Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common. Approximately one third of children have experienced some type of dental trauma, and more have experienced a dental emergency.
There are two peak risk periods for dental trauma – the first being toddlerhood (18-40 months) when environmental exploration begins, and the second being the preadolescent/adolescent period, when sporting injuries become commonplace.
Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.
Toothache is common in children of all ages and rarely occurs without cause. Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss. If pain persists, contact the pediatric dentist. Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).
If a tooth has been knocked-out of the child’s mouth completely, it is important to contact the pediatric dentist immediately. In general, pediatric dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the tooth bud, and thereby damage the emerging permanent tooth.
Pediatric dentists always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage. The reimplantation procedure is almost always more successful if it is performed within one hour of the avulsion, so time is of the essence!
Sometimes, dental trauma forces a tooth (or several teeth) upwards into the jawbone. The prognosis is better for teeth that have been pushed up to a lesser extent (less than 3mm), but every situation is unique. Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.
If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact the pediatric dentist immediately. Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or perform root canal therapy to preserve the structure of the tooth.
Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma. A luxated tooth remains in the socket – with the pulp intact about half of the time. However, the tooth protrudes at an unnatural angle and the underlying jawbone is oftentimes fractured.
The term “extrusion” refers to a tooth that has become partly removed from its socket. In young children, primary tooth extrusions tend to heal themselves without medical treatment. However, dental treatment should be sought for permanent teeth that have been displaced in any manner in order to save the tooth and prevent infection. It is important to contact the pediatric dentist if displacement is suspected.
The crown is the largest, most visible part of the tooth. In most cases, the crown is the part of the tooth that sustains trauma. There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).
The pediatric dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign. Minor crown fractures often warrant the application of dental sealant, whereas more severe crown fractures sometimes require pulp treatments. In the case of crown fracture, the pediatric dentist should be contacted. Jagged enamel can irritate and inflame soft oral tissues, causing infection.
A root fracture is caused by direct trauma, and isn’t noticeable to the naked eye. If a root fracture is suspected, dental x-rays need to be taken. Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worse case scenario.
A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.” Typically occurring in toddlers, dental concussion can cause the tooth to discolor permanently or temporarily. Unless the tooth turns black or dark (indicating that the tooth is dying and may require root canal therapy), dental concussion does not require emergency treatment.
If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze. To reduce swelling, apply ice to the affected areas. If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.
If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room. In the meantime, encourage the child not to move the jaw. In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.
If the child has received trauma to the head, proceed immediately to the Emergency Room. Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.
If you have questions about dental emergencies, please ask your pediatric dentist.
In contrast to general anesthesia (which renders the child unconscious), dental sedation is only intended to reduce the child’s anxiety and discomfort during dental visits. In some cases, the child may become drowsy or less active while sedated, but this will quickly desist after the procedure is completed.
When is sedation used?
Sedation is used in several circumstances. Firstly, very young children are often unable keep still for long enough for pediatric dentist to perform high-precision procedures safely. Sedation makes the visit less stressful for both children and adults and vastly reduces the risk of injury. Secondly, some children struggle to manage anxiety during dental appointments. Sedation helps them to relax, cope, and feel happier about treatment. Thirdly, sedation is particularly useful for children with special needs. It prevents spontaneous movement, and guides cooperative behavior.
What are the most common types of sedation?
Most pediatric dentists have several sedation options available, and each one comes with its own particular benefits. The dentist will assess the medical history of the child, the expected duration of the procedure, and the child’s comfort level before recommending a method of sedation.
Conscious sedation allows children to continually communicate, follow instructions, and cooperate during the entire procedure. The major methods of conscious sedation are described below:
Nitrous oxide – The pediatric dentist may recommend nitrous oxide (more commonly known as “laughing gas”) for children who exhibit particular signs of nervousness or anxiety. Nitrous oxide is delivered via a mask, which is placed over the child’s nose. Nitrous oxide is always combined with oxygen – meaning that the child can comfortably breathe in through the nose and out through the mouth.
Laughing gas relaxes children extremely quickly, and can produce happy, euphoric behavior. It is also quick acting, painless to deliver, and wears off within a matter of minutes. Before removing the mask completely, the pediatric dentist delivers regular oxygen for several minutes, to ensure the nitrous oxide is eliminated from the child’s body. On rare occasions, nitrous oxide may cause nausea. For this reason, most pediatric dentists suggest minimal food intake prior to the appointment.
Oral sedation – Children who are uncooperative, particularly anxious, or unable to control their muscles for prolonged periods, may be offered an oral sedative. Oral sedatives come in many different forms (usually tablets, pills, and liquids), and may make the child feel drowsy. If oral sedatives are to be used, the pediatric dentist may require parents to prepare the child before the appointment. Some common preparatory measures may include: limiting food and fluid intake prior to the appointment, having the child wear comfortable clothing to the appointment, and preparing to stay with the child for several hours after the appointment. Oral sedatives rarely produce serious side effects – nausea is among the most common.
Other forms of conscious sedation – Other less common ways to administer sedatives include intravenous (IV sedation), the use of suppositories, and even the use of a nasal spray. In most cases, the method of delivery may change, but the chemical nature of the sedative remains the same.
What about general anesthetic?
General anesthetic (which puts the child in a deep sleep), is rarely used in dental work unless:
General anesthetic requires more intensive preparation before the treatment and a longer period of recovery after the treatment. Conscious sedation is usually favored wherever possible.
If you have questions or concerns about sedation techniques, please contact your pediatric dentist.
Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities. Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile. In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.
The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity. Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.
How can mouth guards protect my child?
The majority of sporting organizations now require that participants routinely wear mouth guards. Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain). In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.
Mouth guards also reduce the prevalence of the following injuries:
What type of mouth guard should I purchase for my child?
Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.
Some points to consider when choosing a mouth guard include:
In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:
Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth. The fit is universal (one-size-fits-all), meaning that that the mouth guard doesn’t adjust. Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores. Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.
Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores. First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold. Boil and bite mouth guards are slightly more expensive than stock mouth guards, but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.
Customized mouth guards – These mouth guards offer the greatest degree of protection, and are custom-made by the dentist. First, the dentist makes an impression of the child’s teeth using special material, and then the mouth guard is constructed over the mold. Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.
If you have questions or concerns about choosing a mouth guard for your child, please contact your pediatric dentist.
Dental bonding is a minimally-invasive procedure used by dentists to repair damaged teeth. Since it uses composite resin, it is also sometimes referred to as composite bonding. This procedure earns its name because it “bonds” composite resin to the natural tooth surface in order to improve the look of the tooth. It is also commonly used to restore teeth that have become cracked, chipped, or fractured during sports or play.
The composite resin used for dental bonding procedures is also a common dental material used for dental fillings. This is because composite resin bonds with the natural tooth surface and preserves the most amount of natural tooth structure.
Your child may benefit from dental bonding if they have minor tooth damage, such as chips or cracks. Since kids are so active and unpredictable, it is not unheard of to suddenly have a child with a chipped tooth. Luckily, dental bonding provides an easy and safe way to restore the natural shape of a damaged tooth. To find out if dental bonding is right for your child, schedule a consultation with your Chino Pediatric Dentists today!
Before beginning the dental bonding procedure, your child will first need to have their teeth cleaned. This prevents plaque and bacteria from being trapped under the surface of the composite resin. Once their teeth are clean, an acidic liquid will be brushed over the treatment area. This roughens the enamel so that the resin can create a stronger bond with the tooth surface. The composite resin will then be applied to the treatment area and hardened into place with a curing light. If more than one layer is required, then each layer will be applied and hardened one at a time. The final step is to shape and polish the area so it blends with the other teeth.
The dental bonding procedure should not cause your child any pain or discomfort. However, if they are extremely anxious or have a hard time sitting still, mild dental sedation may be recommended to keep them calm and still during the procedure.
The results of dental bonding usually last about 5-7 years if properly cared for. However if the treated tooth is a primary tooth, then it can be expected to fall out as usual. A tooth treated with dental bonding will require no additional care, nevertheless it still requires care by practicing good oral hygiene habits. Therefore, you should encourage your child to brush their teeth with fluoridated toothpaste twice a day for two minutes at a time and floss once a day. Additionally, you will need to schedule their dental checkup appointment and teeth cleaning every six months.
Tooth decay has become increasingly prevalent in preschoolers. Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.
Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay. Especially when used in combination with other preventative measures, like biannual checkups and an excellent daily home care routine, sealants can bolster the mouth’s natural defenses, and keep smiles healthy.
How do sealants protect children’s teeth?
In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids. These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean. Molars mark the site of four out of five instances of tooth decay. Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars. These areas are extremely difficult to access with a regular toothbrush.
If the pediatric dentist evaluates a child to be at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth). The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.
Dental sealants do not enhance the health of the teeth directly, and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care. In general however, sealants are less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.
How are sealants applied?
Though there are many different types of dental sealant, most are comprised of liquid plastic. Initially, the pediatric dentist must thoroughly clean and prepare the molars, before painting sealant on the targeted teeth. Some sealants are bright pink when wet and clear when dry. This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.
When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand). This specialized light works to harden the sealant and cure the plastic. The final result is a clear (or whitish) layer of thin, hard, durable sealant.
It should be noted that the “sealing” procedure is easily completed in one office visit, and is entirely painless.
When should sealants be applied?
Sealants are usually applied when the primary (baby) molars first emerge. Depending on the oral habits of the child, the sealants may last for the life of the primary tooth, or need replacing several times. Essentially, sealant durability depends on the oral habits of the individual child.
Pediatric dentists recommend that permanent molars be sealed as soon as they emerge. In some cases, sealant can be applied before the permanent molar is full grown.
The health of the sealant must be monitored at biannual appointments. If the seal begins to lift off, food particles may become trapped against the tooth enamel, actually causing tooth decay.
If you have questions or concerns about dental sealants, please contact your pediatric dentist.
Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.
How can fluoride prevent tooth decay?
Fluoride fulfills two important dental functions. First, it helps to minimize mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.
When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel – especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.
Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.
How much fluoride is enough?
Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste on a clean toothbrush twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.
The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.
Does my child need fluoride supplements?
The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement may be recommended.
Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.
If you have questions or concerns about fluoride or fluorosis, please contact your pediatric dentist.
Dental radiographs, also known as dental X-rays, are important diagnostic tools in pediatric dentistry. Dental radiographs allow the dentist to see and treat problems like childhood cavities, tooth decay, orthodontic misalignment, bone injuries, and bone diseases before they worsen. These issues would be difficult (in some cases impossible) to see with the naked eye during a clinical examination.
The American Academy of Pediatric Dentistry (AAPD) approves the use of dental radiographs for diagnostic purposes in children and teenagers. Although radiographs only emit tiny amounts of radiation and are safe to use on an occasional basis, the AAPD guidelines aim to protect young people from unnecessary X-ray exposure.
What are dental X-rays used for?
Dental x-rays are extremely versatile diagnostic tools. Some of their main uses in pediatric dentistry include:
When will my child need dental X-rays?
Individual circumstances dictate how often a child needs to have dental radiographs taken. Children at higher-than-average risk of childhood tooth decay (as determined by the pediatric dentist) may need biannual radiographs to monitor changes in the condition of the teeth. Likewise, children who are at high risk for orthodontic problems, for example, malocclusion, may also need sets of radiographs taken more frequently for monitoring purposes.
Children at average or below average risk for tooth decay and orthodontic problems should have a set of dental X-rays taken every one to two years. Even in cases where the pediatric dentist suspects no decay at all, it is still important to periodically monitor tooth and jaw growth – primarily to ensure there is sufficient space available for incoming permanent teeth.
If the oral region has been subject to trauma or injury, the pediatric dentist may want to X-ray the mouth immediately. Developments in X-ray technology mean that specific areas of the mouth can be targeted and X-rayed separately, reducing the amount of unnecessary X-ray exposure.
What precautions will be taken to ensure my child’s safety?
Though dental radiographs are perfectly safe for use on children, the pediatric dentist will take several precautions to ensure the X-ray process does not unduly damage the child’s cells and bodily tissues.
First, the child will be covered in a lead apron to protect the body from unnecessary exposure. Second, the dentist will use shields to protect the parts of the face that are not being X-rayed. Finally, the pediatric dentist will use high-speed film to reduce radiation exposure as much as possible.
If you have questions or concerns about dental radiographs or X-rays, please contact your pediatric dentist.
A comprehensive dental exam will be performed by your dentist at your initial dental visit. At regular check-up exams, your dentist and hygienist will include the following:
Professional Dental Cleaning
Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists. Your cleaning appointment will include a dental exam and the following:
Infants to adolescents are the primary patients of pediatric dentists. Pediatric dentistry used to be called Pedodontics. According to the American Dental Association (ADA), pediatric dentistry is a specialty that requires each dentist to complete an additional two or three years of training after earning a degree in general dentistry. Pediatric dentists earn a special diploma, called a Diplomate ABPD after this additional training. Pedodontists are pediatric dentists whose specialty is oral care for children with special needs. These children might have cerebral palsy, autism, or mental retardation.
Child psychology is very important to the practice of pediatric dentistry. Pediatric dental offices are often colorful and set up with toys and books that can help ease patients’ anxiety. Pediatric dentists are trained to adjust their communication to children and always avoid negative words associated with dental exams or procedures. Pediatric dentists are sensitive to the fact that childhood dentist anxiety can have lifelong effects, so establishing positive associations with dentists is paramount.
What Does a Pediatric Dentist Do?
Pediatric dentists focus on maintaining baby teeth because of how those teeth affect future oral development. Baby teeth, which are replaced by permanent teeth, affect the development of good chewing habits and proper speech. The services that pediatric dentists provide for baby teeth influence the child’s overall oral health and hygiene.
Other functions of pediatric dentists include the following:
Education: Pediatric dentists use models, computer technology, and child-friendly terminology to educate children about oral wellness. They also provide parents with guidance about preventing disease and oral trauma while encouraging nutritious eating. Pediatric dentists also help establish dental hygiene routines that parents help children carry out at home.
Growth Monitoring: Dental issues can be predicted by continuously tracking the child’s oral growth and development. The specialized knowledge of pediatric dentists can address issues early, before they worsen. Quickly resolving dental problems can preserve the child’s self esteem.
Prevention: Tooth decay can often be prevented with a nutrient-dense diet and strong oral care routines. In certain cases, pediatric dentists can apply dental sealants or topical fluoride during checkups or dental cleanings. These applications can prevent tooth decay. Pediatric dentists can provide information about thumb sucking, orthodontic pacifiers, or bottle and sippy cup cessation. They can also demonstrate best practices for brushing and flossing teeth.
Intervention: When appropriate, a pediatric dentist might discuss options related to early oral treatments. Symptoms that might require a treatment plan can include oral injury, malocclusion (jaw and teeth alignment), or bruxism (teeth grinding). Appliances such as night guards or space maintainers might be necessary. In more serious cases, reconstructive surgery might be necessary.
There has been an upsurge in the amount of teenagers getting tongue piercings. Teenagers often view these piercings as a harmless expression of their growing individuality. Oftentimes, parents allow teens to pierce their tongues because the metal bar is impermanent. In addition, tongue bars are not as visually apparent as a tattoo or eyebrow piercing might be.
Unfortunately, tongue piercings can have a serious (even deadly) impact on health. Pediatric dentists routinely advise adolescents to avoid intraoral or perioral piercings for a number of good reasons.
Why is tongue piercing harmful?
First, there are a growing number of unlicensed piercing parlors in throughout the country. Such parlors have been recognized as potential transmission vectors for tetanus, tuberculosis, and most commonly, hepatitis. Second, a great number of painful conditions can result from getting a tongue piercing – even in a licensed parlor. These conditions include:
What are the most common tongue piercing problems?
To pierce a tongue, the body piercer must first hold it steady with a clamp. Next, a hollowed, pointed metal needle is driven through the tongue. Finally, the piercer attaches the tongue bar to the bottom end of the needle, and then drags it upwards through the tongue. Two metal screw-on balls are then used to secure the tongue bar.
Most commonly, severe pain and swelling are experienced for several days after the piercing episode. Moreover, the new holes in the tongue are especially infection-prone, because the oral cavity is home to many bacteria colonies. In the medium term, saliva production may increase as the body responds to a completely unnatural entity in the mouth.
Are there long-term problems associated with tongue piercing?
Long-term problems with tongue piercings are very common. The screw-on balls constantly scrape against tooth enamel, making teeth susceptible to decay and gums susceptible to periodontal disease. Soft tissue can also become infected in specific areas, as the tongue bar continues to rub against it.
If the tongue bar is inappropriately long, it can get tangled around the tongue or teeth. In a similar way to an earring getting ripped out of the ear, a tongue bar can be ripped out of the tongue. This is extremely painful, as well as difficult to repair.
In sum, the American Dental Association (ADA) advises against any type of oral piercing, and so does the pediatric dentist.
If you are a concerned parent, or would like the pediatric dentist to speak with your teen about tongue piercing, please contact our office.