Dark Tooth

dark_toothWhat do you see? Child has one or two dark teeth that are now sore or you have noticed for first time.  Tooth may or not be loose.

This is a:For baby teeth, this is tooth that has lost its blood supply AT LEAST a couple of days ago.  It may be loose now from a recent injury or a normally loose baby tooth for child’s age.

What else it could be:  Make sure the tooth is a baby tooth, small worn, not the same size as an adult, with child at least 6years old.  If it is a permanent tooth it needs an immediate referral for a root canal.

Is this an emergency, urgency or problem? It is only a problem.
Very often, baby teeth will be bumped and lose their blood supply- you are seeing the old blood through the tooth!  This is a previous injury the parents likely know about so do nothing.

If the tooth has been bumped again or is wiggly, treat the pain with reassurance or OTC analgesia.

What to tell the parent: Most attentive parents will know of this tooth, but you can reiterate they are seeing old blood through the tooth and it is a sterile injury, no infection.  The tooth will normally fall out when ready. Welcome to the dark tooth club.

First Aid:  none

Follow up: none

 

Enamel Chip

img class=”alignright size-full wp-image-197″ src=”https://web.archive.org/web/20160123113439im_/http://199.168.190.18/~pediatri/wp-content/uploads/2015/04/enamel_chip.jpg” alt=”enamel_chip”/>What do you see?  One or more teeth have a small chip out of corner or along biting edge that is rough to touch and may be sensitive.

This is a:  Class One dental fracture or an enamel chip.  It only involves the outer enamel covering.  Usually is a front tooth, but may be aback cuspid if child hits chin.

What else it could be: Look for a chip into the body of the tooth by looking straight on with the child head tilted back, that would be a class two or three fracture.

Also look for other injuries such as a laceration to lip or tongue.

Is this an emergency, urgency or problem?  Problem
A tooth chip only into the enamel will be sensitive for a while (hour) due to the percussive force, and the rough, fractured enamel will be very sharp. Usually these are not repaired since they are small.  Often the chip can be smoothed out by a dentist for cosmetics when desired.

What to tell the parent: Tell the parent how the chip occurred and that it is not serious. No immediate treatment is needed and chip can be smoothed down later.

First Aid: OTC analgesia is necessary.  Take a small nail file or emery board and graze it over the rough, chipped area to take off the sharp enamel, giving the tongue relief.

Follow up: none. Child can see a dentist for cosmetics at parent’s convenience.

Class II Fracture

class2_fractureWhat is this: an obvious fracture that extends into the body of the tooth. It is sensitive to air, and may or may not have blood.

Situation: Class II fracture, a fracture of the enamel and dentin (inner layer) of the tooth.

Is this an emergency, urgency or problem?Urgency
First aid is required to relive sensitivity and to keep the tooth from becoming more inflamed. The tooth will be sharp, and the child may be panicky over the pain and the appearance. Contact a dentist for first aid care within 24 hours.

Tell the Parent: Explain the history of the injury and that the tooth will need care from a dentist, including an x-ray. Explain that the tooth can be restored to look whole again, but that a healing period is required to rule out the need for a root canal. A temporary filling will be placed to cover the inside of the tooth (dentin) to relive sensitivity. The child should avoid directly biting on the tooth. Over-the-counter analgesia may be helpful.

First Aid: Cover the dentin of the tooth to shield it from air and saliva. Dry the mouth with a tissue and apply dental wax or Chap Stick to the tooth to form a moisture barrier. A warm, wet towel may be held against the tooth during transfer to a dental office or until pain can be relieved. Give over-the-counter analgesia.

Follow-up: A dentist will place a temporary filling, take an x-ray, and allowing healing time. If symptoms persists, root canal therapy may be needed.

Class III Fracture

class3_fractureWhat do you see? Child has obvious fracture into the body of the tooth. It is extremely sensitive. It is bleeding from the middle of the tooth and has a bullseye appearance of white outer enamel, yellow body (dentin) and red (pulp).  If it is an older pulpl exposure the pulp may swell out of the tooth or look brownish. It may or may not be accompanied by blood around the tooth.

This is a:  This is a class 3 fracture.  A fracture into the pulp (nerve and blood supply) of a tooth.

What else it could be:Check for other injuries of the teeth and soft tissues. Check for mobility of the tooth (root fracture)

Is this an emergency, urgency, or problem?  Emergency.
Immediate first aid is required to relieve sensitivity and keep tooth from becoming necrotic.  The tooth will need to have a root canal treatment started or a “Cvek” pulpotomy done to prevent an infection of a young tooth with recent injury. The tooth will be sharp and the child may be panicky over the pain as well as the “look” of the permanent tooth.  Contacting a dentist for first aid care under 2 hours is a must.

What to tell the parent:  Explain the history of the injury and that the tooth will need first aid treatment from a dentist with xray exam to save the tooth.  This is a true dental emergency.

Tell the parent these injuries need rapid treatment to save extensive and costly therapy later or loss of the tooth.  Nerve treatment is needed within 2 hours, and possibly referral to a root canal specialist called an endodontist.  The child can be directly referred to an endodontist if one is available, otherwise contact the family dentist or dentist on call for the school.

First Aid:  A warm, wet towel may be held against the tooth for transfer to the dental office or until ibuprofen can relieve pain.  No temporary material will “stick” to the pulp. Give ibufprofen.

Follow up:  A dentist will do a partial pulpotomy depending on circumstances or start root canal therapy which relieves pain.  Narcotics and antibiotics may be prescribed.  Depending on age, specialist treatment to grow the root before final therapy may be done and take months.

Partial Avulsion

img class=”alignright size-full wp-image-200″ src=”https://web.archive.org/web/20160123113439im_/http://199.168.190.18/~pediatri/wp-content/uploads/2015/04/partial_avu.jpg” alt=”partial_avu”/>What do you see? Child has a tooth displaced and cannot bite teeth together normally.

This is a: This is a Luxation (broken bony socket) or Partial Avulsion (almost out of socket).

What else it could be: Baby tooth that is overretained Bone and tooth fracture (lots of blood, see alveolar fracture)

Is this an emergency, urgency, or problem? Urgency.
First aid is only required if it is a permanent tooth; this is usually to a traumatic blow to face on a child 6-10 years. Is the tooth small and worn or does is look like your front tooth?  Does is have a ragged, moth eaten root or a sharp flat break to it?  Was the tooth “wiggly” before?  That’s a baby tooth.

A permanent tooth Luxation needs so have the tooth placed back into the socket and held there by a dental splint.  If the tooth can be pushed back into place do so immediately.  If the bony socket has been broken, the tooth root may need to be “snapped” back into place with a firm grip and push by squeezing the tooth up and back between the thumb and finger knuckle against the roof of the mouth. This usually non- painful to the child.

What to tell the parent:  Explain the history of the injury and that the tooth will need first aid treatment from a dentist to stabilize it into the socket.This is done with a wire brace in the dental office.  Even if the tooth is firmly in place and dentist should examine the tooth within 24 hours.

Tell the parent these injuries must have splint therapy to prevent the tooth from healing in a bad position that will require braces to adjust.  A root canal therapy will very likely be necessary within 10 days. The child should avoid directly biting on the tooth, and OTC analgesia may be helpful.

First Aid:“Pop” the tooth back into the socket with firm pressure or have the child bite slowly to seat the tooth. This may be painful (ache) to the bone but must be done.  Hold with a warm towel.

Follow up:  A dentist will place a temporary splint to hold the tooth into place. The splint will be removed in 7-10 days and a root canal done. Cosmetics will be looked at after RCT.

Full Avulsion

img class=”alignright size-full wp-image-201″ src=”https://web.archive.org/web/20160123113439im_/http://199.168.190.18/~pediatri/wp-content/uploads/2015/04/full_avu.jpg” alt=”full_avu”/>What do you see? Child is missing a tooth and has a shallow hole in gum tissue.

This is a:  This is an Avulsion (knocked out) tooth.

What else it could be:Baby tooth that was pulled out or bumped out early. Bone and tooth fracture (lots of blood, see alveolar fracture)

Is this an emergency, urgency, or problem?  Baby tooth- problem.  Adult tooth- Emergency
First aid is only required if a permanent tooth comes out; this us usually to a traumatic blow to face on a chlild 6-10 years.  Above that, adult, below 6 generally baby tooth but be sure.

Is the tooth small and worn or does is look like your front tooth?  Does is have a ragged, moth eaten root or a sharp flat break to it?  Was the tooth “wiggly” before?

A baby tooth avulsion is cause for celebration and talk of the tooth fairy. Bleeding will stop within 10 minutes tops.
A permanent tooth avulsion REQUIRES YOU TO PUT THE TOOTH BACK INTO ITS BONY SOCKET IMMEDIATELY. NO EXCEPTIONS.

What to tell the parent:  Explain the history of the injury and that the tooth will need first aid treatment from a dentist  stabilize it into the socket.This is done with a wire brace in the dental office and CANNOT BE DONE IN THE EMERGENCY ROOM.

Tell the parent these injuries have a critical time frame to save the cells that hold the tooth into the bone and need stabilization and splint therapy.  A root canal therapywill then be necessary within 10 days. The child should avoid directly biting on the tooth, and OTC analgesia may be helpful.

First Aid: Put the tooth back into the socket with firm steady pressure or have the child bite slowly to seat the tooth. This may be painful (ache) to the bone but must be done.  Hold with a warm towel.  If the child is hysterical, place tooth without washing into cold milk or Hank’s buffered Salt Solution.  Do NOT touch root or attempt to wash tooth.  Time is essential to protect the ligament cells that hold the tooth in the bone, and crushing, drying or washing them will cause long term dire consequences for the child.

Follow up: A dentist will place a temporary splint to hold the tooth into place. The splint will be removed in 7-10 days and a root canal done. Cosmetics will be looked at after RCT.

Avulsion Fracture

alv_fractureWhat do you see? Child is missing a tooth and has a shallow hole in gum tissue.

This is a: This is an Avulsion (knocked out) tooth.

What else it could be: Baby tooth that was pulled out or bumped out early. Bone and tooth fracture (lots of blood, see alveolar fracture)

Is this an emergency, urgency, or problem? Baby tooth- problem.  Adult tooth- Emergency
First aid is only required if a permanent tooth comes out; this us usually to a traumatic blow to face on a chlild 6-10 years.  Above that, adult, below 6 generally baby tooth but be sure.

Is the tooth small and worn or does is look like your front tooth?  Does is have a ragged, moth eaten root or a sharp flat break to it?  Was the tooth “wiggly” before?

A baby tooth avulsion is cause for celebration and talk of the tooth fairy. Bleeding will stop within 10 minutes tops.
A permanent tooth avulsion REQUIRES YOU TO PUT THE TOOTH BACK INTO ITS BONY SOCKET IMMEDIATELY. NO EXCEPTIONS.

What to tell the parent: Explain the history of the injury and that the tooth will need first aid treatment from a dentist  stabilize it into the socket.This is done with a wire brace in the dental office and CANNOT BE DONE IN THE EMERGENCY ROOM.

Tell the parent these injuries have a critical time frame to save the cells that hold the tooth into the bone and need stabilization and splint therapy.  A root canal therapy will then be necessary within 10 days. The child should avoid directly biting on the tooth, and OTC analgesia may be helpful.

First Aid: Put the tooth back into the socket with firm steady pressure or have the child bite slowly to seat the tooth. This may be painful (ache) to the bone but must be done.  Hold with a warm towel.  If the child is hysterical, place tooth without washing into cold milk or Hank’s buffered Salt Solution.  Do NOT touch root or attempt to wash tooth.  Time is essential to protect the ligament cells that hold the tooth in the bone, and crushing, drying or washing them will cause long term dire consequences for the child.

Follow up:  A dentist will place a temporary splint to hold the tooth into place. The splint will be removed in 7-10 days and a root canal done. Cosmetics will be looked at after RCT.