Local Dental Care - Pediatric Dental Management

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.

Preventing Baby Bottle Tooth Decay

The Oral Health Hazard of Baby Bottle Syndrome

Baby bottle tooth decay is a condition resulting from frequent and long-term exposure of baby teeth to sugar-containing liquids, from sodas and sweetened drinks to baby formula, milk, fruit juice, and even breast milk. It doesn't matter whether the liquid is artificially sweetened or contains natural sugars. Breast-fed infants with prolonged feeding habits are also at risk in developing this condition. Baby bottle tooth decay may also be called baby bottle syndrome or bottle rot.

Bacteria found in plaque feed off the sugar in these liquids producing an acid byproduct. Acid attacks the gums and teeth, putting children at risk of tooth decay. If left untreated, the potential for pain and infection exists. Long-term effects include crooked teeth, speech problems, poor eating habits, and damaged adult teeth with the potential for tooth loss.

Tips to preventing baby bottle tooth decay or baby bottle syndrome

• Do not put a child to bed with anything other than water. While an infant may suck on a bottle while falling asleep, it is very important to remove bottles containing either artificial or natural sugars before napping or at night. During sleep, the amount of saliva decreases, and sugars from the drink coat the gums and teeth for an extended amount of time, increasing the chance of cavities.
• Daily cleaning and massaging a child's gums help establish healthy teeth, as well as provide special comfort while teething. At least once a day, moisten a gauze square or washcloth and gently rub your baby's gums.
• As baby teeth appear, brush them gently with a soft toothbrush and do not use toothpaste until two years of age.
• Wean children from bottles whenever they can drink from a cup. However, pediatric dentists recommend waiting until children are at least 6 to 12 months to provide adequate time for strengthening facial muscles developed by the sucking motion from a bottle or breast.
• Take "baby" steps for achieving good oral health. To help in the weaning of sugar-containing liquids, gradually dilute the bottle's contents with water over a two- to three-week period. If your child still is using a bottle after that time, fill it with water since it's the only liquid which doesn't pose any risk for baby bottle tooth decay or baby bottle syndrome. You could also give your child a clean pacifier recommended by your child's dentist. Be sure to check with your child's physician regarding any changes in feeding routines.
• Between the ages of 6 to 12 months, schedule your child's first visit to the pediatric dentist.

Stop baby bottle tooth decay or baby bottle syndrome before it starts! Follow these prevention tips for optimal oral health.

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.