Dental Emergencies

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How to Make a Dental First Aid Kit
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An Oral Answers reader, Rebecca recently asked the following question:

“In the wake of the earthquake in Japan, my friends and I have been checking/building our disaster kits. One thing that’s come up has been what should be packed in a dental first aid kit. None of our first aid kits contain dental first aid items so we thought we’d build our own. What would you suggest that we add for a family of four? We’re assuming that a toothbrush, toothpaste and floss is only the beginning.”

Dental First Aid KitRebecca brings up a good point about the importance of being prepared for dental emergencies when they occur.  We never know when one of our children might lose a tooth in an accident.

If you’re interested in making your own dental first aid kit, there are many items that you may choose to include, depending on your level of dental experience.  Also, you need to know if you want to pack regular oral hygiene items (such as toothpaste and floss) in with your main disaster kit, or if you want to include it in your dental first aid kit.

For the purposes of this article, I will simply go into the things that you may want to have on hand in case a dental emergency occurs and you are unable to make it to the dentist for whatever reason.

What to Put in a Dental First Aid Kit: A List of 14 Possible Dental First Aid Kit Items

You can use the list below to find some things that you may want to include in a dental first aid kit, broken up into a few categories.

Help with Examining the Dental Emergency

1 – Medical-Grade Exam Gloves – Even if you’re comfortable reaching into your child’s mouth without gloves, it may be a good idea to wear gloves anyway due to the germs that you have on your hands.

2 – Dental Mirror & Flashlight – If a piece of tooth chipped off, or if someone has lost a tooth, it’s a good idea to look inside of the mouth and see if there is anything remaining at the site of the accident.  A mirror can also help you visualize the tongue-side of the front teeth.

Saving a Knocked Out or Lost Tooth

Save a Tooth System

3 – Save-a-Tooth System – The Save-A-Tooth System is simply a saline solution that is compatible with our bodily fluids.  It is the best way to keep a tooth “alive” when it is knocked out and not immediately re-implanted.  It is important to remember that a tooth can only be outside of its socket for a few hours before the probability of successful re-implantion starts to go down-hill fast!

 

In short, you only need to get this if you’ll be able to make it to the dentist within a few hours of having a tooth accidentally knocked out so that the dentist can re-implant the tooth.

Helping with a Lost Crown, Lost Filling, or Chipped Tooth

4- Temporary Crown and Filling Material – These materials, which I talked about in a previous post about the best temporary crown cement can help you get by until you can see a dentist.  Note that it is always best to see a dentist first when a crown or filling falls out.

To learn more on this topic, read about what to do when a filling comes out and what to do when a crown falls off.

5 – Dental Wax – Wax can be used to help with irritation from braces or a chipped tooth.  Some people have also used it to temporarily fill in a lost filling.  Dental wax can be found for pretty cheap on Amazon.

6 – Toothbrush & Tweezers – When putting a loose crown back on and replacing a lost filling, it is important to make sure that the tooth is clean by using a toothbrush.  You’ll also need a good way to handle the filling material, which is where the tweezers come in.

Controlling Bleeding

7 – Sterile Gauze – Gauze placed over the site of bleeding can help stop bleeding. You can also use gauze to move the tongue (it’s usually pretty slippery with gloves on!) so that you can see what’s going on inside the mouth.

8 – Tea Bag – If bleeding hasn’t stopped with just gauze, it can sometimes help to place a wet tea bag inside of a piece of gauze and hold that over the wound to stop bleeding.

9 – Hydrogen Peroxide – If you need to disinfect and clean up blood, hydrogen peroxide good to have around in your dental first aid kit.

Alleviating Dental Pain

10 – Floss, Toothpicks – Sometimes tooth pain is simply caused by food that is stuck between teeth that can easily be removed with floss and/or toothpicks.

11 – Clove Oil – Clove oil (or eugenol in dental-speak) has a sedative effect on the dental pulp and can be used to help alleviate tooth pain.  Many dentists use eugenol in their offices to help calm down teeth after deep fillings.  This is why clove oil is commonly associated with the dental office smell.

If you’re looking for a quick way to get some clove oil into your dental first aid kit, it can be found along with sesame oil in these Red Cross Toothache Medication Drops over at Amazon.

12 – Ice Pack – An ice pack can help reduce swelling when a tooth is lost.  At my dental school, whenever we extract a tooth, we recommend that the patient place an ice pack on their face intermittently (20 minutes on, then 20 minutes off) to reduce swelling.

13 – Orajel or Anbesol – Sometimes Orajel or Anbesol can do a better job at relieving oral pain than clove oil.  When giving an oral anesthetic to your children, it’s important to be aware of methemoglobinemia, a serious side effect.

14 – Pain Medication – Over the counter pain medication, such as ibuprofen and acetaminophen can help relieve oral pain, but should only be taken as directed.

Where to Buy a Dental First Aid Kit

Some people don’t want to go through the hassle of making their own dental first aid kit and prefer a ready-made solution.  There are a variety of different dental first aid kits available for sale online.  Here are two from Amazon that grabbed some good customer reviews:

Dental First Aid Kit - Dental MedicDental Medic Dental First Aid Kit (Pictured to the left) – This kit includes dental wax, floss, a tea bag, and an oral pain reliever among other items.  It also has an instruction booklet for dealing with common dental emergencies and comes in a waterproof bag.

Emergency Dental Kit (Pictured below) – This dental first aid kit appears to include a few more things compared to the dental first aid kit above.  It includes a mirror and appears to also have a Dental First Aid Kit Emergency Kitcontainer of clove oil included.

If you’re looking for some other options, this Google Shopping results page and this page at Amazon both show many other dental first aid kits that are available.

Conclusion

Dental first aid kits can be valuable assets when it comes to your oral health and your children’s oral health.  Nobody knows when an emergency will occur, so it is always a good idea to be prepared to handle dental emergencies.

Do you have any questions or comments about dental first aid kits?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Why Your Child Has a Dark Tooth
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If you have kids, you know that they can get themselves into a lot of interesting accidents.  Many times when kids get a head injury they knock out a tooth.  Other times, they simply hit the tooth really hard and injure it.

It has been estimated that 8-30% of kids under 7 suffer an accident that injures one of their baby front teeth.

Dark Tooth - Tooth DiscolorationAny time a tooth suffers an injury, there is a possibility that it may turn a different color.  If you’re wondering what it means if your child’s tooth has turned pink, red, gray, black, brown, or yellow, then you’re the reason I wrote this article!

Tip – I will use words like pulp, dentin, and enamel in this article. If you don’t know what those mean, you might want to brush up on The Anatomy of a Tooth.

When Your Child’s Tooth Turns Dark (Gray, Brown, or Black) After a Tooth Injury

When blood leaks out of blood vessels after a tooth injury, blood by-products such as iron can make their way into the small tubes inside the dentin layer of the tooth.  As the blood breaks down, it can make the tooth appear to be gray, dark gray, brown or even black.  This color change doesn’t usually occur until 2-3 weeks after the tooth has been injured and can occur after a tooth has turned red (see below.)

The book Paediatric Dentistry by Welbury states that “although the reaction is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period.  In cases of this type, there is some chance that the pulp will retain its vitality, although the likelihood of vitality is apparently low in primary teeth with dark gray discoloration.”

Basically, the author is stating that even if a tooth has a dark color, it may still be able to return to health.  Some experts have said that the darker the discoloration, the more likely it is that the nerve of the tooth has died.  For example, this study “found that 33 of 51 traumatized teeth with gray-black discoloration were necrotic.”  However, other experts state that the shade of darkness doesn’t reflect the health of the pulp.

If your child’s tooth has turned dark, the best thing to do is to have your child’s dentist look at it.  If there are other signs that the tooth is dead such as swelling or an infection that shows up on the x-ray, then your child’s dentist will probably choose to do something about it such as performing a root canal treatment or removing the tooth.

If there is no sign of infection in a dark tooth, the dentist may choose to not do anything and let the tooth eventually fall out on its own when the permanent tooth is ready to take on its role in the mouth.  A study by Sonis showed that 72% of darkened teeth fell out normally without any bad effects on the permanent tooth.

Also, if there are no other signs of infection, this study showed that there is no need to do a root canal.  The researchers concluded that “Root canal treatment of primary incisors that had change their color into a dark-gray hue following trauma with no other clinical or radiographic symptom is not necessary as it does not result in better outcomes in the primary teeth and their permanent successors.”

When Your Child’s Tooth Turns Red or Pink After a Tooth Injury

If a tooth is going to turn red after an injury it can turn red shortly after the injury, or it can wait anywhere from a few weeks to months before it begins to turn a pinkish red color.

Red and Pink Teeth Immediately After the Injury

If a tooth turns red shortly after being traumatized, it usually means that the blood vessels inside the pulp broke.  When the blood vessels rupture, blood leaks inside the whole pulp area of the tooth resulting in a reddish pink color.  This condition is known as pulpal hyperemia.

Sometimes pulpal hyperemia is difficult to detect.  You may have to shine a light on your child’s tooth and look at the tongue side of the tooth with a mirror to detect this color change.

The pink/red color may take a long time to go away or it may never go away and the tooth may start to darken to a shade of gray.

Red and Pink Teeth Weeks after the Injury

As a result of trauma, sometimes cells inside the tooth start eating away at the hard layers of the tooth through a process called internal resorption.  These cells are called odontoclasts and in certain cases they can eat away to the outside of the tooth within a few short weeks.  The tooth looks pink because as the pulp layer of the tooth gets bigger, its red color more easily shines through the thin layer of remaining tooth structure.

A man named James Howard Mummery first noticed this “pink spot” that appears on teeth, which is why it is typically referred to as pink tooth of Mummery.  Pink tooth of Mummery can start occurring anywhere from a few weeks to months after a tooth is injured.

These teeth are usually kept until the crown of the tooth is dissolved.  Then the tooth root can either be removed or it can be left to get dissolved spontaneously as the permanent tooth comes into your child’s mouth.

When Your Child’s Tooth Turns Yellow After a Tooth Injury

The dentin layer of a tooth under the enamel is normally a yellow color.  If a tooth reacts to an injury by laying down a lot more dentin, it is known as pulp canal obliteration (Also called calcific metamorphososis, progressive canal calcification or dystrophic calcification.)

The increase in the amount of dentin and the concurrent decrease in the amount of pulp gives the tooth a yellow, opaque color.

The book Pediatric Dentistry by Pinkham states that “although pulp canal obliteration is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment except follow-up.”

It is important to regularly follow-up with your child’s dentist about any teeth that have turned yellow after an injury.  The book Paediatric Dentistry by Welbury notes that “a small percentage [of yellow teeth] demonstrate pathologic change many years after the injury.”

Conclusion

Many times parents want to rush treatment when their child’s tooth changes color.  It is important to understand that “in the primary dentition of a healthy child, color change alone does not indicate a need for pulp therapy or extraction of the tooth (Pinkham.)”

Basically, if your child’s baby tooth has changed color, often the best treatment is no treatment.  As long as an infection doesn’t develop, simply waiting it out and seeing what happens could mean that your child doesn’t have to go through unnecessary dental treatment.  And that’s a good thing, especially after they’ve already been through a traumatic tooth injury.

Do you have any stories, questions, or comments about tooth discoloration?  Do you still have a question that I didn’t answer?  Feel free to write your thoughts in the comments section below so that we can all learn from each other – Thanks for reading!

Submitted Photos

Krista from The Muminator blog shared the following photos of her daughter after she had an accident in 2012:

Here’s a photo not too long after her daughter was playing on the furniture and fell:

Dark Tooth Following Traumatic Accident

Here’s a photo a few weeks after that.  The tooth continued to get darker:

Dark Tooth Continues to Get Darker Following Accident

And a final photo of the tooth returning almost back to its normal color:

Dark Tooth Getting Light Again Following Accident

You can read all about her daughter’s experience on this thorough blog post that she wrote about the entire experience.

The following photo is from Jennifer, who has left some very informative comments below regarding her daughter’s dark tooth.  She states:

Its not white completely but is a lot better than what it was… The left side of the photo is around 3-4 weeks after the trauma.. and the right side of the picture was taken a few days ago, around 8 weeks after the trauma, It has also moved back into alignment a bit more as well, as it was knocked back with a blunt blow.
Dark Tooth Turned White Again

If you have a photo of your child who had an injury that caused a tooth to discolor, please send them to me using this form and I can post them here to help others who are going through this same experience.

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How Seatbelt Use Affects Dental Health
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One of the questions we ask every new patient who comes in for a comprehensive dental exam at my dental school is this:

Do you wear your seat belt?

Wearing Your Seat Belt Can Avoid Facial Injuries

Why We Ask New Dental Patients If They Wear Their Seat Belt

This question is part of a form that we go through to assess our patients’ risk of dental disease.  A lot of people are caught off guard when we ask them about their seat belt usage.  In fact, when I first got into clinic, I thought it was a rather irrelevant question.  However, as I’ve been studying for my final exams, I found an interesting sentence in my oral surgery book that made this question hit home to me.  It says:

The major causes of facial fractures include motor vehicle accidents and altercations.  Other causes of injuries include falls, sports-related incidents, and work-related accidents.  Facial fractures resulting from motor vehicle accidents are far more frequent in persons who were not wearing restraints at the time of the accident.

Seat Belts Aren’t Just for Saving Lives

Many people don’t bother to put on their seat belts because they know that the chances are very small that they will be killed as a result of not wearing their seat belt.

What I think most people don’t realize is that by not wearing their seat belt, they are drastically increasing the chances that they will fracture a tooth or even worse, fracture bones on their face when they get in an accident.

Conclusion

If you’re getting relaxed about your seat belt wearing, know that if you get in an accident you are putting yourself at a much higher risk of getting a head injury.  It’s extra important during the holiday season when people can drive a little bit crazier!

If you have any comments to share, please leave them in the comments section below.  Thanks for reading!

Reasons to Wear a Mouthguard
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Common sense dictates that it’s a good idea to wear a mouthguard if you play contact sports or engage in any activity where you could potentially damage your teeth.  However, we don’t always do what we know is in our best interest.

Mouthguards: Football TeamThere are several reasons why people don’t wear mouthguards.  Sometimes people don’t know that the activity that they are engaging in requires a mouthguard.   Teenagers may not wear them because there is peer pressure to not wear one.  After all, nobody wants to be the only one on their team that wears a mouthguard!  Others might complain that a mouthguard is uncomfortable or interferes with their speech and breathing.

However, there are several reasons to wear a mouthguard.  I would like to share some of them with you.  My goal is not to convince you to wear a mouthguard (or to convince you to make your child to wear a mouthguard) if you are not already.  But I do hope that this article will increase your awareness of the implications of wearing or not wearing a mouthguard so that you can make an informed decision.

Six Reasons to Wear a Protective Dental Mouthguard

1. Mouthguards Protect Against Tooth Fractures

One of the most important functions of mouthguards are to keep your teeth from breaking.  If your tooth does fracture, it usually can be saved.  Here’s a few types of tooth fractures and their respective treatment:

Lost Filling from Tooth
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Earlier this week, I wrote about what you should do when a crown falls off.  Today, I will discuss what you should do when you lose a filling.

An Amalgam aka Silver FillingLosing a filling from your tooth can be quite a traumatic event, especially if it comes out while you’re eating and you accidentally bite down on it.

However, there’s really no need to worry when a filling comes out of your tooth because your dentist will be able to fix it.

Also, there’s no need to save the filling if it was a composite, amalgam, or glass ionomer filling (the majority of fillings.)

If it was a gold or ceramic inlay filling (rather uncommon) then you may want to save it if you can find it since your dentist may be able to cement it back into place.

What to Do When a Filling Comes Out of Your Tooth

The first thing that you should do is remove it from your mouth so that you don’t accidentally swallow it or breathe it in.  A majority of the time when you swallow a filling, it simply passes without a problem.  On the contrary, if you accidentally breathe a filling into your lungs, it could cause an infection.

Baby Tooth Knocked Out Child
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What should you do when your child comes to you crying with a bloody mouth and a tooth in their hand? A normal reaction to this scenario is panic. However, if you know what steps to take, you could prevent permanent damage to your child’s teeth.

What to Do When a Baby Tooth Gets Knocked OutThe American Dental Association estimates that by the time kids graduate from high school, one in three boys and one in four girls will have suffered some sort of traumatic injury to their teeth. Also, baby teeth are a lot easier to knock out than permanent teeth because their crowns (the top part of the tooth that is visible in the mouth) are a lot longer than their roots (the bottom part of the tooth that’s hidden under the gums.)

Most caring parents wonder what they should do when their child knocks out a tooth. It is critical that parents are informed so they do not inadvertently damage the permanent tooth that is developing underneath the baby tooth in their child’s mouth.

A couple of days ago, I wrote about the steps you should take when a permanent tooth gets knocked out. With permanent teeth, you want to put them back in the socket as soon as possible. However, when you are dealing with a baby tooth you may not want to put it back in because you could end up damaging the permanent tooth that is still developing below your child’s gum-line.

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Permanent Tooth Knocked Out Child
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No matter how careful people are, there always seems to be a way to knock out a tooth. When a tooth gets knocked out, the technical name for this condition is called tooth avulsion. Unfortunately, when a tooth gets knocked out, panic ensues. There may be many people around who “know what to do” and want to help you save your tooth.

Teeth Can Be Knocked Out During Hockey GamesIt is true that once a tooth gets knocked out, it can successfully be re-implanted and return to normal function. However the key lies in what happens during the critical period while the tooth is outside of your mouth. Here, I offer nine simple steps to take when your tooth gets knocked out to keep it healthy so that it can return to its favorite past-time of chewing delicious meals.

Nine Steps to Take When Your Tooth Gets Knocked Out of Your Mouth

As a general rule, the sooner a tooth can get back into its socket inside the mouth, the better chance it has to survive long-term.

1. When a tooth gets knocked out, it is important to pick it up while only touching the crown of the tooth (the crown is the part of the tooth that is normally visible inside your mouth.)  If you can’t find the tooth try as hard as you can to find it.  Although aspiration rarely occurs, it is possible that the tooth could’ve been inadvertently breathed in by the accident victim.

2. Next, rinse off the tooth very gently with tap water, saliva (spit), or saline solution. It is important not to scrub the root of the tooth (the root is the part of the tooth that is normally hidden below the gums in your mouth and is more yellow than the crown.) Many people think it is important to scrub the tooth to get all of the germs off. However, if you scrub the tooth, you could scrub away the periodontal ligament or the cementum, which both help to hold the tooth in the socket. By scrubbing them away, you will reduce the chances of the tooth permanently re-attaching itself inside the mouth. Soap and chemicals such as bleach will damage the cells that are left on the tooth which could make successful re-implantation impossible.