Babies Teeth Chart - In Your Local Palo Alto, CA Area

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.

Dental Care: Malocclusion (Bad Bite) In Children

Malocclusion means "bad bite." It's when the upper and lower teeth are not meeting correctly, or when the teeth and jaws are not positioned for good dental health. This condition affects jaw growth, speech development, facial appearance, gum tissue health, and the ability to clean teeth properly.

What Causes Bad Bite In Children?

Many malocclusions are inherited. This includes crowding of teeth, too much space between teeth, extra or missing teeth, or irregularities in the jaws, face, and teeth.

Malocclusions also can be environmental in nature, caused by accidents, thumb sucking or sucking on a pacifier, obstruction by tonsils and adenoids, dental disease, or premature loss of primary (baby) teeth.

Why Is Dental Treatment Important?

If dental care is delayed or not taken, many problems get worse and more complicated (and expensive) to remedy. Malocclusion can cause excessive wear of tooth enamel, poor chewing, stress on both the gums and jawbone that support the teeth, chronic headaches, and facial and neck pains. Correcting the malocclusion can improve overall oral health and eliminate other potential problems.

Does the Pediatric Treatment Involve Removal of Some Teeth?

Sometimes when permanent teeth are crowded and their spacing and proper positioning is being affected by the primary teeth, removing primary or baby teeth is necessary. Otherwise, the severely crowded permanent teeth will either remain "stuck" (impacted) and unable to erupt, or they will erupt in an undesirable position.

Treatment of a malocclusion involves a thorough evaluation of your child's specific condition by a pediatric dentist and/or orthodontist. This may include recommendations for removal of some primary or permanent teeth because some malocclusions cannot be treated successfully without doing so. Extraction of some teeth in severely crowded conditions enhances proper alignment, function, and appearance, too.

How Is a Diagnosis of a Malocclusion Performed?

Each child's specific condition dictates the diagnostic procedures, but they often include several or all of the following:

• Clinical exam.
• Medical and dental history.
• Impressions of the teeth for making plaster models.
• Photographs of the face and teeth to provide a record of the child's facial appearance prior to treatment.
• Panoramic X-rays showing all the upper and lower teeth in biting position, and teeth that are not yet visible.
• Lateral (cephalometric) X-rays of the entire head showing the relationship of the teeth and jaws to the face and skull.

How Long Does Dental Care Treatment Take?

Each condition is unique and must be treated individually. The actual time is dependent on the growth of the child's mouth and face, the severity of the problem and the cooperation of the child in following instructions. Mild correction problems or early treatment may take only a few months. Treatment for more complex malocclusions range from one to three years.

An attractive smile, proper alignment, and healthy teeth are valuable rewards gained from a custom-designed treatment program made for smile after smile!

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.