Common Dental Emergencies - DENTAL IMPACTION

Dental emergencies happen when least expected. Although some, like toothache and broken tooth can be managed even after 24 hours, some others such as DENTAL IMPACTION need immediate attention at home before a dentist's visit can be arranged.

Dental impaction is the forceful pushing of the teeth inside or into the jaw bone. This is often what happens by a blunt trauma, when the child falls on their mouth or jaw. When the trauma is mild, the tooth is pushed halfway into the jaw, but in severe cases, the entire tooth gets pushed in, with possible injuries to the tooth's ligament and even fracture to the socket.

Often times in case of trauma or fall, there is plenty of bleeding (disproportionate to the trauma), including visible lip tear or injury, thereby preventing early detection of impaction.

PRIMARY MANAGEMENT

In such a case, it is necessary to manage the initial situation as quickly and conservatively as possible;

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

Once the bleeding is under control, the injury must be shown to a pediatric dentist at the earliest. Usually it is just to take advice on further course of action and check if there's any damage, tear or cut in the deeper tissues of the mouth.

TREATMENT

Baby teeth that are impacted often come out on their own, depending on the depth they have gone into the jawline. This may take 3 to 7 months and occurs due to the natural growth of the jaw in children. In case the teeth don't come out and if there are chances of damage to the root of the permanent teeth, then extrusion or teeth removal is the only remedial action performed by the pediatric dentist. 

Oral Injuries and their treatment

In case your child needs medical intervention after a fall or a pediatric dentist to look into her teeth, and decide the further course of action, reach out to Dr.Premila. She can be reached at Small Bites Dental Clinic.

Common Dental Emergencies - DENTAL IMPACTION

Dental emergencies happen when least expected. Although some, like toothache and broken tooth can be managed even after 24 hours, some others such as DENTAL IMPACTION need immediate attention at home before a dentist's visit can be arranged.

Dental impaction is the forceful pushing of the teeth inside or into the jaw bone. This is often what happens by a blunt trauma, when the child falls on their mouth or jaw. When the trauma is mild, the tooth is pushed halfway into the jaw, but in severe cases, the entire tooth gets pushed in, with possible injuries to the tooth's ligament and even fracture to the socket.

Often times in case of trauma or fall, there is plenty of bleeding (disproportionate to the trauma), including visible lip tear or injury, thereby preventing early detection of impaction.

PRIMARY MANAGEMENT

In such a case, it is necessary to manage the initial situation as quickly and conservatively as possible;

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

Once the bleeding is under control, the injury must be shown to a pediatric dentist at the earliest. Usually it is just to take advice on further course of action and check if there's any damage, tear or cut in the deeper tissues of the mouth.

TREATMENT

Baby teeth that are impacted often come out on their own, depending on the depth they have gone into the jawline. This may take 3 to 7 months and occurs due to the natural growth of the jaw in children. In case the teeth don't come out and if there are chances of damage to the root of the permanent teeth, then extrusion or teeth removal is the only remedial action performed by the pediatric dentist. 

Oral Injuries and their treatment

In case your child needs medical intervention after a fall or a pediatric dentist to look into her teeth, and decide the further course of action, reach out to Dr.Premila. She can be reached at Small Bites Dental Clinic.

Management of Autistic Children at The Dentist

Children with an Autism Spectrum Disorder have impaired social interaction and limited communication abilities, combined with a restricted amount of activities and interests. While parents are often able to manage them in familiar places and situations like the home, it becomes difficult to do the same outside, especially when visiting specialized healthcare providers including dentists.

Considering that 1 in ever 30 Indian children displays signs of ASD, pediatric dentists are very sensitive to their dental needs and specialized management. Even so, parents have a large role to play in ensuring all procedures go smoothly, and children come away with the least amount of stress and mental trauma.

Dentists managing autistic children are aware of them exhibiting specific observable behavior;

IMPAIRED SOCIAL RESPONSE - Children are unable to read and respond to feelings and experiences, with absolute no understanding most times

IMPAIRED COMMUNICATION - Children are unable to use and understand gestures, repetition of words (echolalia) and a rigid body stance is often displayed

Besides the atypical behavioral and impaired communication skills that are observed and need careful handling, below are often the main dental problems that such children exhibit;

* Bruxism or teeth grinding, often when asleep or the child isn't aware of it

* Tongue thrusting or repeated tongue movements

* Chewing at all odd times without presence of food

* Self-injury, where pinching gums, biting lips and creating wounds is common

* Erosion of teeth

* Caries, when teeth aren't brushed thoroughly because the child finds it unpleasant

* Poor oral care at home, because of difficulty in managing the child

* Limited dietary preferences. Autistic children have very strong likes and dislikes (Only pureed food, no vegetables, dislike of particular vegetable color, etc.)

Management of an Autistic Child at the dentist, can be divided into two phases;

PRE MANAGEMENT or BEFORE CHILD MEETS THE DENTIST

• It is important to plan a desensitizing appointment with the dentist to help the child familiarize themselves with the doctor and the staff
• Allow the child to bring things that can comfort them, a favorite blanket, stuffed toy or even hold the parent's hand
• Parents need to discuss with the doctor about the child's tolerance to pain and discomfort, and their threshold
• Share the child's intellectual and understanding abilities with the doctor, so that they can phrase sentences or relate with the child accordingly

POST MANAGEMENT or AFTER THE CHILD MEETS THE DENTIST

• The dentist will communicate with the child at a level he/she can understand. They use phrases such as 'Tell', 'Do', 'Show' when explaining any procedures or methods, always speaking in clear, precise tones
• Oral examination is begun with only fingers first, while the hard feel of dental instruments is brought in later
• Dental instruments are only shown later. Suddeness of movements by the dentist is kept to a minimum and light is kept away from the child's face. Sensory input of any kind is kept as less as possible to avoid distraction
• Dentists place same staff at all examinations and interruptions are kept minimal
• Child's co-operative behavior is always encouraged with positive words and nods
• The child's unusual body movements are always observed and pre-empted

Most pediatric dentists are aware of the extra care and effort it takes to manage autistic children, and are extra cautious while carrying out any kind of dental procedures. As a parent, it is important to know what to expect, understand how the process can be made easy and prepare the child for any kind of dental visit.

5 Books That Prepare Your Child For Their First Dental Visit

The high backed chairs, plenty of equipment, unfamiliar space and a doctor poking around inside your mouth....this can be so very intimidating for most of us adults. Imagine what it can do to our kids?

Visiting a pediatric dentist for the first time is a new experience for little ones. They don't know what is being done, and despite parents being there, can resist the experience of a new person handling them from such close quarters.

It is very important for parents, and for us doctors to make them familiar with a few things before their first visit or during subsequent ones. While we take care of them inside the clinic, using the most gentlest way to handle their fears, as parents what you can do, is make the entire process less stressful for them.

Books we have found, are one of the ways to make things more relatable. When a child understands how his teeth work, what is happening in his mouth, through pictures and illustrations, he knows what to expect. It is also a great way to communicate to kids in their own language.

Here are 10 children books, for different ages that explain about dental health, pediatric dentist visit and some of the procedures in ways that will make them understand, relate and reduce stress.

1. Dentist (First Time)

Author, Illustrator: Jess Stockham

Age Group: 2+

First time at a dentist's can be a very nerve wracking experience. This book is part of a series of 'First Time' which rather than telling a story, shows different children experiencing treatment, and the general interaction with a dentist. There is a waiting room, a scene which shows teeth being counted, a look at the equipment, step by step on how a child undergoes dental fillings.

The text is conversational, brightly illustrated, helps children see different situations, and understand procedures.

2. Harry and the Dinosaurs say 'Rahhhh'

Author: Ian Whybrow

Illustrator: Adrian Reynolds

Age Group: 3+

Harry and all his dinosaurs have a dental appointment and everyone is nervous - especially T-Rex who has many teeth. With Harry's reassurances and a special button that makes him grow big, T-Rex lets Dr.Drake examine his teeth.

The illustrations are simple, funny and text easily understandable. It will help relieve the anxiety of this important life lesson for the little ones.

3. Dentist Trip (Peppa Pig)

Author: Lady Bird

Age Group: 3+

Peppa, George and Mr. Dinosaur visit the dentist to get their teeth checked. Although George is nervous, he does get through the procedure while having fun in the process. The story is one among a series revolving around Peppa and her family, and the challenges they face. 

The book has very relatable characters, great illustrations and a simple explanation, which helps kids connect. Since the characters are also favorites among kids, it makes it easier to connect with them.

4. Open Wide

Author, Illustrator: Laurie Keller

Age Group: 3+

32 students (8 incisors, 4 canines, 8 premolars and 12 molars) are taken through a class on how to care for teeth through questions and quizzes. Mr.Flossman, their teacher, peppers their classes with fun facts, and plenty of questions on tooth care.

The book has wonderfully vivid illustrations, is hilarious full of interesting facts and connects all the different procedures that happen during a checkup.

5. How Many Teeth?

Author: Paul Showers

Illustrator: True Kelley

Age Group: 3+

One of the oldest books (30 years), teaching kids about taking care of their teeth, the books starts from the basics, explaining to kids the number of teeth they have, what happens when baby teeth fall off and big teeth come in. The book relates their growth to the fall of the teeth.

Illustrations are older but very familiar with our childhood, text simpler and the book is very engaging. The relation of teeth with growth is simple and easily explained.

Books are the best way to teach kids about life. When it comes to their teeth, there is no better thing than books to make them relate to what their teeth go through. 

Do let us know if there are any other books related to dental health in kids that you may know of. It will help us and other parents add more to their list.

Choosing the Right Toothbrush for Your Children's Teeth

Toothbrushes are one of the most important tools in dental hygiene, and yet they are often taken for granted. While adults choose toothbrushes based on ease of use and other fancier requirements - dual bristles or unusual shape, with children we often buy what we assume is best for them in terms of their looks.

Toothbrushes have come a long way - from 'chew sticks with frayed edges', still used in rural areas, to those crafted with bone or wood. Nylon bristled plastic toothbrushes, as we see them today, were only introduced in the 1930's.

Why Brush?

Toothbrush plays an important role in a child's oral health. Brushing removes accumulated food, plaque found between teeth and even the yellowish stain on them (a sticky film of bacteria). If plaque is left untouched, it leads to tartar formation or whitish deposits between teeth. When this tartar hardens, brushing becomes difficult, leading to gum tissue swelling or bleed. This is when periodontal or gum disease actually begins.

Which is the best toothbrush to choose for your child's teeth?

The toothbrush market is bursting with them in various sizes, colors and shapes. It is often difficult to choose which is the perfect one. Below are a few pointers about what you can look out for;

·        

•       Soft Bristled - Children have small teeth, and their gums are sensitive. Soft bristles help remove plaque and food from the gum line, as well as are gentle on gums. It is better to choose toothbrushes that have a rounded end or are polished. 
•       Comfort matters - It doesn't matter what toothbrush you choose for your child's teeth, it must be comfortable. Long toothbrushes can cause injuries and short ones may not reach certain areas of the mouth. The only criteria you should look for, is whether the brush fits their mouth and reaches the back of it as well.

•       Regular or Powered Toothbrushes - Electric powered toothbrushes are very popular abroad, but haven't yet caught the fancy of Indians in a big way. While powered have been thought to clean teeth better, regular ones are just as good, safer and also cost-effective.

Age specific brush use;

1. Babies and Toddlers - Using a damp cloth or gauze, rubbed gently in circular motions is sufficient to clean baby's teeth. Toothbrushes are available for babies, which are small and convenient. Beginning their use early, makes the child get used to the ritual and removes accumulation of milk and food.

By 2 years of age, toddlers are eager to brush themselves, and longer toothbrushes with small heads and soft grips can keep them busy with their teeth.

2. Five to Eight - At this age, the child shows his readiness to brush independently. The toothbrushes although similar to adult ones, are still small with large handles. Manual and powered are often available for pre-adolescent children.

Buying the right toothbrush for your child's teeth, isn't where it all begins and ends. For clean and healthy teeth, brushing must be done twice a day, after breakfast and before bed at night. Flossing must be done whenever possible, to remove food accumulated between teeth. When toothbrush bristles fray or after a period of three months - whichever earlier - new toothbrushes have to replace the old ones. Brushes for kids are to be replaced more frequently than that of adults.

It is always important to involve your child when buying toothbrush for themselves, so that they grow to love the entire process of cleaning their teeth lifelong.

Diwali and Dental Caries - Here's What To Expect

It is time for Diwali, the season of celebration that starts now and lasts till the end of the year. This festival is also all about fun, frolic and most definitely food. It is difficult to imagine celebrations without food, without elaborate mithais prepared for friends and family, ladoos and jalebis enjoyed by the family, and children rushing about with sweets stuffed in their mouth.

As much as this whole scenario conjures up happiness and fun, there is a lot to deal with once the festivities are up, and the most important being BAD TEETH and oral problems.

Sweets and delicacies are unavoidable, and so are the after-effects of gorging on them; bad teeth, bad oral odour, and with children, the first signs of caries and gum trouble. 

As much as we love snacking on food throughout Diwali and thereafter, there are little unwelcome visitors snacking on the food collected in our and the kid’s mouth, that if left untreated or not looked after, can cause a whole host of problems, many of which are already known.

• Plaque and Caries - Sugary foods cause tooth decay. Period. Whether you give your child something mildly sweet or chocolates and desserts loaded with sugar, they will cause harm in the mouth and eventually caries. Another important factor, is the frequency at which they are eaten.

Eating foods of different kinds, almost always causes something to remain in the mouth, debris that gets accumulated between teeth and gums. Bacteria present in the mouth, feed on all these foods. In the case of sweet stuff, these bacteria feed on the carbohydrates in sugar, especially refined sugars in desserts to produce acids, which combine with saliva to form plaque. The plaque deposits itself on the teeth over a period of time, causing erosion of the tooth and caries.

• Bad Odor – Infrequent brushing and rinsing of teeth, causes the accumulated food build-up to cause an additional set of problems. Bad odour from the mouth is one such. Acid build-up in the mouth due to remaining food, tends to cause further damage to the teeth, leading to bad breath. The tongue is also a storage of bacteria and contributes to it.

• Dry Mouth – The more you eat, the more saliva is produced, yet consequently, the more sugars you consume, makes that saliva get used up quickly and causes dry mouth and bad breath. Dry mouth can result in frequent gum irritation, pain, inflammation and difficulty in swallowing.
  

As much as the harm that sweets can do during this time, Diwali is really incomplete without indulging in them. You really can’t stop the children from eating what they like. Here are a few practices to follow during this festive period;

• Brush the children’s teeth twice daily, even more frequently if required. No matter how long the day is, how tired and sleepy they are, never put them to bed without cleaning their mouth and brushing their teeth. This will help them in the long run by also enforcing a good habit.
  
  
  
  

• Avoid kids indulging in frequent snacking, in between meals. This helps reduce food accumulation in the mouth, and also lowers the exposure to sugar. Let them eat whatever they like, but in one sitting at one time.

• Drink juices, milk and other liquids with a straw. Sweetened liquids remain longer on children’s teeth than solids. Using straws will limit their contact with teeth, and also make it easier to get rid of them when brushing.

• Ensure they drink a glass of water after having sweets, or rinse their mouth every time they do. This can loosen up any accumulated food particles and prevent further damage.

• Enjoy sweets and sugary foods during a meal, rather than before or after it. Indulging in juices or snacks throughout the day, is giving bacteria a fertile ground to grow and flourish. But letting children have sweets together with their meals, ensures that the other foods prevent these sugars from sticking to the teeth and remaining in the mouth.

• Reduce rewarding good behavior with a sweet treat. Occasional snacking on sweets is fine, but keeping children busy with such foods for distraction, or as reward for a good job, sends across a wrong message. This not just harms their behavior, but teeth as well.

• Brush, rinse, clean and ensure nothing remains in the mouth. This cannot be emphasized enough. Brushing all areas of the teeth, especially the ones at the back and the molars, cleaning the tongue and flossing the mouth whenever possible, ensures that the festivities don’t leave children with harmful, long-lasting effects.

Children can and must enjoy Diwali, indulge themselves with sweets, but it is left up to us as parents to ensure their teeth and dental health don't take a hit because of this.

Bruxism - Teeth Grinding Isn't Always Harmless

When children are growing, there are several things you need to be aware of, their weight gain, their food intake and the general state of their health. Often parents tend to ignore the mouth, assuming that as long as teeth are brushed and general mouth hygiene is maintained, everything will be alright.

Teeth brushing and observing the regular milestones of milk and permanent teeth aren’t the only things that need to be observed, since there are many other problems that point out to underlying issues in children, which if not treated affect teeth and their physical health, as well as add to the stress as they grow up.

One such condition that many parents tend to overlook, is Teeth Grinding or Bruxism. Although not a symptom, it points to an underlying .

Teeth grinding, teeth gnashing, or the unconscious act of clenching and unclenching teeth is present in most kids, with 2-3 out of 10 children having this problem. Most children grow out of it by the age of 7 years, but many others carry this habit well into adulthood. 

 Although the reasons are unknown, experts have given a few reasons for this condition,

• Stress induced teeth grinding, especially when children aren’t able to cope with a new situation, such as a test at school or meeting new people. An argument with parents or siblings or arrival of a second sibling is also seen as a probable cause
•  Mal-aligned top and bottom teeth which causes irritation and subsequent teeth gnashing
•  Pain anywhere in the face is also a cause, whether earache or appearance of new teeth 
•  Hyperactivity and restlessness
•  Kids with medical conditions ( such as cerebral palsy) or who take certain medication.

 How does one whether your child is grinding their teeth?

Have you heard your child’s jaw moving continuously or regular sounds from their mouth during bedtime? If you hear them grind their teeth while asleep, without being aware of it, and they experience a painful jaw or mouth on waking up or pain when chewing, it indicates they suffer from the condition.

What harm can it cause?

Bruxism as such is a temporary harmless condition, and children most often outgrow it. In those children where this condition persists, symptoms of headache or earaches are often complained. 

What harm can it cause the teeth?

A side effect of bruxism is the harm it can do to the child’s teeth. Nightime grinding, gnashing and clenching the teeth, can wear down tooth enamel, gradually chip off teeth, make the tooth temperature sensitive and also cause lingering jaw and mouth problems and pain.

It is important to take the child to a pediatric dentist, before the condition causes severe irreparable damage to the teeth in the long run. A dentist will examine the child’s teeth for chipped tooth enamel, and any other wear and tear.  In addition questions related to stress or tension will try to be discerned.

All these observations will give the dentist information on whether the cause for bruxism is psychological (stress induced) or structural (misaligned teeth) and treat the child accordingly. 

 Treatment

While the condition is outgrown by most children, some kids who have severe pain and wearing out, are prescribed a mouthguard; a thin protective mouthpiece moulded to the child’s teeth that acts as a barrier between the opposing sets. This can take care of the major problem.

If the cause is emotional or psychological, the underlying cause needs to be found out by talking to the child, understand reasons that are upsetting them, and try and resolve the issue. If it seems more complicated, then their fears will need to be eased by counseling.

Bruxism usually stops when the milk teeth are lost. In few cases the condition might continue well into teenage years. The condition cannot altogether be avoided, because most often, it is a coping mechanism in children, and their natural reaction to growth and development. It can however be avoided by talking to children frequently, letting them open up and ensuring regular visits to the pediatric dentist are carried out for optimal dental health.