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.
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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.
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:
-
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
Perinatal
& Infant Oral Health
The
American Academy of Pediatric Dentistry (AAPD) recommends that all
pregnant women receive oral healthcare and counseling during
pregnancy. Research has shown evidence that periodontal disease can
increase the risk of preterm birth and low birth weight. Talk to your
doctor or dentist about ways you can prevent periodontal disease
during pregnancy.
Additionally, mothers with poor oral
health may be at a greater risk of passing the bacteria which causes
cavities to their young children. Mother's should follow these simple
steps to decrease the risk of spreading cavity-causing bacteria:
-
Visit your dentist regularly.
-
Brush and floss on a daily basis to
reduce bacterial plaque.
-
Proper diet, with the reduction of
beverages and foods high in sugar & starch.
-
Use a fluoridated toothpaste recommended
by the ADA and rinse every night with an alocohol-free,
over-the-counter mouth rinse with .05 % sodium fluoride in order to
reduce plaque levels.
-
Don't share utensils, cups or food which
can cause the transmission of cavity-causing bacteria to your
children.
-
Use of xylitol chewing gum (4 pieces per
day by the mother) can decrease a child’s caries rate.
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 (ECC). ECC can
be 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 & Gums
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.
-
The inappropriate use of fluoride supplements.
-
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:
-
Use baby tooth cleanser on the toothbrush of the
very young child.
-
Place only a pea sized drop of children’s
toothpaste on the brush when brushing.
-
Account for all of the sources of ingested
fluoride before requesting fluoride supplements from your child’s
physician or pediatric dentist.
-
Avoid giving any fluoride-containing supplements
to infants until they are at least 6 months old.
-
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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Top]
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.
-
White or red leathery patches on the lips, and on
or under the tongue.
-
Pain, tenderness or numbness anywhere in the
mouth or lips.
-
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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GENERAL TOPICS:
