For decades, antibiotics have greatly benefited the medical community’s efforts to fight bacterial infections. However, we now face a new challenge with bacteria becoming resistant to this treatment modality as a consequence of widespread (and often unnecessary) use. Providers are now learning to be more prudent in appropriate prescription of these drugs. Here’s some things to know about current recommendations and guidelines:
1- In an otherwise healthy child, abscess from dental decay localized to the tooth or surrounding tissues is not an indication for use of antibiotics. The tooth however, needs to be treated as soon as possible.
2- When an acute infection that originated from tooth decay becomes systemic (ie. facial swelling, fever), oral and or intravenous antibiotics may be indicated.
3- Oral wounds at times require antibiotics. The provider needs to consider, amongst other things, the extent of damage as well as nature of contamination of wound.
4- When impact to the face has occurred, certain types of dental trauma may benefit from localized or systemic use of antibiotics to improve healing and long term prognosis of involved teeth.
5- Some gum diseases may require localized or systemic use of antibiotics . These conditions occur very rarely in children and should involve careful evaluation and a multifaceted treatment plan.
Of note, tetracycline and similar antibiotics are known to internally discolor developing teeth. Ask your child’s provider for details.
By: J. Shahangian, DDS, MS- San Diego Board Certified Pediatric Dentist
Broken, Fractured, Displaced Tooth
Dental emergencies can happen at any moment. If your child is injured and looses a tooth, it is imperative to stay calm. Call my office immediately to assess whether the tooth is a primary or permanent tooth. Permanent teeth should only be held by the crown and never by the root. Try to reinsert the tooth into the socket, holding the tooth by the crown. An effective technique for keeping the tooth in place is biting down on a piece of wet clean gauze. If you are not able to keep your child’s tooth in place, then make sure to deposit the tooth in saline, milk, or your child’s saliva until you arrive at my office, or if necessary, the emergency room.
In case your child breaks a tooth, the first thing you must do is to help your child rinse his/her mouth to remove any debris and blood. Next, place a cold cloth on the gums, or cheek that is closest to the injury to minimize any swelling. Please call our office immediately if this happens.
In the case of a minor tooth fracture, I can either leave the tooth alone, or smooth it out. In more serious cases, I may need to restore the tooth if the pulp has been severely damaged. I recommend that parents take precautions, such as feeding your child soft foods and making sure your child abstains from using the fractured tooth. Fractures that are moderate include damage to the tooth including the enamel, dentin (the actual bony part of the tooth), and even the pulp (this includes the blood vessels and nerve of the tooth). If there is damage to the pulp, a root canal may be necessary to save the tooth. The way to do this procedure is to add a filling or a permanent crown.
In extreme cases of tooth fractures, there may be a slim chance that there will be no recovery and a total loss of the tooth.
What If a Tooth Gets Knocked Out During Sports?
Imagine this scenario; your child is swimming in the pool. Suddenly, your child rises to the surface, and accidently bangs his/her tooth on the ledge of the pool. The front tooth is knocked out and falls to the bottom of the pool.
Imagine another scenario; your child is playing in his/her school basketball team. Unexpectedly, a player from the opposing team rams in, hitting your child’s mouth, instantly knocking out her/his tooth.
The first thing to do is to remain calm. If you are able to act promptly, you may be able to save your child’s tooth.
First-aid steps in case of a loose or fallen tooth:
- The first step is to pick up the tooth. You must hold the tooth by the crown, and not the root. Next, try to place the tooth back into the socket. If the tooth is not able to stay in place, then put the tooth in saline, milk, or even your child’s saliva.
- Washout your child’s mouth with water, and then apply cold compresses to the injured area to minimize swelling. This also makes treatment much easier.
- If your child’s tooth is only loose, then try to push the tooth back into place, and stabilize it by having your child bite down on wet gauze.
After these emergency preventive measures have been taken, call and make an appointment with me as soon as possible. The sooner your child seeks treatment, the more likely I will be able to save your child’s tooth.
 http://www.doctortsmilezone.com/sub.php?page=tooth_knocked, accessed January 2, 2012
By: J. Shahangian, DDS, MS- San Diego Board Certified Pediatric Dentist
It is important to keep calm in emergency situations such as having your child knocking out a tooth or biting his/her tongue. It is imperative to maintain calm in these dental emergencies and to also learn preventive measures for unnecessary dental restoration and damage. You can apply cold compresses to bring down the swelling, and of course, I recommend that you call our office immediately.
Temporary or Permanent Crown Came Off/Knocked Off
If your child’s crown falls out, the best thing to do is to try and place it back in the tooth cavity, and if you are not able to place it back in the cavity, bring it with your appointment with me.
Broken, Knocked Out, Fractured, or Displaced Tooth
There is no big alarm for a displaced or fractured tooth as long as a quick decision is taken.
While waiting to see me in the office, the best thing to do if your child’s tooth has been knocked out is to try to place the tooth back into the socket.
If your child’s tooth has been knocked out, the first thing you must do is to help your child rinse his/her mouth to remove any debris and blood. Next, place a cold cloth on the cheek that is closest to the injury to minimize any swelling.
If you are not able to place the tooth back into the socket, then hold the tooth by the crown (make sure you do not hold it by the root). Next, place the tooth in saline, milk, or your child’s saliva until you arrive at my office, or if necessary, the emergency room.
In case of a fractured tooth, I recommend also helping your child rinse his/her mouth, and doing cold compresses to minimize the swelling.
In case of a minor tooth fracture, I can sand down the tooth, or if necessary, I can restore the tooth if the pulp has been severely damaged.
There are several ways in which your child’s teeth can become loose. For example, emerging permanent teeth, or even your child biting down on a piece of hard candy can make the teeth loosen.
 http://www.andoverfamilydentistry.com/sub.php?page=care_emergency, accessed January 2, 2012
By: J. Shahangian, DDS, MS- San Diego Board Certified Pediatric Dentist
The term TMJ (temporomandibular joint) refers to our jaw. This joint connects the mandible, or lower jaw, to the temporal bones, or side bones on our head. This highly flexible joint allows for smooth movement of our jaw, enabling us to talk, chew, and even yawn. The surrounding muscles of this joint stabilize and control our jaw’s movement.
Condyles are the curved ends of our lower jaw, and when we open our mouth, they move smoothly alongside the socket of the temporal bone.
“TMJ syndrome” or “TMD” refers to temporomandibular (jaw) disorder which is a disorder that is usually associated with the jaw. There are several ways that your child could develop TMD or TMJ syndrome. For example, this could occur when your child does side-motion movements and closing and opening the jaw.
TMD is usually an assortment of conditions that are often painful and that affect muscles that are responsible for chewing, and the joint itself. Although the exact number of people who suffer from TMD is unknown, according to the NIDCRF (National Institute of Dental and Craniofacial Research), women are twice as likely to have TMD as men. Luckily, symptoms like jaw muscle and jaw joint pain are not necessarily indicators of more serious problems. Moreover, discomfort and pain for the most part is sporadic and temporary, and only occurs in cycles or waves.
According to the NIDCRF, only a small percentage of people who suffer from TMD actually develop long-term symptoms.
There are three main categories of temporomandibular disorders:
- The most common form of TMD is myofascial pain. This discomfort and pain is located on the muscles that control the shoulder and neck, and especially the muscles that control the jaw function.
- Internal derangement of the joint, injury to the condyle, or dislocated jaw or disc
- Degenerative joint disease, for instance rheumatoid arthritis in the jaw joint or osteoarthritis
Your child may have pain and problems if he/she has a severe injury to the TMJ or jaw. Your child may experience arthritis in the jaw after the injury. In the past, orthodontic treatments such as the use of headgear and braces had been blamed for different forms of TMD. However, recent studies conducted by the NIDCRF have disproven these claims.
Research conducted by the American Academy of Pediatric Dentistry has shown that in the past few years, there has been increased attention on treatment of temporomandibular disorders in young adults and children. There has been a new reassessment regarding important symptoms and signs of TMD and TMJ disorder in children, the importance of some diagnostic tests, and what is the appropriate therapy.
 http://www.sunnysidedentistryforchildren.com/library/2023/PacifiersandThumbandFingerSucking.html, accessed January 2, 2012
It is important to get an evaluation from one of our dentists as soon as possible if your child has intraoral pain. Please call our office ahead of time so we may reserve the most effient appointment time for you. If ignored, dental pain may lead to larger problems in some cases.
If your child has a toothache, rinse the irritated area with warm salt water. Gently use dental floss or an interdental cleaner to ensure that there is no food or other debris caught between your child’s teeth. Place a cold compress on the face if it is swollen.
Acetaminophen is effective for any pain. Never place aspirin directly on the teeth or gums. Some people try placing an aspirin or other kind of pain killer on a painful tooth, but this is not a sound practice. These kinds of substances can actually burn your gum tissue.
What do the following have in common?
A knee or elbow
A hard surface, such as the ground or the bottom of a swimming pool
They all are things that could easily come into contact with your child’s mouth when participating in sports. And they all have the potential for damaging or knocking out teeth, or fracturing or dislocating a jaw. High-risk activities include “contact” sports, such as football, boxing, martial arts (including karate and kick-boxing) and hockey, as well as non-contact sports such as basketball, baseball, bicycle riding, roller-blading, soccer, wrestling, racquetball, surfing, and skateboarding.
Even swimming, with all of its gentility, poses serious hazards for your child’s teeth. Common swimming pool accidents occur when children, swimming underwater, quickly ascend to the surface, hitting the hard ledge, and loosening the front tooth. Running on slippery, slick cement and ceramic pool surfaces also can send your child headfirst into the ground, increasing the likelihood of a chipped or loose tooth.
According to the Academy of General Dentistry, many sports-related emergencies involving teeth can be avoided by following the rules and remembering dental first aid steps. If your child participates in any sports, a mouth guard is a smart investment. Mouth guards are soft plastic devices that fit over the front of your child’s mouth, protecting his teeth, lips, cheeks, and gums from sports-related injuries. A well-fitting mouth guard can protect your child from injuries to the teeth, face, and even some severe injuries to the head.
You’re in the swimming pool, swimming underwater, and quickly rise to the surface, hitting the hard ledge. Your front tooth falls out, floating to the bottom of the pool.
You’re in a fast game of basketball when an opposing player accidentally elbows you in the mouth, knocking your tooth to the floor.
First, don’t panic. If you act quickly, you may be able to save your tooth if it gets knocked out.
Follow these simple first-aid steps for a tooth that has been either knocked loose or knocked out:
First, gently pick up your lost tooth by the top or “crown” not by the bottom or “root.” If you are unable to replace the tooth easily back in its socket, try to put it in a small container filled with low-fat milk, saline (salty) solution, or your own spit.
Rinse your mouth with water and put a cold compress or towel with ice on your face near where the tooth came out. This helps to keep the swelling down and makes it easier for the dentist to do his magic.
If your tooth is knocked loose (and not out), push it back into its original position and bite down so the tooth does not move.
Visit the dentist as soon as possible – the longer your tooth is out of the mouth, the less likely that it will be able to be saved.
If your child loses a tooth from an injury, try to remain calm. Call our office immediately and we will help you to determine if it is a permanent or primary tooth. If it is a permanent tooth, avoid touching the root in any way. If it is a permanent tooth, gently rinse the tooth under running water, but avoid rubbing the root area. Hold it by the crown rather than the root and try to reinsert it in the socket. (Your child can keep it in place until treatment by biting down on a wet piece of clean gauze.) If that is not possible, put the tooth in a glass of milk, saline solution, or saliva, and take your child and the glass immediately to our office, or an emergency medical treatment facility.
For a broken tooth, rinse your child’s mouth out with warm water to clean out any debris or foreign matter. Use a cold compress on the child’s cheek or gum near the affected area to keep any swelling down. Call our office immediately.
Minor fractures may be smoothed with a sandpaper disc or simply left alone. Another option is to restore the tooth with a composite restoration. In either case, treat the tooth with care for several days. Keep your child on a soft diet that avoids use of the broken tooth.
Moderate fractures include damage to the enamel, dentin (the bony hard portion of the tooth), and/or pulp (the nerve and blood vessels within the tooth). If the pulp is involved, the tooth may need a nerve treatment, including the possibility of a root cnal in order to save it. The tooth may be restored with a composite filling or a permanent crown. If damage to the pulp does occur, further dental treatment will be required.
Severe fractures often mean a traumatized tooth with slim chance of recovery.
If a wire is causing irritation, cover the end with a small cotton ball, beeswax or a piece of gauze until you can get to the dentist. If a wire gets stuck in the cheek, tongue or gum tissue, do not attempt to remove it. Contact our office. If an appliance becomes loose or a piece of it breaks off, collect the broken appliance or piece and contact our office immediately.