From time to time CDMU Documentation Centre receives queries related to drugs and therapeutics from doctors and the general public which are answered by our panel of experts. Some of these queries would be of interest to all our readers and in this section we would like to share them with you. Readers are welcome to send in their own questions to the editorial office in writing. It should be noted that, as matter of policy, we will not reveal the identity of the individual raising the query and will not pass judgement on actual prescriptions.

Query: My 6 year old son has a couple of worn out teeth in the lower jaw. They appear to be decayed. Milk teeth fall off anyway. Therefore, is it necessary to take him to the dentist ?
Response: The hygiene of milk teeth is as important as that of permanent teeth. Children start losing their milk teeth at around age 4, the front teeth usually falling out first. The loss of milk teeth continues till about the age of 12 or 13 when all the permanent teeth have finally erupted with the exception of the wisdom teeth (third molars). It is important to maintain the milk teeth properly as they reserve space for future eruption of the permanent teeth. If a milk tooth decays or is removed too early, space for corresponding permanent teeth is lost and may need to be regained through orthodontic treatment. Further, carious (dental caries is the medical term for tooth decay) milk teeth can cause the permanent teeth to develop improperly resulting in pits, stains and generally weaker teeth.
Therefore, it is important to take your son to a dentist without further delay. Also background factors responsible for decay need to be looked into and removed. In children, taking too much of sugar-rich foods and lack of oral hygiene, such as not washing the mouth after eating, are common risk factors for dental caries. These must be discouraged.

Query: Are thumb sucking and teeth grinding innocent habits or are they damaging to teeth in some way?
Response: Thumb sucking and teeth grinding are common habits in childhood. In many cases they appear to develop without apparent reason and disappear on their own. Occasionally, particularly when such habits persist in older children, there may be underlying stress factors, such as psychological insecurity, involved.
Thumb sucking is generally an innocent habit in that there is no significant damage to teeth. However, if it persists beyond age 5 or if the child is a constant or vigorous thumb sucker, then this needs to be stopped. Excessive thumb sucking can cause unwarranted movement of teeth and impair normal jaw bone development.
Tooth grinding or bruxism has more serious implications. Vigorous grinding during night-time sleep can gradually wear down the teeth. In severe cases teeth have been worn down to the gumline! There is a common idea that teeth grinding reflects gastrointestinal problems or parasite infestations. This is not true. However, if an underlying stress factor is discovered, this trigger needs to be removed. If the problem persists, the dentist may have to prescribe a nightguard to restrict further damage to the teeth.

Responses submitted by Dr. Sanjay Prasad, BDS

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