Cut or Bitten Tongue, Lip or Cheek:

Apply ice to bruised areas. If there is bleeding, apply firm but gentle pressure with a clean gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to a hospital emergency room.

Knocked Out Permanent Tooth:

Find the tooth. Handle the tooth by the top (crown), not the root portion. You may rinse the tooth, but DO NOT clean or handle the tooth unnecessarily. Try to reinsert it in the socket. Have the child hold the tooth in place by biting on a clean gauze or cloth. If you cannot reinsert tooth, transport the tooth in a cup of milk(preferably) or water (if no milk) or even saliva. See a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

Toothache:

Clean the area around the sore tooth thoroughly. Rinse the mouth vigorously with warm salt water or use dental floss to dislodge trapped food or debris. DO NOT place aspirin on the gum or on the aching tooth. If face is swollen, apply a cold compress. Take Acetaminophen (Ibuprofen) for pain and see a dentist as soon as possible.

Broken Tooth:

Rinse dirt from injured area with warm water. Place cold compresses over the face in the area of injury. Locate and save any broken tooth fragments. Immediate dental attention is necessary.

Other Emergency Conditions:

Possible Broken Jaw- If a broken jaw is suspected, try to keep the jaws from moving by using a towel, tie, or handkerchief, then take the child to the nearest hospital emergency room.

Bleeding After Baby Tooth Falls Out- Fold and pack a clean gauze or cloth over the bleeding area. Have the child bite on the gauze with pressure for 15 minutes. This may be repeated once; if bleeding persists, see a dentist.

Cold/Canker Sores- Many children occasionally suffer from "cold" or "canker" sores. Usually over-the-counter preparations give relief. Because some serious diseases may begin as sores, it is important to have a dental evaluation if these sores persist.

1. Potato Chips: When you eat starches, including pretzels and pasta enzymes in your saliva break the food into simple sugars, feeding the bacteria that causes tooth decay.

2. Peppermints: Sucking on sugary hard canidies all day puts your teeth under constant attack by tooth-decay-causing bacteria.

3. Cough Drops: Gram for gram, some cough drops have as much, if not more, sugar as chocolate. The same is true for other "medicinal" products, such as antacids and breath mints.

4. Soda: If you want to feed the bacteria in your mouth drink soda. It's just loaded with sugar and flavor additives, and the acids, also found in diet sodas too, can destroy tooth enamel.

5. Bottled Water: Not all dentists sing the praise of fluoride, but the ADA stresses the decay preventing benefits. Most bottled waters do not have it and most home water filtration systems remove all fluoride.

6. Coffee Drinks: Whipped cream, chocolate sauce, and flavor syrups are loaded witrh sugar. A small caramel macchiato, for example, has more sugar that a Snickers bar.

7. Juice: Even unsweetened juices contain naturally occurring sugar; an 8-ounce glass of orange juice contains about 30 grams of sugar. And the same serving size of Mountain Dew contains 31 grams of sugar.

8. Sports Drinks: "High Energy" and sports drinks are high in sugar and have the highest " mean buffering capacity" which means they can severely erode your enamel, according to a study in General Dentistry.

9. Fruit Leather and Roll ups: Made from sweetened fruit purees, these sticky snacks are essentially candy. Bits stick to teeth leaving your teeth susceptible to decay.

10. Gum: Sugary chewing gum puts your teeth under prolonged attack. But don't rule out gum altogether, Xylitol is a sugar substitute in some gum that has been shown to actually prevent tooth decay.

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GE Reflux- gastroesophageal reflux, nickname "GERD"

Dental Manifestations

• Enamel erosion from the stomach acid (pH=1)
• Tooth sensitivity can develop once the enamal covering is gone
• Acid reflux can make untreated cavities worse
• In severe cases the nerve can be exposed

Suggested life style changes to help reduice reflux

• Avoid fried foods and acidic juices (OJ with pulp)
• Avoid over eating
• Don't lie down after eating
• Put a 2x4 under the head of the bed

Your Pediatrician may recommend

• Zantac, Prilosec, or Reglan
• Tum (sugar free)
• Referral to a Pediatric GI Specialist

Long Term Dental Risks - If untreated, GE reflux can cause irreversible loss of tooth structure.

Long Term Medical Risks - If untreated, GE reflux c an predispose your child to esophageal (throat) problems in adulthood.

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Causes and Treatment Options

What is enamel hypoplasia?

Enamel Hypoplasia (EH) is a defect in tooth enamel that results in less quantity of enamel that normal. The defect can be a small pit or dent in the tooth or can be so widespread that the entire tooth is small and/or mis-shaped. This type of defect may cause tooth sensitivity, may be unsightly or may be more susceptible to dental cavities. Some genetic disorders cause all the teeth to have enamel hypoplasia.

What does enamel hypoplasia look like?

EH can occur on any tooth or on multiple teeth. It can appear white, yellow, or brownish in color with a rough or pitted surface. In some cases, the quality of the enamel is affected as well and the quantity.

What causes enamel hypoplasia?

Enviromental and genetic factors that interfere with tooth formation are thought to be responsible fo EH. This includes trauma to the teeth and jaws, intubation of premature infants, infections during pregnancy or infancy, poor pre-natal and post-natal nutrition, hypoxia, exposure to toxic chemicals and a variety of hereditary disorders. Frequently, the cause of EH in a particular child is difficult to determine.

What are the treatment options for enamel hypoplasia?

Treatment options depend on the severity of the EH on a particular tooth and the symptoms associated with it. The most conservative treatment consists of bonding a tooth colored material to the tooth to protect it from further wear or sensitivity. In some cases, the nature of the enamel prevents formation of an acceptable bond. Less conservative treatment options, but frequently necessary include use of stainless steel crowns, permanent cast crowns or extraction of affected teeth and replacement with a bridge or implant.

Trreatment Options

Treatment of teeth with enamel hypoplasia must be determined on an individual basis in consultation witht the child's pediatric of family dentist. The following treatment options are based on the available literature ad the experiences of faculty members in our department and should be adapted to meet the needs of each patient.

Treatment for posterior teeth:

• For sensitive teeth with minimal wear, you may apply SuperSeal or another desensitizing agent as needed.
• For mildly hypoplastic molars, place pit and fissure sealant on the occlusal surface. At 6 months re-evaluate to see if sealant is lost.
• Remove demineralized enamel and restore with composite. At 6 months re-evaluate to see if composit is lost and then replace using good isolation techniques.
• Perform minimal reduction of tooth and cement a stainless steel crown. Check as needed.
• For permanent molars, stainless steel crowns are intended for temporary use only. These teeth should be restored with a permanent cast crown in the late teen years or early adulthood.
• In cases where the first permanent molars are unrestorable or marginally restorable, extraction prior to the eruption of the second molars may be reasonable alternative.

Treatment of anterior teeth:

• For sensitive teeth with no wear, you may apply SuperSeal or another desensitizing agent as needed.
• If there are esthetic concerns, direct or indirect composite veneers may be bonded to the affected tooth.
• For permanent anterior teeth, composite or porcelain veneers or porcelain crowns may be used.

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