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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.

Dental Care: Toothbrush Tips For Kids

There are so many designs for toothbrushes. How does anyone know what to select? Here are some tips from a pediatric dentist to make the right decision and get the most out of your purchase.

Let's begin with preschoolers. Toothbrushes should have extra soft bristles with small, rounded heads. The handles should be larger for a good grip. Some toothbrushes have rubber on the handle to make them slip-proof. A colored area on the bristles indicating the correct amount of toothpaste to dispense can be helpful. Do not permit your preschooler to chew on his or her toothbrush or run with a toothbrush in his or her mouth. You should do the brushing until six years of age. No toothpaste should be used until after age two.

The six-year molars erupt (come in) behind the primary (baby) molars in the back of the mouth. When they begin to erupt, it is time for another toothbrush design. This brush should have a larger head to accommodate the larger permanent teeth and a longer tuft of bristles on the end of the head. As the six-year molars erupt, they are lower than the teeth that are beside them. A toothbrush with a longer set of bristles at the end, an end tuft, is better for cleaning erupting molars.

Around age twelve, when the twelve-year molars are erupting, use the same style brush with an end tuft, but the head should be larger.

During orthodontic treatment, a toothbrush that can clean around the braces is necessary. These brushes will have a short row of bristles in the center and two longer rows on the outside. They will clean around the brackets more effectively. A tiny brush, called an interdental brush, is used for cleaning areas that are hard to reach. Your orthodontist will instruct you regarding the extras needed for good dental care during orthodontic treatment.

All brushes, for all ages, should have soft bristles. Hard bristles are hard on gums. As soon as the bristles look frayed, the toothbrush should be replaced. It is impossible to clean teeth properly with a tattered toothbrush. Replacement may be once a month for some heavy-duty brushers and less often for those with a healthier gentle technique.

All toothbrushes should be rinsed thoroughly with hot water before and after brushing. Rinsing toothbrushes has been shown to reduce the growth of bacteria on the bristles between brushing.

Toothbrushes should be replaced after any illness. If a strep infection is being treated, the toothbrush should be replaced. The strep grows on the toothbrush and can re-infect your child. When you pick up your prescription, also pick up two new toothbrushes. Begin a new toothbrush 24 hours after the antibiotic is started and begin the second toothbrush upon completion of the antibiotic. The same holds true for acrylic orthodontic appliances. They must be disinfected during a strep infection because strep grows on appliances too.

Because viruses and bacteria are growing on the toothbrush bristles during an illness, do not touch the toothpaste tube with the bristles of the toothbrush. Place the toothpaste on a clean finger for transfer, or if the child has herpes, place the toothpaste on a cotton swab for transfer to the toothbrush.

What about the power or electric toothbrushes? Do they do a better job of cleaning? Yes, yes, yes! The first electric brush can be used at age six when children begin to do their own brushing. They must be kept clean and the heads should be changed when the bristles become frayed. The head can be soaked in mouthwash containing alcohol for disinfecting if an illness occurs just after starting to use a new brush. Keep all mouthwash out of the reach of children!

Bedtime brushing is the most important time of day. Morning brushing may be done before breakfast, but after breakfast is more important. After you have purchased the appropriate toothbrush for your child, the only thing left is for you to say, at least twice each day, USE IT!!!

By Jane A. Soxman, 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.