Preventing mouth injuries

Young children stumble often and their teeth are located at a perfect heigh for crashing into the edge of a coffee table. So crashproof your toddler's cruising area. Take extraordinary care to make sure he doesn't have the opportunity to bite any electrical wires. (And while you're at it, make sure you cover all electrical wall sockets, to prevent shocks.) Don't let your child parade around the house with a toothbrush in her mouth. It may do serious damage if she falls.
The risks of dental injuries rises when children play sports. All too often, a child can be unintentionally kicked in the mouth, struck with a ball or hit by a bat. Children in organized sports generally need to wear a comfortable protective mouth guard, sort of a crash helmet for the teeth. Mouth guards are sold at sporting goods stores or pharmacies; or your child's dentist can make a custom-fitted mouth guard. Rough individual activities such as in-line skating, skateboarding and martial arts also call for mouth guards.

Dental injuries

Dental injuries can occur to all teeth, most commonly the teeth in the front of the mouth. Teeth can be cracked, displaced from their sockets or completely knocked out. Dentists are concerned about trauma to primary teeth and even more so about damage to permanent teeth, which may have important lifelong consequences. Parents should always consult their child's dentist after tooth trauma. Some injuries are not easily observable. A dentist is trained to make a complete diagnosis and perform the proper treatment.

Cracked teeth. A tooth is composed of three layers: the outer protective enamel; the internal supportive structure, called dentin; and the soft tissue centre of the tooth containing the nerves, called the dental pulp. A crack (fracture) in a tooth can affect any or all of these layers. A small fracture may require only smoothing by the dentist using a sandpaperlike instrument. A more extensive rack may require a dental restoration to reestablish the form, function and appearance of the tooth. If a dental fracture affects the hollow portion in the centre of the tooth and exposes the dental pulp (there is usually bleeding from the exposed region), a dentist should be seen as soon as possible so he can repair the damage and prevent loss of the pulp. If a part of the pulp does die, the tooth can still be saved with endodontic (root canal) therapy: removing the dead pulp tissue and filling the root canal space with a sterile filling material. The tooth can then be repaired in the usual manner.

Loosened teeth. Most times slightly loosened teeth will reattach themselves and become stable after a few days'rest. Sometimes, however, teeth are so loose that the dentist needs to splint them together to stabilize them while healing occurs. Antibiotics are sometimes beneficial, to prevent infection of the dental pulp and attachment tissues. Dentists will advise a soft diet for a time to help the healing process.

Avulsed teeth. Sometimes, a tooth may be completely knocked out of the mouth (an avulsed tooth). If a baby tooth is avulsed, dentists usually recommend not to reimplant it. Underlying permanent teeth may suffer developmental damage when a traumatized primary tooth is reimplanted. A permanent tooth should be reimplanted as quickly as possible, however, usually within thirty minutes, to maximize the chance of keeping the pulp alive. First, make sure that the tooth is indeed permanent and is intact. Gently hold it by the crown (the part that shows in the mouth), not by the pointed roots. Rinse it very gently under tap water. Do not scrub or rup the root in any way; that will damage the attached tissue, which is required for reattachment. Insert the tooth back into its normal position. If you can not reimplant the tooth, place it in a glass of milk or commerially available tooth rescue container. Then take the child to a dentist or seek dental emergency servise at a hospital A&E department. Time is important with permanet tooth avulsions. After a tooth has been out of the mouth for thirty minutes, the chances for succesful reimplantation drop fast.

Sealants

Sealants are another important part of preventive dentistry. Many teeth have small grooves or pitted areas in the enamel where bits of food and dental plaque accumulate. Most of these tooth surface imperfections are too small for bristles to enter, so the food material and bacterial plaque cannot be brushed or flossed away. Tooth decay, called pit and fissure caries, usually results. However, the dentist or hygienist can often prevent such tooth decay. A sealant consists of a liquid resin that flows across the tooth surface and fills the grooves and pits. It then hardens, sealing off the enamel imperfections. Food debris and dental plaque cannot enter a groove or pit that has been sealed with bonded resin. Other materials are also used as sealants, as dentist continue to seek the ideal method of protecting enamel pits and fissures. Some primary molars may also be given the protection of sealants, but dentists are selective in sealing baby molars. Clinical experience has shown that sealants don't stay bonded to primary teeth as well as they do to permanent teeth. Sealants last for many years; depending on a child's diet and oral habits, they eventually need to be repaired or replaced.

Toothbrushing and flossing

Effective brushing. How can tooth decay be prevented? The secret is daily, consisstent removal of dental plaque before it does its nasty work. First, a tip about cleaning babies'teeth: use a soft-bristled toothbrush. There is a myth that one should use a soft gauze or cloth to wipe a baby's teeth and gums so as not to damage the delicate gum tissue. Those 'delicate' gum tissues chew on table legs, cots, coffee tables, siblings and anything else in their way. A baby's gums are no more delicate than alligator hide. Brush, don't wipe. babies love it.
A child's teeth should be carefully brushed after breakfast and before bedtime, with daily flossing between adjoining teeth, usually before the evening brushing. If possible, an after-lunch brushing is helpful too, to remove food residue. Starting at about two, your child may insist on doing everything herself, but most young children do not have the manual dexterity required for proper brushing and flossing until they are nine or ten years old. You can let your young child begin the brushing by herself from the earliest ages, but you will probably need to finish up to ensure that all dental plaque has been eliminated. You can gradually let your child take over completely when she proves capable, usually between six and ten years.

Flossing. Some parents question the need to floss a child's teeth. Most teeth in the back of a child's mouth are in close contact with those on either side. Even some front teeth may be in tight contact with their neighbours. Such teeth are so close together that food and dental plaque can get wedged in between. No matter how vigorously or carefully they are brushed, the bristles cannot penetrate to clear out the food and plaque. Dental floss disrupts and dislodges that debris so that the toothbrush can sweep it away.
It's worth getting your child used to gentle flossing as soon as you notice food wedged between her teeth. Your child's dentist or dental hygienist can demonstrate all the methods used to hold a child for perfect brushing and flossing. Best of all, when your child is able to brush and floss effectively without your help, she will already be accustomed to the daily habit.

Tooth decay

Some children get a lot of cavities, others almost none. Why is this so? We still don't know all the factors that lead to tooth decay (dental caries), but we do know that heredity plays a role, as do the diet of the pregnant mother, the child and access or lack of access to good dental care.

Bacteria and plaque. The principal cause of tooth decay is acid produced by bacteria living in the mouth. The bacteria combine with food debris to form a material called dental plaque that sticks to tooth surface. The more hours of the day this plaque remains on the teeth, the greater the number of bacteria and the more acid is produced. This acid dissolves the minerals that make up the enamel and dentin of the tooth, eventually destroying the tooth. The bacteria live off sugars and starches in the child's diet. Anything that keeps sugars sitting in the mouth for a long time is likely to be good for the bacteria and bad for the teeth. That is why frequent between-meal snacking promotes tooth decay. Especially harmful are lollipops, sticky sweets, dried fruit, fizzy drinks, which cling to the teeth.
Saliva contains substances that help teeth resist attack by bacteria. Since the body produces less saliva during sleep, nighttime is when cavities form most. That is why brushing the teeth before bed is so important. Foods that promote saliva - such as sugarless gum - can help fight cavities. There are also substances in some sugarless chewing gums, xylitol and sorbitol, that kill cavity-forming bacteria and another substance, casein, that strengthens teeth.

Baby-bottle cavities. An especially severe type of tooth decay is nursing caries or baby-bottle tooth decay. When formula or breast milk sits on a baby's teeth for a long time, the sugars in the milk promote the growth of cavity-forming bacteria, which then destroy the teeth. The teeth most at risk are the upper front teeth, sice the tongue covers the lower teeth during nursing and sucking. There is normally enough time between feedings for the flow of saliva to clean the teeth. But when babies keep a nipple in their mouths much of the time, this normal cleaning may not have a chance to occur. The worst baby-bottle tooth decay happens when babies fall asleep with the bottle in their mouths. While they sleep, formula sits on their teeth and the bacteria multiply away.
Baby-bottle decay may start even before the first birthday. Sometimes nursing caries are so severe that the infected teeth have to be removed. For this reason, a baby should not be put to bed with a bottle of milk, juice or other sweetened fluid. The only acceptable fluid for sleep time is water. Even diluted sweet fluids can promote decay.

What makes good teeth?

Nutrition for strong teeth. The crowns (the parts that show) of a baby's first teeth are formed in the gums before birth. A few of the permanent (adult) teeth also begin forming before birth and others begin within a few months after. Growing teeth need proper nutrition, including plenty of calcium and phosphorus, vitamin D and vitamin C. Good sources of calcium and phosphorus include vegetables, cereals, calcium-supplemented juices and milk (although nondairy diets may have some benefits). Sources of vitamin D include fortified milk, vitamin drops and sunshine. If you are breast-feeding, it's wise to take a vitamin D supplement (200 units a day) just to be on the safe side. Sources of vitamin C include most fruits, especially citrus; vitamin drops; raw tomatoes; cabbage and breast milk. Other vitamins are also heplful, including vitamin A (in yellow, orange and red fruits) and some of the B vitamins (in grains).

Fluoride. One mineral known to be especiaaly valuable in forming strong, decay-resistant teeth is fluoride. Fluoride is a naturally occurring mineral; we all have some in our teeth and bones. A small amount in the diet of the mother while she is pregnant and in the child's diet greatly reduces the risk of later tooth decay. When the enamel of a tooth is formed with fluoride, it resists the action of acid much better. In addition, fluoride in the mouth discourages the activity of the bacteria that cause tooth decay.
In regions with high levels of natural fluoride in the water, tooth decay is rare. Childrencan also get fluoride in the form of tablets or drops. It also helps to put fluoride directly onto the teeth, in the form of toothpastes, mouth rinses or special preparations that dentists use.

Fluoride in the water. For decades, fluoride has been added in very small, safe a mounts to the water of many communities as a public health measure. If you're not sure whether your water has enough fluoride, you can call the information umber on your bill and ask. Adequate fluoridations is 0.7 to 1.0 ppm (parts per million). If your water is low on fluoride, your family mostly drinks bottled water or you use a home purification system that takes out all the fluoride and other mineralws, it makes sense for you and your child to use a fluoride supplement (drops or pills).

Fluoride for babies. If you're breast-feeding and drinking fluoridated water, you don't need to give your baby extra fluoride. If your water is not fluoridated, consider giving your baby an infant vitamin with fluoride. Baby formulas contain little fluoride, but if you mix the formula with fluoride water, your child will get plenty of fluoride. If not, consider adding fluoride drops.

Enough, but not too much. Your child's doctor or nurse practitioner and dentist can help make sure your child gets the right amount of fluoride. If there is no fluoride in your water supply, your doctor or nurse practitioner may prescribe the appropriate daily dose for your infant, which will vary depending on your community and your child's age and weight. Too much fluoride can cause unattractive white and brown specks on the teeth, so it's importantto give the correct amount. Your child may also receive periodical topical applications of special fluoride solutions in the dentist's office. Fluoridated toothpastes are also beneficial for their surface effect on the enamel. But becareful: children who eat toothpaste, as most young children will, are at risk of getting too much fluoride. So use very small amounts (pea size) and keep the toothpaste away from very young children so that it doesn't become a convenient bathroom snack.

Teething

Symptoms of teething. Teething has different effects on different babies. One chews things, frets, drools, has a hard time getting to sleep and generally makes life miserable for the family for a month or two as each tooth comes through. In another baby, a tooth is discovered with no idea that he was teething. Most babies start to drool at around three to four months when their salivary glands become more active. Don't be fooled into thinking that drooling always indicates that teething has started.
Since babies get twenty teeth in their first three years, it's easy to understand why they seem to be teething for most of the infant and early childhood years. This also explains why it's so easy to blame every ailment on teething. It was once believed that teething caused colds, diarrhoea and fevers. Of course, these conditions are caused by germs (bacteria and viruses), not by teething. Teething mainly causes teeth and not much else. If your baby has a fever or appears ill, don't assume it's because of teething . Call her doctor or nurse practitioner.

Help for teething. Any teeth may distress a baby, but the first four molar teeth, at around twelve to eighteen months, are more likely to cause trouble than the others. What to do? First, let her chew! Provide chewable objects that are dull and soft enough so that if she falls with them in her mouth, they won't do any damage. Rubber teething rings of various shapes are good. You should avoid toys made from thin, brittle plastic, which can break and cause choking. You also need to be careful that your baby does't gnaw the paint off furniture and other objects if there is any danger that the paint is made with lead. (Anything painted before about 1980 may contain lead.) Fortunately, nowadays all baby furniture and painted toys sold in the UK are painted with lead-free paint.
Some babies prefer to chew on a certain kind of cloth. Try trying an ice cube or a peace of apple in a square of cloth. Some parents swear by frozen bagels. Frozen slices of banana can also work well. Many babies love to have their gums firmly rubbed at times. Be creative. Let your baby chew what she wants as long as it's not dangerous. And don't fret about germs on the teething ring or piece of cloth. Your baby is putting all sorts of things in her mouth anyway, none of them germ-free. Of course, it's a good idea to wash the teething ring after it has fallen on the floor or the dog has slobbered over it and you should wash or boil the piece of cloth occasionally. There are lots of teething medicines on the market that may occasionally offer some relief, but you should talk to your doctor or nurse practitioner before using them.

Tooth development

Baby teeth. How and when will your baby's teeth come through? The average baby gets his first tooth at around six months, but this quite variable. One baby may get her first tooth at three months, another not until eighteen months. Both may be perfectly healthy, normal infants. It is true that certain diseases can influence the age of teething, but this is rare. For most children the age of teething is simply a matter of the pattern of development the child was born with.
Usually the first two teeth to appear are the lower central incisor is the name given to the eight front teeth (four on the bottom and four on the top) that have sharp cutting edges. After a few months come the four upper incisors, so the everage baby has these six teeth, four above, two below, at about a year old. After this, there's usually a lull of several months before the next onslaught. Then six more teeth quickly appear: the two remaining lower incisors and all four first primary (baby) molars. The molars don't come in next to the incisor teeth but farther back, leaving space for the canine teeth.
After the first molars appear, there is a pause of several months before the canines (the pointed dog or eye teeth) erupt in the spaces between the incisors and the molars. The most common time for this to happen is in the second half of the second year. The last four teth in the baby set are the second primary molars, which come in right behind the first primary molars, usually in the first half of the third year. Remember that these ages are all averages. Don't worry if your baby is ahead of or behind the schedule.

Permanent teeth. permanent teeth begin to appear at about six years of age. The six-year (first permanent) molars come through behind the baby molars. The baby teeth lost first are usually the lower central incisors. The permanent incisors, pushing up underneath, come into position where the baby tooth roots have been dissolved away. Eventually, all the primary teeth become loose and fall out. The baby teeth are lost in about the same order in which they came in. Your toughest decision may be order in which they came in. Your toughest decision may be figuring out the monetary value of these baby teeth when the Tooth Fairy makes her appointed rounds.
The permanent teeth that take the place of the baby molars are called bicuspids or premolars. The twelve-year molars (second permanent molars) come in behind the six -year molars. The third molars (eighteen-year molars or wisdom teeth) may be impacted in the jaw. Sometimes they need to be removed so they won't do any damage to neighbouring teeth or the bone of jaws. Permanent teeth often appear with jagged edges (called mammelons). They either wear down or the dentist can trim them. Also, permanent teeth are more yellow than primary teeth.
Permanent teeth sometimes come through crooked or out of place. They may eventually straighten out by the muscular action of the tongue, lips and cheecks. If they don't straighten out or are crowded or crooked or if the jaw alignment is abnormal orthodontic treatment (braces) may be required for bite improvement.