This was a topic discussed by Dr.Abhijit Misra at Siliguri December 2024 :43rd West Bengal State Pedicon Uttorcon 2.0
vaccination
Looking for a Pediatric Dentist?This is what you should know!
Are you looking for a Pediatric Dentist near you?Word of mouth from a patient is probably your best chance of getting a great Pediatric dentist .
Who Is A Pediatric Dentist?
A pediatric dentist specializes in the treatment of children from infancy through early adulthood and special needs patients.
After receiving their dental degree, they spend an extra 3 years in a training program specifically designed to train them on how to manage children and those with special needs.
Children are not just small adults! Their teeth, brains, physiology, and temperament are very different from adults and pediatric dentists are trained to manage all of those differences.
Why Are Baby Teeth So Important?
Primary, or โbaby,โ teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt. When do the Primary Teeth Develop & Erupt?
Primary teeth begin developing between the 6th and 8th week of fetal development. The permanent teeth have begun to form by the 20th week of fetal development. The first primary teeth to erupt are usually the lower central incisors around 6 months of age. The American Academy of Pediatric Dentistry recommends a childโs first dental visit be within 6 months of the eruption of the first tooth or by 1 year of age. All 20 baby teeth usually erupt by 3 years of age. Exact sequence of eruption varies slightly depending on the child. All 20 baby teeth will be replaced by a permanent successor.
The permanent teeth begin to erupt around 6 years of age. The first teeth to erupt are usually the 6 year molars (1st molars) and the lower central incisors. The full permanent dentition is 32 teeth, which includes the wisdom teeth (3rd molars).
How Can I Help My Child in a Dental Emergency?
Toothache:
First, rinse the mouth or affected area with warm salt water. If the face is swollen place a cold compress on the area and call your pediatric dentist immediately. Give Paracetamol or Ibuprofen for pain and see a dentist as soon as possible.
Cut or Bitten Tongue, Lip or Cheek:
Quickly apply ice to the affected area to help with swelling. Try to control bleeding by applying firm pressure to the affected area. If simple pressure does not control bleeding, it is important to see a doctor or visit the hospital emergency room.
Knocked Out Permanent Tooth:
Quickly try and find the tooth. Rinse the tooth with water and try to handle the crown, not the root, of the tooth. DO NOT clean off any tissue that may be still attached to the root. If the tooth does not appear to be fractured and the child is cooperative, try and reinsert the tooth into the socket. Have the child bite on a washcloth or gauze to hold it in place. The tooth can also be transported in โSave a Toothโ solution, childโs own saliva, or milk. Time is critical. The child must see a dentist very quickly for the most favorable outcome.
Knocked Out Baby Tooth:
This is usually not an immediate emergency and examination can be delayed until normal business hours. Usually, no treatment is necessary.
Broken, Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist as soon as possible. Early treatment can prevent infection and reduce the need for extensive dental treatment. Sometimes the fractured tooth can be reattached. If possible, save the fractured piece and bring it in to the dentist.
Chipped or Fractured Primary Tooth:
This is usually not an immediate emergency. Contact your pediatric dentist to schedule an evaluation of the affected area.
Severe Head Injury and/or Possible Broken or Fractured Jaw:
Keep the jaw stable and visit the nearest emergency room immediately.
What is Pulp Therapy / Nerve Treatment?
The pulp (nerve) is the most center part of the tooth. It contains blood vessels, nerves and reparative cells. When the cavity of a tooth is into the nerve or, sometimes even when it is close to the nerve, a โpulpotomyโ (nerve treatment) must be completed to maintain the vitality of the tooth. Sometimes, a โpulpectomyโ is performed and this is just a more extensive version of the pulpotomy. Either treatment is an effort to maintain the tooth as long as possible.
Once the affected nerve tissue is removed, an antibacterial agent is placed to prevent bacterial growth and calm the nerve tissue. The nerve treatment is followed by a permanent restoration, which is usually a stainless steel crown.
What is the Best Time for Orthodontic Treatment?
Pediatric dentists are trained to recognize possible issues with the developing dentition. Early treatment can prevent more extensive dental problems in the future. Some dental malocclusions (bad bites) can be recognized as early as 2-3 years old.
Children have 3 different phases of tooth development. The first phase is all primary (baby) teeth from 2-6 years old. During this time in a childโs life we are concerned with underdeveloped dental arches, premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated during this phase can have great results and may in some cases prevent need for future orthodontic treatment.
The second phase is called โmixed dentitionโ and this happens from around 6-12 years of age. This phase has both permanent and primary teeth and begins when the 6 year molars and lower central incisors begin to erupt. Treatment concerns and goals during this time of a childโs life are directed at correcting jaw relationships by redirecting growth and aligning teeth that are excessively out of place. When indicated, treatment during this phase is very successful because the hard and soft tissues are very responsive to orthodontic movement.
The last phase of a childโs dentition is when all adult teeth are present and this is when we make the final decision as to whether or not the child would benefit from orthodontic treatment.
Author :Dr.Amrita Pal
About Dr. Amrita Pal (BDS,MDS-Pediatric Dentistry)
I am a Pediatric as well as General dental surgeon by profession, previously attached to Medical College.
Also read
Shingles:Cause, Prevention
One in 3 people has the risk of developing Shingles. That’s what the CDC says.But why do you need to know this? If you or a relative is aged fifty or more, it’s a good idea to get vaccinated and you must have seen Big B talk about it on the television.But let’s start from the beginning.There are many strange articles and misinformation online about this disease.
Tldr:First of all, it’s not a STD or sexually transmitted disease .Second, it’s a viral disease and caused by the same virus that causes chicken pox, but Shingles occur most commonly in old age.
According to Harrison Internal Medicine, Varicella Zoster is a virus which causes two distinct clinical presentations :chicken pox and Shingles.
Chicken pox is most common in children and has characteristic vesicular rash while Shingles occur as dermatomal rash in specific parts of body .Chicken pox in adults is a serious disease and may have extensive systemic involvement and complications.Incidentally vaccination exists even for chicken pox where like all other vaccines one may get infected still but the expression and clinical disease may limit severity.
So what is Shingles? It’s caused by the Varicella Zoster virus.
You remember I mentioned chicken pox also known as the Varicella zoster virus?If that virus getting reactivated in old age Shingles(Herpes Zoster) is what happens.According to the medical science these chicken pox virus stays sleeping or dormant in the nerve cells and during episodes of immune suppression weakness gets reactivated and starts giving you trouble.They characteristically have a burning sensation associated with skin lesions along the area of distribution of that nerve and make life difficult .It causes a dermatomal rash The regular painkillers don’t work and prevention is the best policy .
They may suffer multiple episodes with waxing and waning i between with itching ,tingling ,burning sensation in specific areas associated with rashes.The rash can appear on the third to fifth day with or without fever.The herpetic neuralgia or pain is difficult to manage and is one of the main reason behind poor quality of life.
In my ENT clinic, Ear manifestation of Shingles present as earache with rashes over the pinna and in the ear canal .
Statistics:
India : A million cases of Shingles each year.Incidence of 705 per million population per year. In USA approximately 1 out of 3 people develop herpes zoster during their lifetime Shingles, and about half of people over age eighty have had shingles.The Shingles vaccine for people above 50 years is a good way to ensure no trouble from this virus .
So when can Shingles occur?In people above 50 years of age having any cause of immune suppression, because of disease or drugs.Like HIV,Cancer treatment,Cancer itself,autoimmune disease,diabetes,severe cardiac ,liver or kidney disease .Any disease which over powers your immune system can cause Shingles.So the best way to prevent it ,is to have healthy habits,eat nutritious food and get vaccinated on time.
Shingles Vaccine in India: Shingrix Zoster Vaccine[source]
2 doses needed at a gap of two to six month.Protection is said to be for ten years ;Age group-Above 50 years.India has 260 million people above 50 years who can be saved from a disease causing poor quality of life with a vaccine.
Who should get vaccinated?
At-risk group.Age greater than fifty.Those who have suffered one episode of shingles.Those who received a chicken pox vaccine previously.
Consult your doctor for checking whether you are eligible for the vaccine.This is not a replacement for a medical consultation and is strictly for the purpose of awareness.Though we try to keep updates current, since medical science is a rapidly evolving field, inadvertent additions and omissions while unfortunate is occasionally unavoidable .The author or the website under no circumstances will be held liable for the same.Kindly consult a health care provider for personalized vaccine recommendations
References
1.Harrison’s Infectious Disease
2.https://medwinpublishers.com/MJCCS/can-india-let-go-the-opportunity-to-minimize-million-shingles-cases-annually-as-india-launches-shingrix-zoster-vaccine-in-april-2023.pdf
3.CDC
Nose bleed and Thalassemia
Nose bleeds in children are common.In nine out of ten cases its due to nose picking.It’s the rest which we need to rule out.
What you should do if your child has nose bleed?
1)Don’t panic.Seeing you panic or cry will scare your child scared and he/she will start to cry.This can cause the nose bleed to become worse.
2)Pinch the nose and ask child to breathe gently through the mouth.Child should be bending forward over a wash basin ,or you can hold a vessel in front of his mouth .
3)Talk to the child gently and calm him down.
4)You can then hold a cold damp cloth over the nose bridge.This helps control bleeding too.Pinching the nose helps stop bleeding within 5 to 10 minutes.
When should you worry and visit your nearest emergency?
1)If the bleeding happens for longer than 10 minutes.
2)Happens frequently and takes a long time to stop .
3)Bleeding also from other places ,like from gums,while peeing etc.
4)Baby is very pale and blood tests show hemoglobin to be low .
5)Even minor cut injury ,takes a long time to stop.
6)There is history of swelling of knee and other parts of body with discolouration even with minor trauma.
7)When bleeding causes baby to become lethargic.
8)There’s family history of similar bleeding.
9) There’s family history of consanguinous marriage.
10.Preconceptional testing not done for Thalassemia.
11.Family history of Thalassemia trait in one parent and other not tested.
What tests will your doctor suggest?
If its the first episode and bleeding stopped quickly few tests may be suggested depending on history and clinical examination
But if the doctor has grounds for clinical suspicion ,a thorough checkup may be needed.Nasal bleeding can sometimes be a danger sign of bleeding problems like, Thalessemia,Haemophilia and Leaukemia and other bleeding disorders.
A complete blood work up like:
- Haemoglobin
- Complete blood counts
- Platelet levels
- Prothrombin time
- APTT(Activated partial thromboplastin time)
- Liver function test
- Peripheral blood smear
- Haemoglobin electrophoresis to rule out Thalessemia
Radiology can be suggested keeping in mind history and clinical features. CTPNS (Computed tomography Paranasal sinus) helps rule out nasal masses.
If nose bleeding is due to trauma, it will stop with the first steps explained.After that nose drops ,oral antibiotics and topical antibiotic creams will be prescribed.One of the commonest preventable cause of nose bleeding in children is Thalessemia.
This prevention happens through blood tests done before marriage or atleast before planning to have a baby(preconception test).
Even now with massive awareness around this disease,there is multiple examples of Thalassemia baby ,especially in Eastern part of India
Data
Every year 10,000 to 15000 babies are born with Beta Thalassemia major in India.
India
1.5% of Global population are Beta Thalassemia carriers.60,000 new symptomatic patients every year make this a cause for concern.
Thalassemia Screening is crucial
High prevalence of Thalassemia in the Indian subcontinent.Carrier state high and often goes undiagnosed because it’s remains asymptomatic except for anemia .
Awareness about pre-marital counseling and tests – for all couples should be mandatory to avoid unfortunate problems.
For arranged marriages its highly adviced to avoid marriage between two individuals with Thalassemia trait.High risk of Thalassemia Major babies in couples with carrier state in both parents.
Nose bleeds in kids :3 Things you must know
Management of Pediatric epistaxis:Scientific Paper
Juvenile Nasopharyngeal Angiofibroma
Previously published on mycity4kids
Thalassemia Screening :Why You Need to Know About this!
High prevalence of Thalassemia in the Indian subcontinent makesย 8th May Thalassemia day specially important. Thalassemia is a major public health concern in India.
Eastern India shows a high incidence as also Sindhis..Carrier state high and often goes undiagnosed because it’s remains asymptomatic except for anemia .
Awareness about pre-marital counseling and tests – for all couples should be mandatory to avoid unfortunate problems.High risk of Thalassemia Major babies in couples with carrier state in both parents.
India has the largest number of children with Thalassemia major in the world โ about 1 to 1.5 lakhs and almost 42 million carriers of ร (beta) thalassemia trait. About 10,000 -15,000 babies with thalassemia major are born every year.
India accounts for 25% of global,people living with Beta Thalassemia census.
Since there’s a high prevalence of hemoglobinopathies in the eastern part of India, routine premarital screening and genetic counseling is a must.
There’s is upto 19% of Beta thalassemia trait in the Indian population.The Prevalence ranges between 5%to 17% in certain populations.But usually between 3 to 5%
What can be done?
Premarital and pre-natal screening must be made mandatory .
Genetic Counseling
Make testing incentivized.
Screen and educate relatives of all known patients wuth Beta thalassemia and carriers .This will help reach those at risk quickly .
Mandatory screening of all kids at birth.
Affordable tests .
Conclusion:
Transfusion still remain the major modality of treatment. This together with the poor quality of life in the patient and family due to frequent,recurrent transfusions make this a particularly serious problem.
Reference:
https://pubmed.ncbi.nlm.nih.gov/37947120/
https://www.pib.gov.in/PressReleseDetailm.aspx?PRID=1841433
https://journals.innovareacademics.in/index.php/ajpcr/article/download/47258/28122
https://journals.lww.com/jfmpc/fulltext/2024/13040/quality_of_life_and_thalassemia_in_india__a.7.aspx
Jawahirani A, Mamtani M, Das K, Rughwani V, Kulkarni H. Prevalence of ?-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase survey. Public Health 2007;121:193โ8
https://www.researchgate.net/publication/375549144_Current_Status_of_b-Thalassemic_Burden_in_India
Autism Care and Screentime #WorldAutismDay
Screentime is an addiction.Lets accept that. On World Autism Day I will share my experience at the Sishumangal Child Development Centre and Research Institute Raigunj where they had an interesting panel discussion on the screen usage it’s effect on kids and what is a safe zone.
Autism spectral disorder represents a range of neurodevelopmental condition presenting with challenges in social skills language delays and presents in various degrees of severity.A genetic component is there, but environment has a role to play to especially those on the borderline of the spectrum .Early childhood parental interaction ,avoiding screentime ,and early diagnosis of speech or language delay will go a long way in fighting the battle.
Most research is from TV watching data.
Research for tablets, smartphones is still limited.Based on survey results:
Over 40% of children regularly watched TV, DVDs, videos by 3 months.
By 24 months, this rose to 90%.
Children 0-24 months watch approximately 2 hours of TV/day in the US.
In 2017, the Hospital for Sick Children in Toronto presented research regarding the relationship between screen time and language development .
Around 900-1,000 children, ages 6-24 months folowed between 2011-2015.By their 18-month check-ups, 20 percent of the children had daily average handheld device use of 28 minutes, according to their parents.
Used the ITC- Infant Toddler Checklist.
RESULT: Infants with more handheld screen time have an increased risk of an expressive speech delay.Every 30-minute increase in handheld screen time was linked to a 49% increased risk of โexpressive speech delayโ (i.e. score below the 10th percentile in the symbolic, social or the total score of the ITC).
Guidelines for Screentime by AAP
- Birth-18 months = no screen time; facetiming
- 18-24 months = high-quality programming- CO-VIEW
- Blueโs Clues, Sesame Street, Barney
- 2-5 years = 1 hour daily of high-quality programming- CO-VIEW
- 6+ = make sure it isnโt replacing sleep, physical activity, etc.
- Be consistent with how long kids can watch media
- Designate media-free times: dinner, driving, one hour before bed
- Watch WITH your children: โmindful useโ
American Academy of Pediatrics, 2016
Screen exposure increases the sensori overload that can cause even more difficulty I communication in kids who haven’t yet developed speech.
Speech and language development delay occurs if children exposed to screen less than 18 months of age.
Data shows that :
Less than 3 months screen exposure 40%
By 2years 90%
By 10 years personal phone!
There’s a problem right there.
Happinetz or similar device is a good solution right,out of the gate for young kids developing screen addiction.Remember the tantrums now are better than what happens later.
But in this scenario I will tell you a problem we adults are facing too.In this rapidly changing world of bricks and cements we are stick indoors with no physical activity.The smart phone is a whole world right from your palm and when you take out that phone to scroll and refresh instagram/Facebook/X for random number of times we are not walking the talk.I am guilty of that too.But I am also a digital creator for health and educational content.The solution lies in choosing where and how to spend our time .It’s not going to be easy .But nobody said it would be !
Sishumangal Child Development Centre and Research Institute is doing their best to spread awareness and help the kids and parents requiring special help,training and support .
Know about managing Internet Access for kids
This is part of Blogchatter A2Z challenge C post and the Ultimate Blog Challenge .