each of the beam used is very powerful in its own, but the point where all the beams collide – the spot of the tumour – receives a large dose of radiation to kill the tumour cells.

Chemotherapy: This method uses drugs to eliminate the rapidly growing tissues including tumour cells. This is a very viable option for cases where the tumour has spread to remote body locations or for tumours which do not respond to hormone therapy.

Targeted drug therapy: This type of treatment involves using drug treatment to specifically focus on certain abnormalities in the tumour cells. These abnormalities are identified and the blocked causing tumour cells to die or slowdown in growth.

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