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Management of Injury to Children's Permanent Teeth

Recent studies indicate that 25% of Americans between the ages of 6 and 50 years have experienced traumatic injury to permanent teeth. Ninety percent of traumatized teeth involve the upper incisors. The focus of contemporary treatment of dental traumatic injuries is conservative management of the affected tissues to maximize their excellent healing potential in children. The most important element in this process is the reduction of the time interval between the traumatic episode and the dental treatment. Dental treatment should therefore be sought immediately. It is for this reason that public information on dental trauma management is so critical, particularly in the following three areas.

Coronal Fractures -- Broken Crowns of Teeth

The predominant treatment goal in tooth crown fractures includes protecting the underlying pulp (nerve tissue) within the tooth from bacterial contamination and infection. Additional goals include keeping the adjacent teeth from moving into the space created by the missing tooth portion and restoring the esthetic appearance and function of the traumatized tooth.

Dental treatment of crown fractures involves the following steps. The affected teeth and surrounding soft tissues are cleansed with an antibacterial mouthwash and the exposed dental hard tissues are protected with either an applied protective medicament or an adhesive resin material. These measures provide a seal against bacterial penetration into the porous tooth structure and subsequent infection of the underlying pulp. A resin (plastic) restoration of the lost tooth portion is placed for esthetics and function. In cases where the missing tooth fragment can be found, it can be reattached to the remaining tooth portion with dental adhesives. The treated teeth are then monitored post-operatively for signs of possible infection over a period of several months to a year.

Tooth Displacement Injury -- Loosened or Dislodged Teeth

The predominant treatment goal for displaced teeth focuses on protecting the supporting tissue known as the periodontal ligament from bacterial invasion and subsequent infection resulting from the injury. This tissue surrounds the root of the affected tooth and has the primary function of attaching the tooth to the bone.

Dental treatment includes stabilizing the excessively loosened or displaced tooth by means of short-term splinting. The splinting device consists of an orthodontic brace wire attached to the affected tooth and adjacent teeth with resin adhesive for a one to two-week period. Additional treatment may include esthetic restoration of tooth portions damaged by the injury as previously mentioned, and post-treatment monitoring for signs of healing.

Tooth Avulsion -- Teeth That Have Been Knocked Out

Treatment goals for knocked-out teeth are focused on enhancing periodontal ligament survival. The critical variable is the length of time that the tooth has been out of the mouth without any means of providing hydration and nutrition to the periodontal ligament cells attached to the avulsed root surface. This time length is known as Extra-Oral-Dry-Time (EODT). If the EODT is less than one hour, the chances for periodontal ligament survival is quite good, provided the appropriate management is started immediately.

Dental treatment of avulsion involves minimizing the EODT by immediately replacing the tooth back into the socket or immediately placing it in a transport/storage solution to hydrate and nourish the periodontal ligament cells still attached to the root. The most readily available transport media is cool milk. Special tissue culture fluids are even better, but generally are available only from a dentist, drug stores, or school health clinics. On-site tooth avulsion management includes the following:

1) Rinse the knocked-out tooth under tap water only if there is dirt.

2) Replant the tooth in its socket and keep it held in position, or place it in milk (or culture fluid, if available).

3) Immediately take the child to a pediatric dentist who will stabilize the tooth with splinting devices previously mentioned and provide the necessary treatment of the pulp and the periodontal ligament.

The more we can do to enhance the excellent healing potential of the traumatized tissues in children, the better the outcome.

By Clifton O. Dummett, Jr., DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Ten Tips About Baby Teeth From The Tooth Fairy

I love teeth! They're so shiny, white, and bright! They're so pretty and sparkly. That's why I collect them. But I don't want them until you don't need them anymore, so I wait for the perfect time. It usually begins when you're about five years old or older, but sometimes it happens much later. Some of your baby teeth will start to wiggle and jiggle. Then, they are finally nudged out by your grown-up teeth.

When a loose tooth comes out, that's when I go into action. Collecting teeth is my job. Kids know how much I like teeth, so they save them for me. They put them out at night, sometimes in tiny tooth pillows or plastic cases. Sometimes, I find them underneath pillows when kids are sleeping. I like it when kids think about me. I think each child is special and so are their teeth! That's why I have some tips for keeping your teeth in tip-top shape:

• Brush your teeth in the morning and at night. Twice a day is nice (and needed to keep your teeth healthy.) It's even better if you brush after eating snacks, too.
• When brushing, use just a tiny dab of toothpaste, the size of a match head.
• Brush the outside and inside of every tooth. Brush your teeth for about two to three minutes, about the time it takes to sing, "Twinkle, Twinkle Little Star" eight times!
• When brushing, don't ever eat the toothpaste. It's meant for your teeth, not your tummy.
• Brush your tongue (gently!). Those nasty cavity-causing germs like to hang out on your soft tongue, so you must brush them away.
• Floss every day. Dental floss is a piece of string that looks like thread or yarn. It's used to clean stuff out between your teeth. Ask an adult to help you. Those cavity-causing germs also like the places between your teeth to hide. Flossing gets rid of them.
• Eat healthy snacks. Your teeth like fruits, vegetables, bread, milk, and cheese that give them vitamins, minerals, and other good things for them to grow strong and shiny.
• Don't eat too many sugary foods like candy, cakes, or other desserts. Sugar is the food that those nasty cavity-causing germs really love! It gives them just what they need to go to work causing cavities on your teeth.
• Don't crunch on ice! (My friend, the Ice Fairy, doesn't like it either!) Ice wears down your teeth really fast.
• Visit a dentist twice a year. Dentists are my friends because they help to keep kid's teeth in really good shape.

Take good care of your teeth. Your baby teeth have a big job. They help your permanent teeth (the ones you'll keep forever) come into your mouth, at just the right time, in the right way. Once each baby tooth has done it's job, then I'll come collect it.

In the meantime, take the ten tips for turning your teeth into tip-top shape. (Say that ten times!)

Healthy teeth rule! The Tooth Fairy is cool!

Love,

The Tooth Fairy

By Brian J. Gray, DDS, MAGD, FICO

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.