Teething problems in children

Dentition refers to the development of teeth and their characteristic alignment in the mouth. That is the number, type and morpho-physiology of the teeth.

There are four types of teeth in the oral cavity:

• Incisors- These are 8 teeth in the front center to bite food.
• Canines- These are 4 sharpest teeth in the mouth to tear food.
• Premolars- These are 8 teeth in the mouth with a flat biting surface to tear and crush food.
• Molars- These are 12 most giant teeth in the mouth with a flat biting surface to grind, tear and crush food.

Primary Dentition and Permanent Dentition

Primary dentition or deciduous teeth are the first teeth to erupt in the oral cavity. They are 20 in number. They begin to erupt at the age of six months and continue until twenty-five to thirty-three months of age. However, some babies have teeth eruption when as young as three months and others not until they are a year old. These teeth then get exfoliated as the permanent teeth erupt.

Permanent dentition comprises of 32 teeth. It takes about six years for children to get their primary teeth replaced by permanent teeth between the ages of 6 and 12 years.

It is more important to have a symmetry that is same teeth coming at same time on both sides than the time the teeth emerge.

COMPLICATIONS OF DENTITION

Teething can be very uncomfortable for babies and may cause complications that parents might not know about. The problems during eruption of teeth are as follows:

a.) Early dentition- Early eruption of teeth is most commonly due to hyperthyroidism i.e. overactive thyroid gland. In this the primary teeth erupt and then fall off very early and adult teeth erupt quickly.

b.) Delayed dentition- Diseases that are genetic and affect the endocrine glands most commonly result in delayed dentition. Common conditions such as hypopituitarism, hypothyroidism, Down’s Syndrome and cerebral palsy cause delayed eruption of primary teeth.

c.) Eruption cysts- These are fluid filled sacs that form on top of the tooth, be it primary or adult tooth, which is about to erupt. They are relatively harmless and often go away as the tooth comes through.

d.) Neonatal and Natal teeth- Natal teeth (those that erupt around time of birth) and neonatal teeth (those which are present at time of birth) are normal teeth. At times they are actually an extra tooth that should be extracted by the dentist.

SIGNS AND SYMPTOMS RELATED TO TEETHING

Studies show that teething is not associated with serious or life threatening illnesses such as high fever and convulsions, infections whether respiratory or middle ear infections, vomiting and diarrhea or strong urine. On the other hand teething is linked to the following:

• Daytime restlessness
• Thumb –sucking
• Gum- rubbing or desire to bite on something hard
• Drooling which may lead to possible rash
• Loss of appetite
• Swelling and tenderness of gums
• Crying and irritability
• Slight fever
• Disruption in sleeping habits
• Ear rubbing in some cases

The desire to bite on something hard, gum rubbing, crying and irritability, drooling of saliva are common symptoms that tend to appear 3-4 days before or after eruption of primary teeth and symptoms such as slight fever, decreased appetite to eat especially solids, wakefulness, facial rash and ear rubbing appear to be possible symptoms 1-2 days before or after eruption of teeth.

MANAGEMENT

Parents can observe following measures to help their child with teething troubles and flatulence during dentition.

• During feeding babies’ head should be kept at a higher level than their tummy.
• They should use a nipple with slower flow of milk as this can prevent air bubbles from entering the tummy as much as possible.
• Give due attention and cuddling as this can help even the crankiest of babies and help them feel less irritable and happier.
• Teething rings can be used to provide temporary pain relief. This is best done when the rings are chilled first. Even hard and frozen fruits and vegetables can be used for pain relief. Applying pressure to the painful area can also be achieved with a clean finger or cold spoon.
• If infant is having excess saliva and drooling it should be regularly wiped off to avoid possibility of developing facial rash.
• Repeated application of alcohol to the gums and mucus membrane of an infant’s mouth should be avoided as it is not only ineffective for pain relief but may lead to severe problems due to infant’s small body weight.
• Application of honey, jam or sugar to feeding bottles or pacifiers should also be avoided as it is ineffective in reducing pain and instead may lead to tooth decay.

MEDICINAL MANAGEMENT

Homoeopathy has a valuable role to play in treating such complications due to teething without causing any side effects.

Various homoeopathic medicines helpful during dentition are:

Aconite Napellus- It is indicated when teething is very painful and the baby seems very restless and fearful in countenance. There may be high fever with convulsion during dentition.

Calcarea Carbonica- It is indicated in babies who take cold easily, grow fat, are large bellied, have large heads due to delayed closure of fontanelles, delayed walking, delayed first dentition,have swelling of glands, rachitis, pale skin and chalky look, leucophlegmatic temperament, crave eggs and eat dirt and other indigestible things that cause diarrhea.

Calcarea Phosphorica- It is suited to babies with delayed milestones like late closure of fontanelles, delayed crawling and walking and tardy first and second dentition. Calcarea Phos is well indicated in anemic, scrofulous children who are peevish and always wanting to go somewhere, dark complexioned, thin and spare, weak and unable to stand up, have cold extremities and feeble digestion causing diarrhea and flatulence with aggravation of symptoms from any change of weather.

Chamomilla- This remedy is often indicated when the baby is extremely angry or irritable due to the pain such that it may feel agitated, scream and hit those around him and wants to be carried constantly to distract the baby from pain.
Diarrhea during dentition that is green like chopped eggs and spinach, watery, hot, very offensive like rotten eggs well indicates Chamomilla.

Kreosotum – It is suited to children who are old looking, wrinkled, very tall for age, dark complexioned, lean and poorly nourished. They have painful dentition with teeth beginning to decay as soon as they appear and gums that are bluish red, soft, spongy, bleeding, inflamed and ulcerated. The saliva like other discharges is acrid and fetid.