Oral Injuries and Their Treatment in Children

Besides tooth caries and misaligned teeth, very few children make it through to childhood without mouth injuries. The appearance of teeth in children brings with it a whole set of problems. While some are predictable, some others aren't. 

Mouth injuries, even the most gory ones need immediate and good treatment to avoid any permanent kind of damage. While home treatment often suffices, medical intervention is required in certain extreme cases. Below is all what you need to know to differentiate between the two.

How they happen?

Besides scraped knees and head bumps, cuts and bleeding on lips and inside of the mouth is very common in children. Mouth tissues are soft, and often a fall or hit pushes them against hard bones of the jaw or even the teeth. In addition, slip ups, tumbles, crawling are all activities where a child's mouth is exposed, leading to cuts and bruising.

How to treat them?

Oral injuries in children look much worse than they actually are. Because the mouth and areas in the face and head are suffuse with blood vessels, even a tiny cut can cause excessive bleeding, with the exact location becoming difficult to pinpoint. Often mouth injuries are minor and the crying bouts of the child are more out of fear than actual injury.

The below steps will help you handle any kind of mouth injury in a calm manner, reduce bleeding, minimize the pain and prevent infection.

• 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.

When is a pediatric dentist intervention necessary?

• When bleeding is very heavy, continuous and uncontrolled, and doesn't stop despite applying pressure and ice.
• When the cut is too deep or too wide
• When a rusted or dirt filled object has caused the wound
• When there is dirt or mud in the wound
• When a puncture wound caused due to pen/pencil gets into the roof of the mouth, or hurts deeper tissues of the jaw
• When the wound is caused by bite of an animal
• If there is suspicion of bone injury, swelling of the jaw, locked jaw, broken or impacted tooth
• Any inflammatory changes such as redness, swelling, pain, fever that lasts for more than a day

It is very common for children to have mouth injuries, almost like a rite of passage in childhood. The right kind of treatment immediately, with moral support and without anxiety will help them recover faster.

For more advice on oral injuries or to get treatment for the same, reach out to Dr.Premila of Small Bites Dental Clinic at Indiranagar by contacting her at 080 4125 6715.

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.

Process of Dental Caries in Children

All of us are well aware of what teeth decay actually looks like, how it manifests itself, the physical changes and the causes for it. Not many know the process of decay, and how early intervention can stop and even reverse the deterioration of teeth.

Everyone is susceptible to tooth decay. While adults can prevent it or look after their teeth better, children cannot do the same. It is left up to us parents to ensure we know the stages of caries and how we can intervene at the right time, with the right methods and prevent further damage from taking place.

Dental caries in children unfolds over a prolonged period of time. Below is the process by which this happens,

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•       The mouth is a cavity that is exposed to germs all day, everyday. Bacteria grow in the gut and help in the process of digestion, with the process beginning in the oral cavity. Bacteria also enter the oral cavity with food. The breakdown of food causes the formation of plaques, sticky whitish deposits that collect around the gum line, grooved surfaces of teeth and edges of fillings. Plaque allowed to collect for a prolonged period of time, hardens into 'tartar'.
•       Plaque also uses the remnants of food in the mouth to produce 'acids'. Some foods like beverages and meat are already acidic and affect the teeth.
•       Acid attacks the outer layer of teeth, the enamel and dentine, and erodes them gradually over a period of time. Gradually a small hole or cavity begins to appear on the surface of the tooth or the enamel. This stage is usually painful.
•       Once holes are formed in the enamel or outer lining of the teeth, it becomes easier for plaque and bacteria to reach the dentine (layer just below the enamel). Dentine is usually softer and gets eroded faster. 
•       If treatment doesn't begin at this stage, the bacteria reach the tooth pulp, where nerves are exposed to them, resulting in a excessive pain.
•            When bacteria infect the tissue within the pulp and this isn't treated, it leads to the formation of a dental abscess.

It is often seen that tooth decay typically occurs with molars and pre-molars, large back teeth used for grinding, which have irregular surfaces, making it easier for food to stick and cause infection. These are also unreachable and not cleaned regularly.

Tooth decay in children, can manifest in any number of ways;

•      Breakage of teeth
•      Toothache or pain    
•      Infection of nerve or pulp
•      Death of nerve and numbness 
•      Swelling of face
•      Vomiting, headache and other general symptoms

It is important to remember that dental intervention in children, can save them from pain and many other future problems. It can also help save their milk teeth, in turn ensuring that their permanent teeth grow properly and giving them good oral health for life.

A pediatric dentist not just treats caries once they have begun, but also looks for signs and symptoms of impending tooth damage in children. Beginning a child's dental check-up as early as age 1, can go a long way to ensure that our children don't suffer as much as we do.

Maintaining Children's Dental Hygiene After a Festival

After the long holiday for Diwali celebrations, it is time for the kids to get back to school. Although as parents you have taken much care to ensure that their teeth don’t suffer the damage from too many sweets, the kids will nevertheless be tempted to indulge in or buy similar stuff.

It is important to keep reminding the kids that milk teeth when not taken care of, can affect the growth of adult teeth. Gum problems and dental caries can cause permanent issues of the mouth, caries that may require medical intervention and also cause lots of absences from school and missed school and studies. Oral hygiene is important to be practiced at all times, and children should be aware of this on a daily basis.

Here is what you as parents can ensure;

• Pack lunchboxes rather than giving money to buy food – Although most parents prepare and pack their kid’s lunchboxes themselves, it does become tempting to give them money to eat outside, or grab readymade sweets and pastries while on the go for their lunch. Although this makes things easy, such foods are also high on sugar and starch. One fallout of this practice, is the expectation from the child that these foods are alright, the implicit approval from parents in indulging in them, and the other, is the damage such foods cause to the mouth and teeth. 

 

• Give water rather than juices or soda – Water is the only liquid that the body requires in plenty. Replacing it with soda and juices loaded with sugar not just harms health, but affects the enamel of the teeth. These liquids are also acidic, causing teeth to rot and discolor. Juices and soda contain chemicals, artificial sweeteners and preservatives that damage gums, and cause other health problems in the long run.

• Provide a potable dental kit for school and travel – Good oral hygiene when started at home, can carry on to school as well as everywhere else the child goes. A potable grooming kit with a small toothbrush and toothpaste can be sent with the child to school in case of particularly long hours, when kids travel, stay overnight with friends or indulge in too much of sugar laden foods.

It is difficult for children to get into a routine, especially after coming out of a festival and the accompanying celebratory mood. By ensuring they follow strict dental hygiene, they become equipped to deal with their teeth both within the home and outside it.

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.

Brushing Teeth, a Wonderful Habit To Give Your Children

Brushing your babies' teeth can be quite a stressful ritual. Babies are restless and don't understand why their mothers would want to force open their mouths and insert an object like a brush, that is not just uncomfortable, but oftentimes painful.

As much as parent's may delay this or procrastinate in the hopes of getting children to be more accepting of brushing teeth when they are older, it actually works in the reverse. The older the child gets, the more difficult it is for him/her to make brushing a regular part of their routine. Truth is, the results cannot be observed immediately, and most often children find brushing unnecessary and a chore even when they are older.

Caring for your babies' teeth should begin as soon as they start to appear. Parents are also the best people to lead the way when it comes to teaching kids this important skill.

Teeth are the most vulnerable part of the mouth, do a whole lot of work....masticating, gnashing, biting, chewing, and also have to weather acids from foods that are constantly fed into the mouth. Looking after them must begin when they start to erupt. It's alright if teeth can't be brushed from the start. What matters, is introducing this habit as a part of their daily routine. Start by showing them that brushing is what you do each day, everyday and its the best example you could give.

 In addition to the above,

• Use just a little dab of paste on the finger for babies, and little more than a pea-sized amount for toddlers
• Start with light brushing, and then a little thoroughly, brushing all along the tooth sides and surfaces, twice a day, after waking up and before bedtime.
• Don't turn teeth brushing into a war, pushing and shoving, yelling and fighting which usually happens. Some children take a long while to get used to it. Make this a game, brush yours first and ask them to follow suit, or sing a little rhyme when you do.
• Place your baby in a way that both of you are comfortable. Sit them on your knee and head on your chest and clasp their chin. For older children, stand behind them and tilt their heads upwards.
• Use small circular movements when brushing teeth. This covers all the tooth surfaces, and your child can spit out the paste when they're done. Flouride free toothpastes are better to use when smaller, since kids tend to swallow them otherwise. 

• For babies, it is also important to lightly massage their gums, especially when teething. This can be done after brushing their teeth.
• Teeth brushing is a practiced art which parents need to guide their child on, till they reach an age where they can do it on their own. It has been seen that by age 5-7 years, children are able to do a great job of brushing their teeth.
• The most important aspect of introducing brushing and helping the child take care of their teeth, is the involvement of a pediatric dentist in the entire process. A dentist is not just required to fix things after the teeth are gone bad/caried, but must be a part of the process from the beginning. A regular teeth checkup will ensure that any irregularities, caries, congenital and developmental disorders of the teeth and mouth are looked into at the earliest and treated. This must ideally begin around the age of one year.

This video, explains the act of brushing teeth, and can be shown to your child to make them understand better.

Teeth brushing is as important as eating food, and teeth disorders are linked to various other health and body disorders which can strike later in life. A healthy and regular brushing schedule when started young, will lay the foundation for strong teeth that will last your children for the rest of their life.