General Information

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First Aid For Dental Emergencies

Cold/Canker Sores
Many children occasionally suffer from "cold" or "canker" sores. Usually over-the-counter preparations give relief. Because some serious diseases may begin as sores, it is important to have a dental evaluation if these sores persist. 

Toothache
Clean the area around the sore tooth thoroughly. Rinse the mouth vigorously with warm salt water or use dental floss to dislodge trapped food or debris. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen, apply a cold compress. Give the child acetaminophen for pain and see a dentist as soon as possible.

Broken Braces and Wires
If a broken appliance can be removed easily, take it out. If it cannot, cover the sharp or protruding portion with cotton balls, gauze or chewing gum. If a wire is stuck in the gums, cheek or tongue, DO NOT remove it. Take the child to a dentist immediately. Loose or broken appliances that do not irritate the mouth don't usually require emergency attention.

Cut or Bitten Tongue, Lip or Cheek
Apply ice to bruised areas. If there is bleeding, apply firm but gentle pressure with a clean gauze or cloth. If bleeding does not stop after 15 minutes or cannot be controlled by simple pressure, take the child to a hospital emergency room.

Knocked Out Permanent Tooth
Find the tooth. Handle the tooth by the top (crown), not the root portion. You may rinse the tooth, but DO NOT clean or handle the tooth unnecessarily. Try to reinsert it in its socket. Have the child hold the tooth in place by biting on a clean gauze or cloth. If you cannot reinsert the tooth, transport the tooth in a cup containing milk or water. See a dentist IMMEDIATELY! Time is a critical factor in saving the tooth

Broken Tooth
Rinse dirt from the injured area with warm water. Place a cold compress over the injured area. Locate and save any broken tooth fragments. Immediate dental attention is necessary.

Possible Broken Jaw
If a fractured jaw is suspected, try to keep the jaws from moving by using a towel, tie or handkerchief, then take the child to the nearest hospital emergency room.

Bleeding After Baby Tooth Falls Out
Fold and pack a clean gauze or cloth over the bleeding area. Have the child bite on the gauze with pressure for 15 minutes. This may be repeated once. If bleeding persists, see a dentist.    

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Improving Appearance

Looks are important to self- esteem and success. While orthodontics treats misalignment of teeth, esthetic dentistry addresses imperfections in the teeth themselves. These imperfections usually involve discoloration (whether in spots or on the whole tooth), malformation and chipped or broken teeth.

Discoloration of a Whole Tooth
General discoloration of a tooth can be caused by any of several things:

• A sharp blow
• Serious illness while the teeth are under development
• Taking certain medicines during tooth development
• Poor hygiene during orthodontic treatment
• Genetic factors

General discoloration of a tooth can be treated by bleaching, bonding of tooth colored composite material to the tooth, cementing tooth colored porcelain veneers or by placing porcelain crowns.

Bleaching can be effective in some but not all cases. It has several advantages:

• It is relatively inexpensive
• It removes none of the existing tooth and is painless
• In some cases a home treatment regimen can be prescribed

Porcelain crowns produce great and durable results but are not often recommended for pediatric patients. There are two reasons. First they are more costly than other treatments. Second, by their very nature, they require removal of significant amounts of the original tooth material. That can be a problem because often-large pulp chambers on young teeth do not allow sufficient tooth removal for proper crown thickness of porcelain.

Colored Spots on a Tooth
When part of a tooth is discolored, a technique called microabrasion is sometimes effective. Here a small layer of tooth enamel is removed with a slightly acidic abrasive compound. Microabrasion is a painless process. It is often effective for superficial spot discoloration.

Chipped or Broken Teeth
The original color and shape of teeth can be restored by bonding tooth colored composite material to the tooth or placing a tooth colored porcelain veneer over the teeth. As compared to porcelain veneers or crowns, bonding of composite materials is less costly and requires removal of less of the existing tooth material. The results are less durable, however, and require more care when biting nails or hard foods. They are also subject to staining by certain foods or liquids

As discussed above, porcelain crowns produce very nice and durable results but are not often recommended for pediatric patients. 

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Nitrous Oxide/Oxygen Analgesia

Nitrous oxide/oxygen is a blend of nitrous oxide and oxygen. It is often used in the dental setting to help reduce anxiety. You will notice a sweet, pleasant aroma, experience a sense of well-being, and most likely relax.

Complications with nitrous oxide/oxygen are extremely rare. Its sedative effects are completely gone five minutes after it is stopped. It is eliminated through the normal breathing process. However, each person is unique. In extremely rare cases a patient may become nauseous momentarily. We have used this procedure for over 30 years with absolutely no other adverse affects. Be sure to let us know if any medication is being taken on the day of the appointment. Please advise the doctor or assistant if your child has just eaten a large meal or is prone to motion sickness.

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Fluoride Protection

Fluoride Dentifrices
The use of a fluoride-containing dentifrice (toothpaste) is recommended for children and adults. Regular and thorough tooth brushing with a fluoride dentifrice will provide protection against tooth decay and added protection when used together with most other forms of fluoride therapy. An adult should closely supervise the use of a fluoride-containing dentifrice by children below the age of 6. Because preschool-age children are susceptible to developing dental fluorosis, only a small, pea-size portion of toothpaste should be put on their toothbrush for brushing.   

Professional Application of Topical Fluorides
Dentists and dental hygienists often apply fluorides directly to the teeth. These topical fluorides are either in the form of gels, applied in mouth trays, or solutions painted directly on the teeth. Semiannual applications of these fluorides also substantially reduce dental decay.

The National Institute of Dental Research, one of the National Institutes of Health in Bethesda, Maryland, is studying other approaches and methods of fluoride use. One such possibility is the use of fluoride compounds that could provide a protective cover on the teeth for many hours, as well as ways to release fluoride gradually in the mouth. These efforts are part of a broad program to find better ways of preventing dental decay.

For more information, contact your dentist, state or local health department, or the National Institutes of Dental Research, National Institutes of Health, Bethesda, Maryland, 20892.

This text compliments of :
National Institutes of Dental Research
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
Bethesda, MD 20892 

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Sealants Block Out Decay

Good oral hygiene is essential to decay prevention. Good oral hygiene means, in large part, not letting foodstuffs remain in the mouth for long periods of time. Appropriate food selection and thorough brushing and flossing can accomplish this goal. Unfortunately there are often deep pits and grooves on the chewing surfaces of certain teeth that cannot be reached during either brushing or flossing. It makes sense to prevent food material from getting into these crevices. The dental materials used to make this possible are called, appropriately enough, sealants.

How Do Sealants Work?
A sealant is a thin covering over those tiny imperfections in teeth that trap food and plaque. Sealants can be clear or appropriately tinted to assist identification after being applied to the pits and grooves. They are usually applied to the back teeth, which are more prone to decay.

Doesn’t Fluoride Provide Adequate Protection?
Fluoride is effective in preventing decay on the smooth surfaces of the teeth. It is far less effective, however in the tiny areas to which sealants would be applied. Sealants are recommended for all children with deep grooves in back teeth. They are particularly appropriate for the first permanent (6 year) molars since these teeth are notorious for deep pit and groove development and erupt during more cavity prone ages.

How Long Do Sealants Last?
Sealants are normally effective for several years. They cannot be properly examined with just the naked eye. Your dentist will monitor the state of the sealants over the years and let you know if and when they should be redone. Longevity of sealants greatly depends upon eating habits. Chewing ice, hard popcorn kernels and "sticky" candies often results in less retention time of sealants.

What is the Process?

• Cleaning of the teeth to be sealed.
• Etching (roughening) of the tooth surface so that the sealant will adhere better.
• Application of the sealant material, which quickly hardens.

Sealants can be very effective in preventing more costly dental procedures in the future.  

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Care of Children's Teeth & Gums

It goes without saying that it can be a challenge when you begin to brush and floss your child's teeth. It is important that your child's first experiences with brushing and flossing are not only effective, but also, to the extent possible, be a good experience.

Brushing
Let's discuss three important points: brushing position, brushing sequence and brushing technique.

Brushing Position
Although there are various possible postures in which you can brush your child's teeth, it is important that you find one that is comfortable and effective. Here are a few possibilities:

• Child's head on pillow on bed.
• Child's head on your lap.
• Child's body between your legs with head tilted back against your chest or arm.

By age four your child may be ready to accept brushing in a standup position. It is a good idea to let the child lean against your body for support as described above.

Brushing Sequence
Brushing involves a sequence of things to do. You must brush all accessible surfaces of the teeth. Forgetting or slighting any one part of the process for a very long period of time can result in decay. So, just like so many things we must learn in life, it is important to learn a disciplined process. That means a certain routine or sequence. You can help your child by establishing such a sequence. Here is a good suggestion:

• Start with the outside of back teeth on the upper right side. Then work your way across the front and toward the outside of the back teeth on the upper left side.
• Repeat the last step for the outside of the lower teeth.
• Repeat the last two steps for the inside of the teeth.
• Repeat the last step for the chewing surfaces of the teeth.

Brushing Technique
In order to get good access to the outside of the teeth and gums, use your first two fingers of the hand not holding the toothbrush, to retract the lips. When doing the inside areas, you can carefully use your index finger to keep the tongue out of the way.

• Brush gently, moving the brush in small circles where possible
• Finish each circle before moving on to adjacent teeth. Overlap the circles.

Follow a sequence such as the one described above which was:

1. outside top, circular motion
2. outside bottom, circular motion
3. inside top, circular motion
4. inside bottom, circular motion
5. chewing surfaces, back and forth motion

Of course, there are very important surfaces we have not mentioned. Those are the surfaces between any missing teeth. They must be brushed too. Make sure that the bristles of the brush reach those areas.

Flossing
Brushing does not reach areas between teeth that are tightly contacting each other. These areas need proper cleaning as much as the other surfaces. Now a new technique becomes essential - that of flossing. Here again, as with brushing, we must consider sequence and technique including how to hold the dental floss material correctly.

Flossing Position & Sequence
The same positions used for brushing can be effective for flossing. See the discussion above.  Use any sequence, which gets between all teeth. For example, right to left on top, then right to left on bottom.

Flossing Techniques
While the technique does not vary much, there are two good ways to hold dental floss material during flossing.

• Start with about 18 inches of dental floss material. Wrap about half of it around each of your middle fingers. Leave about six inches unwound between your fingers.
• Start with about 12 inches of dental floss material, then tie the two ends in a knot, making a loop. Place the four fingers of each hand into opposite sides of the loop.

1. You will use your forefingers to guide the floss where you want it to go. When you do so, the forefingers should only be about an inch apart on the floss material.
2. Move the floss up and down between all adjacent teeth two or three times, following your chosen sequence. You must be thorough but gentle. Use a back and forth motion from top to bottom, alternatively pulling the floss toward each adjacent tooth. Rapid up and down snapping and too much forcefulness can damage gums.
3. The floss you are using will become frayed or dirty. When it does, simply roll one turn from finger to finger to get a fresh section of floss.

By age four your child should be ready to begin assuming some responsibility for brushing. No doubt some patience, assistance and inspection on your part will be necessary for some time. Don't forget that your child may be tempted to swallow excessive amounts of that tasty toothpaste which could lead to discoloration. Your time investment will pay off "handsomely" in the future toward assuring a lifetime of confident smiles.  

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Thumb Sucking and Pacifiers

Babies and smaller children often have habits such as thumb, finger and/or pacifier sucking. They fulfill important needs of the young child. There is no reason for concern unless they continue too long. How should you deal with a child that exhibits such behavior?

Most children discontinue these habits on their own somewhere between two and four years of age and often suffer no ill effects. If continued for longer periods the upper front teeth may begin to misalign, pointing outward and upward.

With regular visits, your pediatric dentist can often carefully monitor the development of your child's mouth to catch any abnormalities early, before they become serious. For most children there is no concern until permanent teeth begin arriving, unless the frequency and severity of the habit has greatly distorted arch form.

If a problem develops, many children voluntarily correct the habit when parents and their pediatric dentist adequately explain the situation to them. In those cases where this does not work, appliances are available which make sucking difficult.

There is not much difference between the effects of a thumb, finger or pacifier. The latter habit is, however, often easier to break.

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Which Tooth is That?

A child normally has 20 baby teeth, also called primary teeth. The lower central incisor teeth begin to erupt into the mouth at approximately six months of age. By age 21, all 32 permanent teeth should have arrived unless wisdom teeth are impacted. Click on your choice above to see detailed charts.

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Primary (Baby) Teeth

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Permanent Teeth

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