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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 Health: Tooth Brushing for Pre-Schoolers!

Teaching toddlers some brushing basics is important. Developing good brushing habits for sound dental health early sets a positive pattern.

How Early Should I Begin Letting My Child Brush Their Teeth by Themselves?

Children learn by example and often want to copy the behaviors they observe in adults. "Let me do it!" is often a favorite phrase during the preschool period, so this can work in your favor when they're ready to learn.

When children are about three years old, they're usually ready to learn how to brush with your supervision. Schedule a visit with the dentist. Let them advise you about your child's readiness for proper brushing. The pediatric dentist or dental hygienist will also show your child the right way to brush.

Between the ages of three and five, your child will likely need help brushing the inner surfaces and way in the back. By age seven, most kids are ready to brush alone.

What Are Some Ideas for Teaching Good Brushing Habits?

• Take your child toothbrush shopping. Let them choose among all the colors and designs for child-size toothbrushes. Giving kids a chance to select the one they want helps them feel part of the process. Just make sure it has soft bristles.
• Show your child how to brush properly. Place only a pea-sized amount (at most) of toothpaste on their toothbrush. Tell them this is all that's needed and no more should be used (too much toothpaste at a young age is not recommended). If your child objects to using toothpaste, just brushing alone is fine. Brushing with water works, too (but the fluoride in fluoride toothpaste acts as a cavity-fighter and provides extra protection).
• Provide positive reinforcement. Give them colorful stickers. Make up a chart and have them place a sticker on it every time they brush.
• Put a sticky note on the bathroom mirror with a smiley face reminding your child to brush. When your child is old enough to read, post the 10 Tips from the Tooth Fairy on the mirror or refrigerator for gentle dental reminders.
• Praise them for their brushing ability. Tell them how shiny their teeth look.
• Making brushing fun to learn sets the right tone! Make up a song using their name while they're brushing. Avoid any battles about brushing, since this will only discourage cooperation. Associating it with fun and enjoyment reinforces positive experiences.
• Model good oral care habits. If they see you brush and floss regularly, that sets a good example they will likely want to follow.

Good oral care habits last a lifetime. Starting them early with good baby teeth care strengthens the habit and will help them keep their permanent teeth healthy, too!

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.