Deciduous teeth are 20 teeth that start developing while in the womb, and begin erupting 6 months after the birth until 3 years age. Until age of 6, children only have deciduous teeth. After that age, molar teeth begin to erupt and gradually deciduous teeth are replaced with permanent teeth.

 Caries in deciduous teeth are frequently encountered because of more brittle structure of deciduous teeth compared to the permanent ones and lack of efficient tooth brushing due to the young age of children.
 
Why is it important that deciduous teeth should not be lost?

First, loss of anterior teeth at a young age (3-4 years age) may lead to esthetic concerns and even psychological problems in the child. During age of 6-7, loss of those teeth do not have an important effect on children because this is the time when permanent teeth replace the deciduous ones.

Importance for speech
 
Anterior teeth contribute considerably for generation of certain sounds. Some sounds are created by touching of the tongue on posterior surfaces of those teeth. If these teeth are lost, sounds of s,f,v,z,t,d can not be pronounced accurately.

Importance for chewing
 
Since this region can not be employed in considerably deep caries and loss of many teeth, chewing can not be performed adequately which leads to a reduction in activation of mastication muscles. Digestive disorders can arise due to inadequate mastication, as well.

Guidance for eruption of permanent teeth
 
Deciduous teeth act as guides for the eruption of permanent teeth. If the deciduous teeth have been lost early, corresponding permanent teeth may deviate from their normal eruption site which leads to an orthodontic problem.
 
Owing to the above listed reasons, the children should visit an orthodontist right after the beginning of the eruption of first deciduous teeth should come to controls every 6 months, and their teeth should be treated if required to.  
 
 
Preventive Dentistry 

Preventive dentistry approaches and treatments comprise the following main titles:

Tooth brushing

Monitoring of dental development

Gaining the habit of flossing

Informing the parents

Proper nutrition

Determination and prevention of bad habits

Fluoride applications

Fissure sealant use

Protection from trauma and impacts

What is the importance of preventive dentistry?
 
Preventive dentistry provides a healthy and elegant smile to your child. Children with healthy mouths chew food more easily and comfortably and thus better benefit from their nutritive properties. They can learn to talk faster. Since they have no intraoral diseases that threaten other regions of the body, their overall health is better, as well. Because a healthy mouth appears beautiful, the child has high self-confidence for oneself and his/her appearance. Moreover, preventive dentistry is a less tiresome and more cost-effective treatment approach.
 
When should preventive dentistry start?

Preventive dentistry starts with the first erupting tooth. Take your child to a dentist after the eruption of first tooth to widen your knowledge about maintaining a good oral health. The earlier you begin to visit a dentist, the higher will be your chance to prevent dental diseases in your child. You will be able to take precautionary steps before occurrence of any tooth decay and thus raise a healthy generation without any caries.
 
What is the role of family in preventive dentistry?

After achieving complete dental health in your child, your dentist provides information on maintaining this healthy status by tooth brushing, flossing, nutrition planning, and fluoride use (if required to). Moreover, by monitoring and controlling the dental practices, you help your child to gain a lifelong habit for maintaining dental health.  
 
What is the contribution of a dentist in preventive treatment?
 
Tooth brushing, flossing, and fluoride use are all practices aimed at maintaining the dental health of your child. However, there are practices other than those, as well. For example, fissure sealant use which will be explained later on is another method that is frequently used for the same target by dentists.  
 
Fluoride Applications 

• Fluoride is a substance that body needs at certain levels.
  
  
• Intake of fluoride should start after birth and continue until 8 years age.
  
  
• Fluoride enters body via two routes: First, systemically with drinking water, fruit juices, foods, fluoride tablets and syrups etc. Fluoride taken through systemic route is stored on surfaces during teeth development and shows its effects for a long period of time. It also adheres to the dental plaque and helps remineralization, in other words, restoration of loss in tooth structure caused by caries. Second way of fluoride intake is topical or local. Fluoride taken via local route strengthens present teeth and by adhering to teeth surfaces, increases the resistance against caries. Toothpastes, gargling fluids as well as fluoride gel and pastes can be mentioned among topical fluoride sources.
  
  
• According to the investigators, fluoride prevents tooth decay in three ways:

*Converts hydroxylapatite in the composition of the teeth into fluorapatite and thus reduces the vulnerability of the thinnest layer of teeth, enamel, against acid. *By showing a direct effect on the tooth plaque, prevents it from producing acid.  *Helps repair and recovery of enamel layer, structure of which is damaged by acids.

• In order to benefit from this preventive effect of fluoride against tooth decay, it is recommended that fluoride is used systemically until 8 years age and topically until the eruption of permanent teeth. Ideal fluoride amount determined by American Dental Association is 0,7-1,2 mg/L (ppm). If drinking water contains less than this level, than additional fluoride intake is needed. Ideal doses for your children will be determined by your pediatrician.
  
  
• Topical fluorides used professionally by your dentist, are gels containing fluoride which are applied via mouth by plastic spoons. Depending on the dosage, it is repeated every 3 or 6 months; and this is known to be a very easy and comfortable fluoride application.

 
Fissure Sealant Applications

Fissure sealants are esthetic and transparent substances applied before formation of caries, and placed to seal off the chewing surfaces of teeth, which are most commonly affected by tooth decay inflicted by bacterial plaques.

Even in cases where children actively brush their teeth 2 times a day (morning and evening), it is always hard to clean up the pits and fissures on surfaces. Fissure sealants isolate those problematic areas and prevent formation of tooth decay as a result of food and plaque build up.

First molars which are the first permanent teeth to erupt, and second molars are very important and under high risk for residual food build up and caries development. Therefore, application of fissure sealant particularly on those teeth bears great importance and deemed as a necessity.

Fissure sealant is an easy method, applied in single session. First, tooth is cleaned, a chemical is applied, and it is dried. Following application of the colloid and transparent sealant onto the tooth, it is hardened by a special light-cure. Your child can eat after the procedure.

Fissure sealant applications are much cheaper than caries therapy and also does not cause any discomfort.

After the application of fissure sealant, child should continue maintaining oral health as well. Applied fissure sealant should be controlled every 6 months. If required to, an addition or renewal can be performed.

Bad Habits and Prevention Methods 

Finger sucking, lip sucking, tongue thrust, and mouth breathing can be mentioned among bad habits of children. While until 3 years age, they can be considered as normal, after that age, they can cause disorders and orthodontic problems. Therefore, first, the child should become aware of doing these actions and then those bad habits should be prevented by habit breakers. The sooner those habits are treated, the easier will be breaking them.

Early loss of teeth and space in children and the role of space maintainers 
 
Deciduous teeth are either shed due to pressure of erupting permanent teeth, or extracted because of trauma or untreatable caries, which leads to early loss of teeth and space. Resultant space which may cause adjacent teeth to shift into the gap resulting in blockage and deviation of the permanent tooth erupting from beneath the space. Therefore, by applying plastic or metal appliances called as space maintainer, these unwanted outcomes can be prevented. There are 2 types of space maintainers:

- Removable (which children can remove and wear by themselves)
- Fixed 
 
Removable space maintainers are made of an acrylic-based material in the laboratory according to the measurements performed inside the oral cavity of the child. In cases there is more than one missing teeth in both sides of the jaw, we prefer removable space maintainers. Children wear this appliance all along the day and remove it only while eating.
 
In cases where there is only single missing tooth on one side of the jaw, particularly if the child is small, we prefer fixed space maintainer. Fixed space maintainers are made by the doctor in clinical settings in a single session.

When should a space maintainer made?
 
Approximal caries is frequently seen in deciduous teeth. Because little children can not brush their tooth effectively and clean the posterior teeth adequately, those teeth decay easily, and if left untreated, they can require early extraction. Adjacent teeth which slide into the space to fill the gap or the permanent teeth erupting from beneath, cause space loss, crowding or serious orthodontic problems in the future. Therefore, space maintainer should be applied particularly in cases with early loss of deciduous molar teeth.  
 
The most important space loss is experienced when first or second molar teeth in the lower or upper jaw are lost before the eruption of permanent first molars. The large space that permanent first molars require may be blocked due to shifting of the adjacent deciduous teeth into that gap. Thus, using a space maintainer especially in this area bears significant importance.  
 
What is the benefit of space maintainers?
 
Space maintainers prevent closure of dental spaces. They block shifting of present adjacent deciduous teeth until the permanent tooth erupts in its proper space. Since it does not apply any force on the teeth, it is a more tolerable treatment method compared to a possible orthodontic treatment in the future.  

While wearing a space maintainer, what are things that we should avoid? 

Sticky candies and chewing gums should be avoided

Space maintainer SHOULD be worn all the time except eating.

In order to avoid space maintainer to be broken, heavy force should not be applied while wearing and removing the appliance and it SHOULD be kept in its proper box.

Following tooth brushing, prior to wearing, space maintainer SHOULD be brushed and cleaned.

Regularly (every month) a dentist should be visited for control.