All I Want For Christmas…

This week’s guest columnist is Dr. Ronald Hebert, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

My 1 year-old daughter was climbing everything in sight, including standing and balancing on her bouncer seat.  Quite a trick, until one day it flipped and she flopped, just avoiding a face plant.  I thought about maybe storing the bouncer in the attic but, duh, decided against it.  One Friday night she climbed on again, balancing and babbling away, and flipped again, only this time landing face first.  After consoling her, we went to wipe up the blood that had poured from her upper lip, and found a tiny white chip on the floor.  Looking in her mouth, an upper front tooth had that chip missing.

Toddlers are hurting their mouths all the time as they learn to stand, walk, and run away when you need them to stand still the most!  They trip and hit their mouths on floors, furniture, toys, etc.  Fortunately, their mouths seem designed to take the punishment.  The mucosa, what we call that shiny wet skin inside your mouth, heals remarkably.  Deep or long cuts that many parents, and walk-in clinic providers, think need stitches usually heal well without.

Also, toddlers’ teeth are their primary, or baby, teeth.  These are pretty much disposable.  If they get chipped or knocked out, it’s no big deal- there’s permanent teeth waiting to replace them.  Occasionally your dentist might want to put a knocked-out baby tooth back, to hold it’s space for the next tooth to come in straight.  If the tooth is knocked out, put it in some cold milk or saliva.  Then call your dentist about what to do next.  Don’t put a baby tooth back in yourself- jamming it in may damage the permanent tooth underneath.

When we got to the dentist with our daughter and tooth chip, alas, the piece was too small to glue back.  It would likely break back off next time she bit something hard.  Her beautiful smile has not been the same, but the adorable snaggle tooth smile has grown on me.  And one day, it will fall out and be replaced by the new model.

I was sharing this story with one of my mentors, and he had one to top mine.  One day his seven year-old daughter was at a birthday party with a fun jump.  She was jumping around, smiling away, when she hopped face first into the netting.  Her two upper front teeth were snagged in the net, and just like that they were yanked out and gone!

Like we said above, if your child loses a baby tooth, it’s no tragedy.  There’s spare parts, the permanent teeth, waiting underneath.  Sometimes the dentist will want to put a baby tooth back, to hold it’s space open so the permanent tooth comes in straight.  Otherwise, the other teeth may crowd that space, and the next tooth be guided in crooked.  Often though, it can be left out.

However, like my mentor’s daughter, permanent teeth are a different matter.  To save them, they need to be re-implanted right away.  Find those teeth!  When you do, wash them off with clean water, without soap.  It’s going to hurt briefly, but then push them back in the socket.  Don’t put them in backwards!  Then have your child hold the teeth in place with a clean cloth, and get to the dentist.  Like we said above, don’t put baby teeth back in yourself- this may damage the permanent tooth underneath.

If this makes you squeamish (there is usually a lot of blood when a tooth gets knocked out), or you’re not sure if the tooth that’s out is a baby or permanent, call your dentist.  While waiting for a call back, put the teeth in cold milk or saliva after washing them off.

Sometimes teeth aren’t knocked out when injured, just crooked.  This often can wait to see your dentist the next day, but call your dentist to check.  A tooth may need to be straightened right away if its an upper tooth that’s pushed back so it’s tip ends up behind the lower teeth, instead of in front.  In other words, your child’s tooth suddenly is an under-bite, rather than an over-bite.  If you can’t push it back in place easily, your dentist may have to do the job.

Pearly Whites

My brother-in-law was in a bar on a cruise ship.  A woman from ”coal-mining country” liked him so much she exclaimed, “Ain’t you pretty- you got all your teeth!”  Teeth are important for good looks, and good health.  Listen to this week’s guest columnists: Drs. Libby Going and Rati Venkatesh, Family Practice residents at the University Hospital and Clinics here in Lafayette. 

In the Pediatric Emergency Department, we see lots of coughs, fevers, injuries of all sorts, and concerns about kid’s teeth.  While infrequent, parents sometimes come to ask about tooth care.  And we see lots of visits for tooth and mouth trauma.

We saw a precious two year-old girl recently, with big brown eyes a red bow in her hair, and a runny nose.  She was bubbly and fun but when she smiled, her teeth took away some pizazz.  They were brown stubs, an obvious case of “bottle rot.”  Her parents had been putting her to bed with a bottle, the milk sitting in her mouth all night, destroying her teeth.

Dental care is important early in life.  Start good habits for both baby teeth and permanent teeth.  Even before baby has teeth you should gently clean his gums with a wet washcloth.  When you see that first tooth and document it in the baby book, it’s time to start cleaning that tooth.  Use a soft baby toothbrush and a very tiny smear of toothpaste.

When you celebrate that first big birthday, baby enjoys her first cake, and you get that picture with icing all over her face and high chair.  Then it’s time to schedule a dentist appointment.  The first visits to the dentist are for a check-up, and to get the child used to the dentist. Dental visits aren’t the horror we feared when we were kids- children should learn early that dentistry is pretty painless.

What your child eats is also important for healthy teeth.  Sippy cups filled with juice or milk (or worse, soda!) lead to tooth decay.  Limit juice or milk to meal time only, with water offered the rest of the day.  And again, no bed time bottles after you have gently brushed those pearly whites.

Falls, sports injuries, and plain horsing around cause all sorts of injuries, but one of the scariest is a knocked-out tooth.  There’s screaming, blood, and an ugly gap.  What to do depends on whether it’s a baby tooth, or a permanent one.  Baby teeth usually start coming out in the first two years, and fall out on their own about age 6.  They are then replaced by the permanent teeth, which need to last the rest of the child’s life.

The best way to handle knocked-out teeth is prevention.  Mouth and face guards are very important for sports at risk for tooth injury- those with regular impacts, sticks, and flying objects- like football, baseball, hockey, softball, and lacrosse.  Cheering too- cheerleaders are often flying objects themselves!

What to do when a tooth gets popped out?  If it’s a baby tooth, don’t worry, just call your dentist.  Your kid may have a gapped-tooth picture for awhile, but her permanent tooth should grow in fine.  If it’s a permanent tooth, that’s more trouble.  It’s important to get that tooth back in so it won’t die, but take root and live.

First, pick up the tooth by the whitest part (the crown)- don’t touch the root.  If it’s dirty, rinse it for 10 seconds only.  Then match it to it’s hole and push the root into the socket.  Have your child bite down on a cloth to hold it in place, and call your dentist.  Put that tooth in with the outside facing out- backwards teeth make for future orthodontic trouble.

Scared to put that tooth back in?  Many are, with all that blood and crying.  Have your kiddo spit into a cup, and put the tooth in the saliva.  Or put it in milk.  Then immediately see your dentist.  Teeth re-implanted within one hour have better chances of surviving.

Mouth and dental emergencies can be scary, so it’s important to have a dentist by the first birthday.  Then you have an expert to call when things get hairy, and you can keep your child’s smile pretty.