Teeth are the strongest parts of the human body, even stronger than bone, but that doesn’t mean they’re injury proof. Children chip or break their teeth all the time due to falls, sports injuries, and even chomping down on hard foods like candy or ice. There are four classes of dental fractures:
Class 1 – Fractures in the outer enamel layer
Class 2 – Fractures into the dentin layer
Class 3 – Fractures into the pulp
Class 4 – Fractures of the root
If your child has broken a tooth, he or she needs to come in for an x-ray and exam as soon as possible. The dentist will determine the severity of the fracture and discuss the appropriate treatment options with you. Depending on the class of the fracture and whether or not it’s a permanent or primary tooth, treatment options could involve smoothing the chip out, placing a small composite filling, doing a root canal and crown, or extracting the tooth in the most severe cases.
Call our office and we will work your child into the schedule for an evaluation. In the meantime, you can give your child whatever over the counter pain reliever you normally use, and apply ice if there is facial swelling. Bleeding is common with tooth injuries, and you can use a piece of gauze to apply gentle pressure.
Tooth Knocked Out
When a frantic parent calls our office because their child has knocked a tooth out, the first thing we ask is whether it was a permanent or baby tooth because the situations are handled very differently.
Knocked Out Baby Tooth
A child knocking out a baby tooth is a terrible situation, but it’s usually nowhere near as severe as knocking out a permanent tooth. They should still come into the office for an exam and x-rays to check the surrounding teeth and unerupted permanent teeth, but in most cases no treatment is necessary. Sometimes a spacer will need to be placed to prevent the teeth from shifting and closing the space that the permanent tooth will eventually erupt into.
If the knocked out tooth is in the front and the parents are concerned about the appearance, an appliance called a “pedo-partial” can be placed. It’s basically a denture with a fake tooth that is cemented into place until the permanent tooth is ready to erupt. Most parents do not opt for such an appliance because it’s very expensive and not covered by insurance.
If your child has knocked out a baby tooth, call our office and we will work you into the schedule. In the meantime, try to find the tooth to ensure your child has not accidentally inhaled it. If you think he or she has inhaled it, call your pediatrician or go to an emergency room for an x-ray. You can bring the tooth with you to the dentist appointment, but do not try to put it back into the socket because you could inadvertently damage the permanent tooth. You can control the bleeding by applying light pressure with gauze, and you may give your child whatever over the counter pain reliever you prefer.
Knocked Out Permanent Tooth
If your child has knocked out a permanent tooth, he or she needs to be seen by the dentist immediately. You need to locate the tooth and follow these steps precisely:
- Gently hold the tooth by the crown, not the root, and rinse it off with plain water. Do not scrub it.
- Either re-insert it back into the socket and hold it in place with gauze, or place it in a glass of milk to transport it to our office.
- Call us immediately because time is of the essence to save the tooth. If it’s after hours, our voicemail will give you the phone number of the on call doctor.
- If you cannot locate the tooth and think your child may have inhaled it, call their pediatrician or go to the emergency room for an x-ray.
Over the counter pain relievers are fine to use, and you can apply ice for any facial swelling. The eventual treatment may include anything from a root canal and temporary splint to a porcelain crown or implant.
What is a cavity?
A cavity is a hole in a tooth caused by the disease process known as “tooth decay.”
What do cavities look like?
Cavities vary in appearance and evolve over time, but typically look like dark spots, holes, or chips in the teeth. They usually have a yellow, brown or black appearance and can be as small as a tiny dot or as large as the entire tooth.
How do I know if my child has a cavity?
Depending on the size and location, a cavity may not be visible to you in your child’s mouth. Cavities that are in between teeth or on the back surfaces can be difficult to see at home, but are easily seen with the right dental equipment and x-rays. When you bring your child to the dentist for a check-up every six months, he or she will be evaluated for cavities. In between appointments, if your child complains of a toothache or you see a hole, dark spot, or chip, you should come in right away. Waiting can cause the cavity to grow in size and severity, and the treatment can become more invasive.
What causes cavities?
There are several causes of tooth decay including diet, oral hygiene, and genetics. Typical dietary causes include foods that are sticky, sugary, or starchy, and drinks that are sugary and/or acidic. Typical oral hygiene causes include improper brushing techniques, not brushing often enough, and not flossing. Some children still get cavities even with a great diet and oral hygiene because the bacteria in their mouths is aggressive. If your child has a cavity, the dentist will discuss his or her diet and oral hygiene routine with you to see if any adjustments need to be made.
How do I prevent cavities?
Monitoring your child’s diet and overseeing their oral hygiene routine are the best things you can do to prevent cavities. Around the age of 6 or 7, most children have the manual dexterity to brush and floss properly, but until then, you should be helping them daily. A good rule of thumb is if your child cannot tie shoelaces independently, he or she should not be brushing independently either. In children who have a genetic predisposition to decay, the dentist may recommend a prescription toothpaste or fluoride to help prevent decay. Dental sealants are also recommended for most children on their 6 and 12 year molars.
How are cavities on baby teeth fixed?
Cavities on baby teeth are just like cavities on permanent teeth, and when they’re caught early, they can be fixed with simple tooth-colored fillings. When they become large, they may require a crown, pulp therapy (like a baby root canal), or an extraction.
If a cavity is on a baby tooth, do I have to fix it?
In most cases, the answer is yes. When left alone, most cavities will become bigger and start to cause pain, and treatment can change from a simple filling to something more invasive and cosmetically undesirable like a root canal with a stainless steel crown or an extraction. Sometimes if the dentist sees a cavity that is either very small or on a tooth that your child is likely to lose soon, he or she may decide to monitor the tooth instead of fixing it.
Abscess or Infection
A dental abscess is an infection deep in the gums and surrounding tissue that is usually caused by bacterial growth from an untreated cavity. It’s an extremely painful condition that will not resolve on it’s own and requires dental intervention. Left untreated, the infection can spread to other areas of the body and even become life-threatening. Typical symptoms of a dental abscess include pain, facial swelling, redness of the face, fever, a pimple-like nodule on the gums, and pus drainage. If your child has any of these symptoms, they should be brought to the dentist for an evaluation. Other more severe symptoms include nausea, vomiting, diarrhea, difficulty swallowing, and difficulty breathing.
An abscess can be diagnosed by the dentist visually or on an x-ray. If your child has an abscess on a baby tooth, the tooth will likely need to be extracted and the abscess drained. If the abscess is on a permanent tooth, it will likely require surgical drainage and a root canal with a crown. He or she may also need a course of antibiotics to kill the bacteria.
To prevent a dental abscess, make sure your child has a good oral hygiene routine, take them to the dentist every six months to check for cavities, and have their cavities fixed promptly.
Two Rows of Teeth
If your child has a tooth growing in behind another tooth, don’t panic. It’s a relatively common occurrence in children, and although it can look scary, it’s easy to treat and there are not usually ongoing problems.
Most children will start to lose their baby teeth and get permanent teeth between the ages of five and seven. When a permanent tooth erupts directly underneath a baby tooth, it resorbs the root of the baby tooth, causing it to become loose and fall out so that the permanent tooth can take its place. Sometimes, however, a permanent tooth will not grow in directly underneath the baby tooth, and the root of the baby tooth will remain intact and it will not get “pushed out”. When that occurs, the permanent tooth will usually start to come in right behind the baby tooth, giving a child a “shark tooth” appearance. The most common place for this to occur is the lower and upper front teeth, but it can happen anywhere.If your child has a tooth behind a tooth, you need to check how loose the baby tooth is. If it’s very loose, encourage your child to work on wiggling the tooth out. If he or she can get it out on their own, that’s always best. If the tooth is only a little bit loose or not loose at all, he or she will probably have to come to our office to get the tooth extracted. Once the baby tooth is out, your child’s tongue will naturally push the permanent tooth forward into the correct position. Children who have moderate to severe crowding may not have room for the permanent tooth even after the baby tooth is out, and an orthodontic consultation would be appropriate.
If your child’s “tooth behind a tooth” involves the lower or upper front teeth, there is a good chance it will happen with the other front tooth right next to it. For that reason, it may be best to wait until both teeth have started to erupt before bringing your child in so that they don’t have to go through the extraction process more than once.
If you’d like to call our office to discuss your child’s situation, we would be happy to help you decide what the best course of action is.