essential for children’s teeth

What is a tooth made of?

Mikhal Haik: A tooth is a complex organ made up of mineralized and non-mineralized parts. The mineralized parts or hard tooth tissue consist of enamel and dentin. L ‘Email is the outermost layer of the tooth at the crown of the tooth. Tooth enamel is the hardest tissue in the body. That dentin is the inner mineral layer of the tooth under the enamel. It is only about 65% mineralized with a composition reminiscent of bone. Tooth enamel, due to its degree of mineralization (approximately 96%) and its special arrangement allows protection of the tooth and its chewing function throughout the life of an individual in terms of permanent teeth. The non-mineralized part of the tooth is the dental pulp, where vessels and nerves give the tooth sensitivity and vitality. That dental pulpa houses inside the cells that are responsible for the inner layer of the tooth, which is the dentin. Tooth enamel is formed only once.

What is a temporary tooth and a permanent tooth in children?

Mikhal Haik: Temporary teeth, also called milk teeth, are 20. They appear from 6 months after birth up to 30 months (second temporary molar). The permanent teeth are 32 in number and erupt from the age of 6 (permanent first molars or 6-year-old teeth) to around the age of 18 (permanent third molars or wisdom teeth). Between the ages of 6 and 12, the temporary teeth and the permanent teeth that replace them “coexist” more or less for a period of time called a mixed set of teeth. The arrival of temporary teeth after 6 months requires the establishment of dental hygiene (brushing) and dietary changes. It is therefore from this age that caries pathology can begin, and therefore an initial consultation with the dental surgeon is necessary as soon as possible to avoid a caries problem occurring. During this consultation, the parents also receive advice of any kind (food, hygiene, etc.) from the dentist.

What do mineralization and remineralization mean?

Mikhal Haik: Teeth are mineralized structures in which the crystal forms these tissues called hydroxyapatite. This crystal, which is a calcium phosphate, belongs to the family of apatites. When well formed in quality and quantity of its constituents, especially calcium, it forms an extremely resistant tissue. Dental enamel undergoes demineralization, but also surface mineralization. This balance, enhanced by prevention such as fluorine or amorphous calcium phosphates, makes it possible to best preserve the integrity of its structure. Respect for strict hygiene on a daily basis, especially with fluorinated toothpastes adapted to each age allows you to keep your teeth for life.

What role does vitamin D play in the process of mineralizing teeth?

Mikhal Haik: Vitamin D is the vitamin called ” calcium carrier in the body. It allows, among other things, and in a non-exhaustive manner, the incorporation of calcium into the mineralized structures. When we are missing vitamin D, the mineralization process is disrupted, which clinically results in structural anomalies in the mineralized tissue, therefore of the hard dental tissue. The role of vitamin D is crucial in this mineralization process, but this role is also important in many other mechanisms and in many tissues and organs. A strong vitamin D deficiency gives rise to serious pathologies such as rickets in the child. Vitamin D is also involved in other physiological processes, such as muscle

What is Vitamin D Deficiency?

Mikhal Haik: Vitamin D is produced naturally by the body. It bears the name of sunshine vitamin because this synthesis is sufficient by short-term and regular exposure to the sun’s rays. The sources of vitamin D are also food. It is found in fish, egg yolk, meat, just to name the most common foods. These sources can compensate for insufficient exposure to the sun, but it is also possible to take vitamin D in the form of medication (after analysis and medical advice) in all patients (adults and children). That Vitamin D deficiency can also be due to a digestive disease in which the intestinal absorption mechanisms are disturbed. The serum level of vitamin D is easily measurable and serves as a reference for the supplements and treatments prescribed by the general practitioner or pediatrician. In children, the current recommendations go in the direction of one daily allowance determined under the opinion and responsibilities of the pediatrician. In fact, it will be necessary to take into account the different sources and vitamin and calcium intake in children. Overdoses should also be avoided. It should also be noted that some milk powders are enriched with vitamin D, something to consider when supplementing with medication.

How does a vitamin D deficiency manifest in the teeth?

Mikhal Haik: The teeth continuously mineralize according to a ” mineralization plan ‘Which is often very far from the date of eruption of these teeth. For example, permanent teeth appear around the age of 7-8 years, while their mineralization begins a few weeks after birth. If the mineralized mechanism fails after a vitamin D deficiency, it turns out that the mineralized tissue is infamous and the clinical result is the appearance of more or less yellowish areas in the enamel and dentin. Teeth that are poorly mineralized due to vitamin D deficiency are more likely to undergo caries demineralization. It should be emphasized that when we detect these anomalies, the process of mineralization of the teeth is completed for many years and that the only possible action is a local intervention on the lesions. We want a preventative approach to cavities and a therapeutic approach to existing lesions and very often both at the same time.

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Can we reliably diagnose lesions related to vitamin D deficiency?

Mikhal Haik: that etiological diagnosis of these lesions are difficult, especially since other dental anomalies affect the ameloblast, the cell responsible for making enamel. These anomalies are hereditary amelogenesis imperfecta (genetic anomalies of various forms) and other anomalies of lesser known origin such as MIH (hypomineralization of front teeth and molars). The latter are still more frequent, with more than 15% of children affected. Lesions related to vitamin D deficiency are generally symmetrical and affect tooth enamel and dentin

What therapeutic strategy should be used in case of tooth damage?

Mikhal Haik: L ‘hypomineralization associated with a dysfunction of the calcium phosphate mineralization process requires protection of fragile structures in restorations and pediatric prostheses and repair of substance loss in order to restore function and aesthetics. All of this is possible, codified and mastered, but requires extensive care, especially in the most severe cases, which fortunately remain very rare.

What can a dental surgeon recommend in case of suspected vitamin D deficiency?

Mikhal Haik: If it is an early visit, that is, as soon as the baby teeth appear, it will oral surgeon may ask the question of taking vitamin D, as recommended by the pediatrician. Current recommendations are for one daily intake from 0 to 2 years. As always, hygiene advice will be given to avoid the occurrence of caries lesions. Similarly, the diversification of foods and the choice of foods rich in calcium and vitamin D are part of the advice given. The establishment of strict hygiene under a global approach qualified as “therapeutic education” is one of the most effective means for all children and even more so for children with fragile tooth structures.

Will vitamin D deficiency in children affect adults?

Mikhal Haik: Yes, without a doubt, but it is possible to remedy this with early diagnosis and supplementation of calcium and vitamin D., under the advice and supervision of the attending physician. Similarly, in adults it is important to avoid the occurrence of many problems, especially osteoporosis, to monitor the level of calcium and vitamin D. Massive supplementation (100 to 200 times the daily dose for a child) in 1 or 2 doses can then help to correct this deficiency. The general practitioner will then be able to follow up to rule out any anomaly other than dietary deficiency and in severe cases remedy it with interdisciplinary care. It should be noted that vitamin D deficiency results in certain periodontal abnormalities (tissue around the tooth) and consequences in cases of dental bone surgery.

What are the good gestures at the oral level in children?

Mikhal Haik: It is a combination of attitudes and procedures that allows the child to keep his teeth completely healthy and functional. that twice daily brushing with an age-appropriate fluoride toothpaste according to the latest UFSBD recommendations is the most important pillar. ONE Healthy diet and diversified provides all the elements (minerals, vitamins, calorie intake) necessary for mineralization and remineralization of dental structures. Regular visits to the dental surgeon as soon as the teeth appear make it possible to detect any anomalies from their earliest stages. Before a cavity is created, dental caries (demineralization) can be detected by the dental surgeon, which makes it possible to perform fluoridation and remineralization treatments. Finally, food consumption is rich in sugar and sticky texture as well as permanently snacking on the main enemies of children’s oral health. Drinks that are rich in sugar and sometimes very acidic should be restricted or even completely banned, especially in case of fragility of the mineralized dental tissue. The dental surgeon will help the patient determine the individual caries risk and food balance.

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