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.
Sedation Dentistry
For young, anxious or
special needs children, we are trained, equipped and able to
complete dental care with sedation.
The goal of sedation is to help your child relax during
their dental treatment.
There are different sedation techniques and
the doctors will evaluate your child and their dental needs to
determine the most appropriate option.
NITROUS OXIDE (LAUGHING GAS)
Nitrous oxide helps children relax for
their dental treatment.
It is administered through a small breathing nose.
Nitrous oxide helps alleviate dental anxiety without
putting children to sleep.
The American Academy of Pediatric Dentistry recommends
this technique as a very safe and effective method of providing
dental care for children.
ORAL SEDATION
Oral sedation involves your child taking a
liquid medication to help them relax for their dental treatment.
There are various types of sedation medications and the
doctors will evaluate your child based on their age, medical
history and needed dental treatment to help determine which
regimen is appropriate.
Unlike general anesthesia, oral sedation is
not intended to make a patient unconscious.
Most children become relaxed and drowsy.
Some children, however, may become agitated but the
doctors and team will work with your child to get them as
comfortable as possible.
INTRAVENOUS (IV) SEDATION AND GENERAL ANESTHESIA
Treatment with IV sedation and general
anesthesia allows us to complete all the necessary dental
treatment in one appointment while your child is asleep.
Both techniques are used for patients with extensive
dental needs, patients with medical, developmental and physical
special needs, the very young or when oral sedation was
ineffective.
IV sedations are performed in one of our
offices by a dental anesthesiologist that specializes in the
treatment of pediatric patients.
For those children that require that their
dental treatment be completed in a hospital setting, both
doctors have staff privileges at various hospital and surgical
centers in the Valley.
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
alcohol-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
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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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to 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.
