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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.
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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:
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Visit your dentist regularly.
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Brush and floss on a daily basis to
reduce bacterial plaque.
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Proper diet, with the reduction of
beverages and foods high in sugar & starch.
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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.
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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.
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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:
-
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.
-
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.
-
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.
-
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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