Injuries to Permanent Teeth

Whether its a toddler falling in the bathtub or a middle school basketball player getting elbowed, the mouth seems to be a magnet for trauma. Accident prevention by careful adult supervision is very helpful but no matter how hard we try, as soon as we turn our backs, our child slips and falls into the coffee table and hits his/her mouth. When an injury occurs in the mouth and is sufficient enough to cause concern, it is always best to call your dentist for advice. Even after hours, your dentist can provide valuable information and help make decisions in the best interest of your child. One tip, please call your dentist shortly after the incident as some injuries require immediate attention.

Injuries to permanent teeth are frequently seen in our practice. They occur from all sorts of situations like falling off a skateboard or bike, slipping with roller shoes, and most sports. Any injury to a permanent tooth from a direct blow or a chip should be evaluated by your dentist. While many situations do not require immediate attention, the dentist should be consulted to help make that decision.

The most common injury occurs when part of a tooth is chipped off. Permanent teeth seem to be more sensitive then primary teeth after an injury. Some chips may require a protective temporary bonded coating over the exposed area to help reduce sensitivity and protect the nerve. Large chips, where the nerve is exposed, will require more extensive treatment of the nerve and later a cosmetic filling or bonding.

Injuries from traumatic blows where a tooth may be mobile but in position are also important to observe. Any pain, swelling or change in the color of a tooth should be immediately reported to the dentist. Also, any injury to a tooth that is pushed out of position should be seen by your dentist.

The best way for parents to prevent accidents to permanent teeth in by the use of mouth guards. While more sports such as hockey, lacrosse and football require their use, others don't seem to emphasize their importance. While baseball players wear helmets, most accidents occur in the field from missed balls, for example, misjudged fly balls or a ball taking a "bad hop". Use of a well fitting mouth guard may be helpful in these situations. Mouth guards can be purchased at most sporting good stores and many dental offices. There are many other play and sporting activities where the use of a simple mouth guard may not be "cool", but offers protection from injury. We insist that our children sit in a car seat, then seat belts, wear helmets when they bike or skate. Perhaps we should also evaluate the use of mouth guards in our children more frequently in situations where dental injury is more prevalent.

Braces 101: Cooperation: Is it a big deal?

A big question on the minds of many orthodontic patients is: How much do I actually need to be involved in the treatment to get it done right? Cooperation from patients has always been an important ingredient in successful orthodontic treatment. The orthodontist asks for cooperation in three basic categories: (1) The application of additional forces with rubber bands, headgear, retainers, etc. to assist with tooth movement and jaw growth, (2) Maintenance of good oral hygiene in order to prevent cavities, gum problems, etc, and (3) Attending all scheduled appointments so that treatment progress can be monitored and progressed properly. This article will focus on the first category.

Most orthodontist want to rely on patient cooperation as little as possible and have designed methods of treatment to increase predictability of results with or without patient involvement. Non-compliance appliances are designed to limit the need for headgear and elastic wear by placing fixed or cemented appliances in the mouth to accomplish this task in a different way. Yes...these appliances came about because of patients who would not comply with instructions, but orthodontists use these on most patients now because of their effectiveness and relative comfort. Head gears and elastics are still necessary in certain circumstances, but are much less common now then in decades past.

The success of non-compliance appliances lies in the design. These appliances can apply forces on teeth full time to make changes occur. Headgear is typically worn (even with best cooperation) 12-14 hours per day, while rubber bands are (at least) taken off during eating. The application of proper calibrated continuous forces enables safe, efficient, and predictable tooth movement.

An important home message is that your orthodontist will do his/her best to make your experience with braces as good as possible. You may be asked to help your progress along with rubber bands, head gear, or something else along the way. Remember, all of these requests are made to benefit the patient and improve the quality of the outcome. Ask lots of questions so that you fully understand why you need to be involved.

What? An Increase in Cavities in Children?

Everyone was surprised by the Center for Disease Control (CDC) recent report stating that children from ages 2 to 5 actually had an increase in tooth decay over the past 15 years. The CDC report clearly shows that young children are not receiving the proper oral health care they for optimal dental health.

The three probable causes for this problem are lack of parental knowledge on the proper age to visit a dentist, limited use of fluoride, and over use of carbohydrates in their children's diets. The American Academy of Pediatric Dentistry recommends that parents use the following practices to help prevent tooth decay in young children:

1. The one year dental visit: Dental visits should begin when your child is about a year of age. These visits are extremely important as they educate the parents with proper oral hygiene techniques, fluoride recommendations, dietary suggestions, and review oral habits. The dentist also evaluates your child's cavity risk by asking the parent questions on their oral health habits and those of other siblings in the family.
2. Fluoride use: The proper use of fluoridated products is very important in young children. Clinical studies have proven that proper amounts of fluoride used daily significantly reduce cavities. Please check with your dentist for their recommendations.
3. Healthy eating habits: Children should eat a balanced diet with limited snacks. Increasing the frequency of eating snacks or drinking juices (even diluted juices) are definitely one of the causes of the increase in tooth decay. I try to explain the situation by telling parents that if their child takes even one sip or drinks two ounces of juice/carbohydrates (the amount is not the same), the bacteria in the mouth produce cavity causing acid for about 20 minutes. Sipping on juice, off and on for hours will produce hours of cavity causing acid production. The simple solution is to serve juice/carbohydrates at meals only and let your child sip/drink water throughout the day.

Finally, with another surprising conclusion, CDC found a decrease in cavities in all other age groups. They attributed this to regular dental visits, the cumulative effects of fluoride as children become older and the use of sealants. So, there is a light at the end of the tunnel!!

Thumb Sucking! What should I do?

One of the more common reasons parents of very young children enter an orthodontic office is to discuss thumb sucking. Thumb sucking is a very soothing, subconscious habit that can make permanent changes in the tooth and jaw positions if persistent. Many parents and their children have significant difficulty deciding why, when and how to address this issue.

When should I start to worry?

Most dentists and orthodontist agree that if the habit is broken by age 4 or 5 there should be few long term issues associated with the habit. Most importantly, thumb sucking should be ceased by the time the first permanent teeth are erupting. Usually children will stop sucking their thumb during the day due to peer pressure. How intensely a child sucks on fingers and thumbs will determine whether or not dental problems may result. Children who rest their thumb passively in the mouths are less likely to have difficulty than those who vigorously suck their thumb.

What will happen to my child's teeth?

The thumb can make a very powerful impact on the development of proper alignment and occlusion (biting) of the front teeth and form of the upper jaw. You may see the upper front teeth pushed forward with or without spaces between the teeth. The lower front teeth may be pushed back. The upper and lower front teeth may have some space between them in an up and down direction. This is called an open bite and sometimes causes difficulty chewing and/or with pronunciation of certain sounds. If the habit persists long term, it can cause the front teeth of the upper jaw (the premaxilla) to deform permanently to accommodate the presence of the thumb.

Secondary to the thumb habit, other long term effects may be present. Even after a thumb habit has ceased, an open bite in the front teeth may persist due to the presence of a tongue thrust. This is a forward positioning of the tongue during speech and swallowing that seals off the spaces between the teeth as a compensation during normal functioning. This habit can be even more difficult to break than the thumb habit sometimes requiring retraining exercises over an extended period of time. The presence of the thumb in the mouth also causes the tongue to rest lower in the mouth, taking away its ability to aid the development of the proper width of the upper jaw. This lower posture can lead to the development of a narrow upper jaw and a cross bite of the back teeth.

How can I help my child break the habit?

Most children stop sucking their thumbs without much intervention at all. However, some individuals need more help. First of all...in order to stop, they need to want to stop. Make sure you use positive reinforcement when trying to break this habit. And...don't be shy about involving your child's dentist, physician or orthodontist. A discussion with someone other than a parent can be helpful encouragement and take some of the pressure away from other family members when dealing with this sensitive issue.

Many devices have been developed to stop children from sucking their thumbs. Plastic thumb guards, thumb splints, spicy or bitter tasting paste to paint on the thumb, socks on hands, and other methods have been developed to aid parents with this difficult task. These methods can all be effective, but will not work for all children. Most importantly, don't make your child feel bad if they are having difficulty. Stopping this habit is the same as taking away a comfort item like a blanket or pacifier. They should be rewarded and encouraged when they have made positive changes. Also...sometimes the first attempt at habit modification is not successful. If this happens, take a short break and try again. Eventually, with persistence, you will be successful.

Consult your local orthodontist if you are having difficulty and need advice. And, remember...ask questions! The more you understand the information being presented to you, the better you will feel about the decisions you will make.

Care of Your Child's Teeth

Begin daily brushing as soon as your child's first tooth erupts. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help determine whether your child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush as a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breathe and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush cannot reach. Flossing should begin when any two teeth touch. You may wish to floss your child's teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back and forth motion to guide the floss between the teeth. Curve the floss into a c-shape and slide it into the space between the gum and tooth until you feel Resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don't forget the backs of the last four teeth!