If you would like more information on dental infections in Fort Collins, Colorado, please call us at 970-407-1020 and schedule an appointment with our pediatric dentists, Dr. Greg Evans and Dr. Rachel Ecker, at Big Grins.
What is this? Child has no real signs of trauma or infection but complains of toothache. The pain is vague and not specified to a single tooth. Pain may be elicited with biting pressure and may be hot or cold sensitive. Oral hygiene may be very poor in area.
Situation: A sore tooth, the most common childhood dental “emergency.”
What else it could be: Erupting permanent tooth behind baby tooth (blue gum), food debris stuck between teeth or under red gums, cavity in between teeth, not readily seen trauma to teeth from recent hard bite or hit to face, small canker sore (aphthous ulcer) low on the gum.
Is this an emergency, urgency or problem? Problem.
Usually, if you cannot readily identify the problem in the mouth looking with a mirror and a good light, the problem is not urgent, despite the child’s concern. Take your time asking about the duration, onset, location and “story” behind the pain. The child may need a pat on the head and ibuprofen. If you can find the source of pain and remove it (e.g. floss out the popcorn husk) or explain it, that treatment goes a long way. A child who is “dying” of pain can transform into a happy kid once they know their big molar is coming in and they are just having “growing pains.”
Tell the parent: Explain your investigation into the pain and the child’s story; often, the parent is aware but did not give it importance or thought the child was bluffing. Suggest follow-up by a dentist unless it was an obvious fix. Give over-the-counter analgesia if that will help the child return to class. Urge regular dental care and a relationship with a dentist.
First aid: As needed.
Follow up: As needed or suggest new patient checkup for child without a dentist.
What do you see? Child has swelling above teeth on gum. It is fluctuant and may or may not hurt when touched. The teeth hurt with biting pressure and may be hot or cold sensitive.
This is a: Dental abscess.
What else it could be: Erupting permanent tooth over baby tooth. Aphthous ulcer (would be white but flat and very painful to touch).
Is this an emergency, urgency or problem? Problem.
An abscess is a bacterial infection that is feeding off a dead pulp and pushing its way into the bone. The body tries to wall off the infection by surrounding it in pus. If the pus pocket bursts, it relieves pressure and the child gets out of pain temporarily. Untreated, the pus pocket grows, and the infection can get into the spaces between facial muscles, growing serious.
What to tell the parent: Explain the tooth is dead. That gets their attention. Explain this is a bacterial infection that will not go away but become more serious, especially at night. Press upon them the need to get an antibiotic started to limit the infection size until the tooth can be treated or removed. Call an on-call dentist for an emergency appointment and arrange for payment assistance if necessary. Put a course of action in motion to make it easier for the parent to follow. Over the counter pain medication will help; ice or topical anesthesia (ambesol) will not help.
First aid: Give the child ibuprofen at 10 mg per kilogram. That is one teaspoon of liquid for a first grader and one 200 mg pill for a fifth grader. Restrict biting on tooth. Do not distract with candy.
Follow up: A dentist will numb the lips, gums and tooth and remove the infected, necrotic tissue from the tooth or remove the tooth. Space maintenance may be necessary.
Dental Abscess With Facial Cellulitis
What do you see? Child has swelling seen outside mouth with possible distortion near eye or below angle of jaw. Fever and malaise present and swollen lymph node as well on affected side. The teeth hurt with biting pressure and may be hot or cold sensitive. Sometimes it is a rapid onset.
This is a: Dental abscess spread into the planes of the face — facial cellulitis.
What else it could be: Trauma, look for outside bruise at point of contact. Look at history. Gland infection or saliva gland blockage.
Is this an emergency, urgency or problem? Emergency.
An abscess is a bacterial infection that is feeding off a dead pulp and pushing its way into the bone. The infection may get into the spaces between facial muscles if the infection comes out the roots under the attachment of muscles to jaw. This spread can be very fast and may impact a child’s airway. If it is rapidly treated with IV antibiotics, it usually quickly goes down. If delayed treatment, bone loss, tooth loss and surgical intervention may be necessary. Children die from facial cellulitis in this country.
The family physician should work with the family dentist to admit this patient to the hospital and have the tooth removed. A pediatric dentist is trained for this scenario and may be able to save the family thousands in unnecessary medical work if alerted early.
What to tell the parent: Explain the tooth is dead. That gets their attention. Explain this is a bacterial infection that will become more serious. Call emergency services if the child has convulsions or trouble breathing. Call a pediatrician or pediatric dentist to see child in ER or office depending on the judgment of the dentist.
First aid: Not much can be done. OTC analgesia should be given with DDS consultation.
Follow up: A dentist will often be able to remove the tooth and get pus drainage, which provides immediate pain relief and accelerates healing. Medical treatment without tooth extraction usually is not effective.