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Dental Emergencies
Toothache: Clean the area of the affected
tooth. Rinse the mouth thoroughly with warm water or use dental floss to
dislodge any food that may be impacted. If the pain still exists, contact your
child's dentist. Do not place aspirin or heat on the gum or on the aching
tooth. If the face is swollen, apply cold compresses and contact your dentist
immediately.
Cut or Bitten Tongue, Lip or Cheek:
Apply ice to injured areas to help control swelling. If there is bleeding,
apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be
controlled by simple pressure, call a doctor or visit the hospital emergency
room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not by the root. You may
rinse the tooth with water only. DO NOT clean with soap, scrub or handle the
tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to
reinsert it in the socket. Have the patient hold the tooth in place by biting
on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup
containing the patient’s saliva or milk. If the patient is old enough, the
tooth may also be carried in the patient’s mouth (beside the cheek). The
patient must see a dentist IMMEDIATELY! Time is a critical factor in saving
the tooth.
Knocked Out Baby Tooth: Contact your
pediatric dentist during business hours. This is not usually an emergency,
and in most cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist immediately. Quick action can save the tooth,
prevent infection and reduce the need for extensive dental treatment. Rinse
the mouth with water and apply cold compresses to reduce swelling. If
possible, locate and save any broken tooth fragments and bring them with you
to the dentist.
Chipped or Fractured Baby Tooth: Contact
your pediatric dentist.
Severe Blow to the Head: Take your child to
the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw:
Keep the jaw from moving and take your child to the nearest hospital emergency
room.
Dental Radiographs (X-Rays)
Radiographs (X-Rays) are a vital and necessary
part of your child’s dental diagnostic process. Without them, certain dental
conditions can and will be missed.
Radiographs detect much more than cavities. For
example, radiographs may be needed to survey erupting teeth, diagnose bone
diseases, evaluate the results of an injury, or plan orthodontic treatment.
Radiographs allow dentists to diagnose and treat health conditions that cannot
be detected during a clinical examination. If dental problems are found and
treated early, dental care is more comfortable for your child and more
affordable for you.
The American Academy of Pediatric Dentistry
recommends radiographs and examinations every six months for children with a
high risk of tooth decay. On average, most pediatric dentists request
radiographs approximately once a year. Approximately every 3 years, it is a
good idea to obtain a complete set of radiographs, either a panoramic and
bitewings or periapicals and bitewings.
Pediatric dentists are particularly careful to
minimize the exposure of their patients to radiation. With contemporary
safeguards, the amount of radiation received in a dental X-ray examination is
extremely small. The risk is negligible. In fact, the dental radiographs
represent a far smaller risk than an undetected and untreated dental problem.
Lead body aprons and shields will protect your child. Today’s equipment
filters out unnecessary x-rays and restricts the x-ray beam to the area of
interest. High-speed film and proper shielding assure that your child receives
a minimal amount of radiation exposure.
What’s the Best Toothpaste for my
Child?
Tooth
brushing is one of the most important tasks for good oral health. Many
toothpastes, and/or tooth polishes, however, can damage young smiles. They
contain harsh abrasives, which can wear away young tooth enamel. When looking
for a toothpaste for your child, make sure to pick one that is recommended by
the American Dental Association as shown on the box and tube. These
toothpastes have undergone testing to insure they are safe to use.
Remember, children should spit out toothpaste
after brushing to avoid getting too much fluoride. If too much fluoride is
ingested, a condition known as fluorosis can occur. If your child is too young
or unable to spit out toothpaste, consider providing them with a fluoride free
toothpaste, using no toothpaste, or using only a "pea size" amount of
toothpaste.
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Does Your Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal
grinding of teeth (bruxism). Often, the first indication is the noise created
by the child grinding on their teeth during sleep. Or, the parent may notice
wear (teeth getting shorter) to the dentition. One theory as to the cause
involves a psychological component. Stress due to a new environment, divorce,
changes at school; etc. can influence a child to grind their teeth. Another
theory relates to pressure in the inner ear at night. If there are pressure
changes (like in an airplane during take-off and landing, when people are
chewing gum, etc. to equalize pressure) the child will grind by moving his jaw
to relieve this pressure.
The majority of cases of pediatric bruxism do not
require any treatment. If excessive wear of the teeth (attrition) is present,
then a mouth guard (night guard) may be indicated. The negatives to a mouth
guard are the possibility of choking if the appliance becomes dislodged during
sleep and it may interfere with growth of the jaws. The positive is obvious by
preventing wear to the primary dentition.
The good news is most children outgrow bruxism.
The grinding decreases between the ages 6-9 and children tend to stop grinding
between ages 9-12. If you suspect bruxism, discuss this with your pediatrician
or pediatric dentist.
Thumb
Sucking
Sucking
is a natural reflex and infants and young children may use thumbs, fingers,
pacifiers and other objects on which to suck. It may make them feel secure and
happy, or provide a sense of security at difficult periods. Since thumb
sucking is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of
the permanent teeth can cause problems with the proper growth of the mouth and
tooth alignment. How intensely a child sucks on fingers or thumbs will
determine whether or not dental problems may result. Children who rest their
thumbs passively in their mouths are less likely to have difficulty than those
who vigorously suck their thumbs.
Children should cease thumb sucking by the time
their permanent front teeth are ready to erupt. Usually, children stop between
the ages of two and four. Peer pressure causes many school-aged children to
stop.
Pacifiers are no substitute for thumb sucking.
They can affect the teeth essentially the same way as sucking fingers and
thumbs. However, use of the pacifier can be controlled and modified more
easily than the thumb or finger habit. If you have concerns about thumb
sucking or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through
thumb sucking:
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Instead of scolding children for thumb sucking, praise
them when they are not.
-
Children often suck their thumbs when feeling insecure.
Focus on correcting the cause of anxiety, instead of the thumb sucking.
-
Children who are sucking for comfort will feel less of a
need when their parents provide comfort.
-
Reward children when they refrain from sucking during
difficult periods, such as when being separated from their parents.
-
Your pediatric dentist can encourage children to stop
sucking and explain what could happen if they continue.
-
If these approaches don’t work, remind the children of
their habit by bandaging the thumb or putting a sock on the hand at night.
Your pediatric dentist may recommend the use of a mouth appliance.
What is Pulp Therapy?
The pulp of a tooth is the inner, central core of
the tooth. The pulp contains nerves, blood vessels, connective tissue and
reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to
maintain the vitality of the affected tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic injury are
the main reasons for a tooth to require pulp therapy. Pulp therapy is often
referred to as a "nerve treatment", "children's root canal", "pulpectomy" or "pulpotomy".
The two common forms of pulp therapy in children's teeth are the pulpotomy and
pulpectomy.
A pulpotomy removes the diseased pulp tissue
within the crown portion of the tooth. Next, an agent is placed to prevent
bacterial growth and to calm the remaining nerve tissue. This is followed by
a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is
involved (into the root canal(s) of the tooth). During this treatment, the
diseased pulp tissue is completely removed from both the crown and root. The
canals are cleansed, disinfected and, in the case of primary teeth, filled
with a resorbable material. Then, a final restoration is placed. A permanent
tooth would be filled with a non-resorbing material.
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What is the Best
Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be recognized
as early as 2-3 years of age. Often, early steps can be taken to reduce the
need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment
encompasses ages 2 to 6 years. At this young age, we are concerned with
underdeveloped dental arches, the premature loss of primary teeth, and harmful
habits such as finger or thumb sucking. Treatment initiated in this stage of
development is often very successful and many times, though not always, can
eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the
ages of 6 to 12 years, with the eruption of the permanent incisor (front)
teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and
dental realignment problems. This is an excellent stage to start treatment,
when indicated, as your child’s hard and soft tissues are usually very
responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals
with the permanent teeth and the development of the final bite relationship.
EARLY INFANT ORAL
CARE
Your
Child’s First Dental Visit - Establishing a "Dental Home"
The American Academy of Pediatrics (AAP), the
American Dental Association (ADA), and the American Academy of Pediatric
Dentistry (AAPD) all recommend establishing a "Dental
Home" for your child by one year of age. Children who have a
dental home are more likely to receive appropriate preventive and routine oral
health care.
The Dental Home is intended to
provide a place other than the
Emergency Room for parents.
You can make the first visit to the dentist
enjoyable and positive. If old enough, your child should be informed of the
visit and told that the dentist and their staff will explain all procedures
and answer any questions. The less to-do concerning the visit, the better.
It is best if you refrain from using words around
your child that might cause unnecessary fear, such as needle, pull, drill or
hurt. Pediatric dental offices make a practice of using words that convey the
same message, but are pleasant and non-frightening to the child.
When Will My Baby Start Getting
Teeth?
Teething, the process of baby (primary) teeth
coming through the gums into the mouth, is variable among individual babies.
Some babies get their teeth early and some get them late. In general, the
first baby teeth to appear are usually the lower front (anterior) teeth and
they usually begin erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more details.
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Baby
Bottle Tooth Decay (Early Childhood Caries)
One serious form of decay among young children is
baby bottle tooth decay, also referred to by dentists as early childhood
caries. This condition is caused by frequent and long exposures of an infant’s
teeth to liquids that contain sugar. Among these liquids are milk (including
breast milk), formula, fruit juice and other sweetened drinks.
Putting a baby to bed for a nap or at night with a
bottle other than water can cause serious and rapid tooth decay. Sweet liquid
pools around the child’s teeth giving plaque bacteria an opportunity to
produce acids that attack tooth enamel. If you must give the baby a bottle as
a comforter at bedtime, it should contain only water. If your child won't
fall asleep without the bottle and its usual beverage, gradually dilute the
bottle's contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth
with a damp washcloth or gauze pad to remove plaque. The easiest way to do
this is to sit down, place the child’s head in your lap or lay the child on a
dressing table or the floor. Whatever position you use, be sure you can see
into the child’s mouth easily.
PREVENTION
Care of Your Child’s Teeth
Good
Diet = Healthy Teeth
Healthy
eating habits lead to healthy teeth. Like the rest of the body, the teeth,
bones and the soft tissues of the mouth need a well-balanced diet. Children
should eat a variety of foods from the five major food groups. Most snacks
that children eat can lead to cavity formation. The more frequently a child
snacks, the greater the chance for tooth decay. How long food remains in the
mouth also plays a role. For example, hard candy and breath mints stay in the
mouth a long time, which cause longer acid attacks on tooth enamel. If your
child must snack, choose nutritious foods such as vegetables, low-fat yogurt,
and low-fat cheese, which are healthier and better for children’s teeth.
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How Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left
over food particles that combine to create cavities. For infants, use a wet
gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting
your child to bed with a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older
children, brush their teeth at least twice a day. Also, watch the
number of snacks containing sugar that you give your children.
The American
Academy of Pediatric Dentistry recommends visits every six months to the
pediatric dentist, beginning at your child’s first birthday. Routine visits
will start your child on a lifetime of good dental health.
Your pediatric
dentist may also recommend protective sealants or home fluoride treatments for
your child. Sealants can be applied to your child’s molars to prevent decay on
hard to clean surfaces.
Seal Out Decay
A sealant is a clear or shaded plastic material
that is applied to the chewing surfaces (grooves) of the back teeth (premolars
and molars), where four out of five cavities in children are found. This
sealant acts as a barrier to food, plaque and acid, thus protecting the
decay-prone areas of the teeth.
|
Before Sealant Applied |
After Sealant Applied |
Fluoride
Fluoride is an element, which has been shown to be
beneficial to teeth. However, too little or too much fluoride can be
detrimental to the teeth. Little or no fluoride will not strengthen the teeth
to help them resist cavities. Excessive fluoride ingestion by preschool-aged
children can lead to dental fluorosis, which is a chalky white to even brown
discoloration of the permanent teeth. Many children often get more fluoride
than their parents realize. Being aware of a child’s potential sources of
fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
-
Too much fluoridated toothpaste at an early age.
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The inappropriate use of fluoride supplements.
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Hidden sources of fluoride in the child’s diet.
Two and three year olds may not be able to
expectorate (spit out) fluoride-containing toothpaste when brushing. As a
result, these youngsters may ingest an excessive amount of fluoride during
tooth brushing. Toothpaste ingestion during this critical period of permanent
tooth development is the greatest risk factor in the development of fluorosis.
Excessive and inappropriate intake of fluoride
supplements may also contribute to fluorosis. Fluoride drops and tablets, as
well as fluoride fortified vitamins should not be given to infants younger
than six months of age. After that time, fluoride supplements should only be
given to children after all of the sources of ingested fluoride have been
accounted for and upon the recommendation of your pediatrician or pediatric
dentist.
Certain foods contain high levels of fluoride,
especially powdered concentrate infant formula, soy-based infant formula,
infant dry cereals, creamed spinach, and infant chicken products. Please read
the label or contact the manufacturer. Some beverages also contain high levels
of fluoride, especially decaffeinated teas, white grape juices, and juice
drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease
the risk of fluorosis in their children’s teeth:
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Use baby tooth cleanser on the toothbrush of the very
young child.
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Place only a pea sized drop of children’s toothpaste on
the brush when brushing.
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Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s physician or
pediatric dentist.
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Avoid giving any fluoride-containing supplements to
infants until they are at least 6 months old.
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Obtain fluoride level test results for your drinking
water before giving fluoride supplements to your child (check with local
water utilities).
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Mouth
Guards
When a child begins to participate in recreational
activities and organized sports, injuries can occur. A properly fitted mouth
guard, or mouth protector, is an important piece of athletic gear that can
help protect your child’s smile, and should be used during any activity that
could result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries to the
lips, tongue, face or jaw. A properly fitted mouth guard will stay in place
while your child is wearing it, making it easy for them to talk and breathe.
Ask your pediatric dentist about custom and store-bought
mouth protectors.
Xylitol - Reducing Cavities
The
American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of
xylitol on the oral health of infants, children, adolescents, and persons with
special health care needs.
The use of
XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery
and until the child was 2 years old, has proven to reduce cavities up to 70%
by the time the child was 5 years old.
Studies using xylitol as either a sugar substitute
or a small dietary addition have demonstrated a dramatic reduction in new
tooth decay, along with some reversal of existing dental caries. Xylitol
provides additional protection that enhances all existing prevention methods.
This xylitol effect is long-lasting and possibly permanent. Low decay rates
persist even years after the trials have been completed.
Xylitol is widely distributed throughout nature in
small amounts. Some of the best sources are fruits, berries, mushrooms,
lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than
one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive results
ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher
results did not result in greater reduction and may lead to diminishing
results. Similarly, consumption frequency of less than 3 times per day showed
no effect.
To find gum or other products containing xylitol,
try visiting your local health food store or search the Internet to find
products containing 100% xylitol.
ADOLESCENT
DENTISTRY
Tongue Piercing – Is it Really
Cool?
You might not be surprised anymore to see people
with pierced tongues, lips or cheeks, but you might be surprised to know just
how dangerous these piercings can be.
There are many risks involved with oral piercings,
including chipped or cracked teeth, blood clots, blood poisoning, heart
infections, brain abscess, nerve disorders (trigeminal neuralgia), receding
gums or scar tissue. Your mouth contains millions of bacteria, and infection
is a common complication of oral piercing. Your tongue could swell large
enough to close off your airway!
Common symptoms after piercing include pain,
swelling, infection, an increased flow of saliva and injuries to gum tissue.
Difficult-to-control bleeding or nerve damage can result if a blood vessel or
nerve bundle is in the path of the needle.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth jewelry.
Tobacco – Bad News in Any Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the dangers of
tobacco.
Smokeless tobacco, also called spit, chew or
snuff, is often used by teens who believe that it is a safe alternative to
smoking cigarettes. This is an unfortunate misconception. Studies show that
spit tobacco may be more addictive than smoking cigarettes and may be more
difficult to quit. Teens who use it may be interested to know that one can of
snuff per day delivers as much nicotine as 60 cigarettes. In as little as
three to four months, smokeless tobacco use can cause periodontal disease and
produce pre-cancerous lesions called leukoplakias.
If your child is a tobacco user you should watch
for the following that could be early signs of oral cancer:
-
A sore that won’t heal.
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White or red leathery patches on the lips, and on or
under the tongue.
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Pain, tenderness or numbness anywhere in the mouth or
lips.
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Difficulty chewing, swallowing, speaking or moving the
jaw or tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are
not painful, people often ignore them. If it’s not caught in the early stages,
oral cancer can require extensive, sometimes disfiguring, surgery. Even worse,
it can kill.
Help your child avoid tobacco in any form. By doing so,
they will avoid bringing cancer-causing chemicals in direct contact with their
tongue, gums and cheek.
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