Local Dental Care - Rhode Island Kids Dental

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 Care: Discolored Primary Teeth

Discoloration of the primary (baby) incisors (front teeth) is most often noticed by parents. This discoloration may be extrinsic or intrinsic. Tooth brushing or a professional cleaning can remove extrinsic discolorations or stains. Intrinsic discoloration occurs within the tooth structure.

Some apple juices and grape juice may cause staining. This type of stain can usually be brushed off the teeth at home. If your child has a tendency to stain, try diluting the juice with water. Once the enamel begins to break down, the staining may be more difficult to remove because it is deep down in the tiny holes created by break down of the enamel. This could progress on to decay. If the teeth appear to be a dull, white color in some spots, discontinue juices completely or dilute the juice with water. Juice is twenty times more decay-causing than milk. Juices should be limited to mealtime only.

Liquid and chewable medicines have a high sugar content and most are colored with dye. A light yellow-brown film may cover the teeth. This occurs most often on the bottom front teeth. Bedtime tooth brushing is especially important when your child is taking liquid or chewable medicine. Tetracycline is the only antibiotic that could cause damage to the developing permanent teeth if given before eight years of age.

Iron in chewable or liquid vitamins may cause staining of the grooves of the primary (baby) molars. This is difficult to remove, but overall is harmless.

You must brush your child's teeth until six years of age. Bedtime brushing is the most important time of day. Staining may occur if plaque remains on teeth for a long period of time. Plaque is made up of cells from the inside of the mouth, bacteria, and food residues. Teeth may appear to be discolored, but a thorough brushing may remove this stain. Do not use toothpaste until two years of age. Baking soda toothpaste seems to be best for stain removal.

Bacteria called chromogenic (colored) bacteria may cause a dark green or brown stain on the teeth. This stain is usually along the gum line. These bacteria are harmless and will one day just disappear. We do not know why they grow in some mouths and not others. A professional cleaning is usually necessary to remove this stain.

Intrinsic discoloration cannot be removed by cleaning the teeth. This occurs because the enamel on the primary teeth did not form in the usual manner. This may be inherited from one or both parents. It does not necessarily mean that the primary teeth will be more susceptible to decay or that the permanent teeth will have the same appearance.

Trauma to a primary incisor (front tooth) may cause discoloration. If the blood vessels deep inside the tooth break, the blood may be absorbed into the tiny tubes that travel from the inside of the tooth to the outer enamel layer. This is similar to a black and blue mark on the skin. Enamel is translucent, so you can see the evidence of the damage. This may resolve without treatment, but your pediatric dentist should be consulted. A procedure to remove the tissue from the inside of the tooth (pulpectomy) may be necessary.

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.