First, if the tooth is only fractured part of the way off, call your dentist immediately. The child will need an x-ray, evaluation and treatment right away to help prevent further complications.

If the tooth has come all the way out (called and avulsed tooth), there are a few things which need to be done and all must be done quickly for the tooth to have any chance of surviving. First, find the tooth and lightly wipe it off with a moist, clean cloth to remove any debris. Ideally, the tooth should be placed in the child or parent’s cheek in an area where it won’t be accidentally swallowed or inhaled. (I know, pretty gross, but it is for the sake of your child). If this is too upsetting or you are afraid it will be swallowed, the tooth can be placed in a glass of milk.

You should immediately take your child to the dentist, ideally within the first 10 minutes of the occurrence. The dentist will likely try to place the tooth back into the socket once it is clean and lacking debris which might cause later infection. The tooth will then likely be splinted to the adjacent teeth for support, to help minimize movement. This support will help the tooth re-tighten back into the socket and is sometimes left for up to two to three weeks. The tooth will likely need a root canal since the nerve was severed, but this likely won’t be done for two or three days after.

If the tooth has been out of the mouth for longer than fifteen minutes, your child still needs to see the dentist immediately to avoid more complication or possible permanent loss of the tooth. Bring the tooth with you as mentioned above.

If you are far from the dentist, the tooth is clean and you feel that the tooth is intact, you can attempt to put it back in the socket yourself. Be sure that if you are going to attempt this, you place it in the correct way! The child should immediately be taken to the dentist for an evaluation. If the tooth cannot be found, the dentist may refer you to the emergency room for a chest x-ray to be sure that it has not been inhaled during the accident.

I won’t go into great discussion about the further treatment sequence in dealing with an avulsed tooth, as it is varies with the child and the extent of the injury. The biggest point being that you should take your child to the dentist immediately to avoid further complications which can be both emotionally and financially draining.

The other item I want to discuss is something called “Hank’s Solution” or “Hank’s Balanced Salt Solution.” This is a special liquid formulated by a scientist that is extremely compatible with living tissues and can help to stabilize an avulsed tooth until it can be placed back in the mouth. This solution is better than milk or any others that I am aware of and can help to increase the likelihood that the tooth will be successfully re-implanted. The only catch is that you have to have it before the injury happens! A great addition to your home first-aid assortment is the “save-a-tooth” kit. It Uses the specially formulated pH balanced solution, as well as a unique removable basket and net container that protects tooth root cells crucial to the success of the re-implantation process.

The good news is that it could also be nothing. There are other causes of tooth pain which may be transient. If your dentist can find no apparent source for the pain, then they will likely search for other possible sources for it. Some of these may include simple things, such as night-time grinding (to be discussed later), food impacting in the gum, and irritation from flossing (this is not typical, since kids in the range usually refuse to floss)!

There are other reasons for tooth pain that can be a sign of something more serious. This is unusual, however, the possibility should not be overlooked. Your dentist should be aware of these and will likely evaluate for them if the problem continues with no apparent cause for the pain.

This is a sticky situation to be in. I will be very honest with you, as a mother I want to be privy to everything that goes on with my children. I understand the natural parental instinct that makes you want to protect your children at all costs. We want to shadow doctors and dentists to be sure that they are taking care of our kids the way that they would their own. However, the dentist side of me will tell you that most of the time children do MUCH better when parents are not in the room during treatment. Many of our mini-sized manipulators (including my own) play the “Dr. Jekyll and Mr. Hyde” game while at the dentist.

It is pretty amazing to see how a child is polite and well behaved in my dental chair until the moment a parent walks in the room. Once the parent enters, there is usually a plethora of temper tantrums and a refusal to open their mouths. When mom and dad leave the room, it is back to cooperation with a smile. However, some children actually will do better with a parent in the room, or even while sitting on the parent’s lap during treatment. I would suggest trying it without the parent first unless you know that your child will in no way go for it. We want them to have a good experience, so whatever it takes is what needs to be done.

If a dentist is good with kids and speaks their “language,” often they will let you do most dental work without much hesitation. Of course, that doesn’t apply to all kids, which is why man invented sedation. I very strongly discourage parents from coming back in the treatment room. I never refuse to allow them back and I personally don’t feel that it is appropriate to do so. If a child does well with a parent in the room, then there really isn’t any reason to have them leave. However, leaving the room can often give mom or dad a little “quiet time” and break from the daily grind. I’ll be the first to admit that those little breaks are some of the best opportunities for me to recharge before tackling the remainder of the day!

The dentist side of me also feels very strongly that a parent should not be allowed to compromise a child’s dental experience or dental treatment. So, if a child is unmanageable while a parent is in the room and the parent refuses to attempt treatment with them out of the room, then I simply decide that this is not a patient relationship that I feel comfortable continuing. As dentists, we are providing medical care to your child and so, it is very important that we have a very open line of communication and trust with you. If that relationship does not exist, then perhaps a relationship with another dentist would better suit the needs of both parties. Another thing that can be difficult about having a parent in the room is that is can be very distracting to the dentist, dental assistant and even the child.

As parents, we have a natural curiosity for the process of things and also to help soothe our children. With such a short attention span from children, it makes it very difficult to work quickly and accurately while a parent is asking questions or talking to the child (obviously if the child is asking you a question, that is does not apply). If you decide to stay in the room during treatment, I would recommend trying to be very quiet and keep questions and conversation to a minimum. Try to save questions either before treatment or after and let the staff attempt to soothe the child first. Too many people talking to the child distracts and upsets them. And please, whatever you do, avoid the trigger words that panic children, like “needle,” “shot,” “drill, “hurt,” “pain,” and the list goes on. It truly is in the best interest for your child’s care and their overall experience. Treating children is very much like playing a game of chess in the middle of a preschool classroom. It already takes a lot of concentration to get the moves right in a quiet setting, much less in the midst of noise and physical chaos! Remember, they are a moving target for us, all while we attempt to do procedures at an almost microscopic level, with materials which have to stay completely dry, with instruments that can cause tissue damage. And, all of this is done in a dark, wet place, about the size of pool ball, with a “trap door” that opens and closes without warning. Wow, I am exhausted just thinking about it!

I am sure that different states have different laws pertaining to the refusal of allowing a parent in the room, so check with your state accordingly. However, if you feel you need to check on the law, then it might be prudent to examine the relationship you have with your current dentist, as I am guessing it is not one built on trust or communication. Of course, there are special situations when refusal to allow parents back in the room is acceptable, such as legal guardianship issues and court orders (for example, restraining orders). If you have any questions regarding these specifically, always seek the advice of your attorney. Remember, try to make the experience a good one for your child. One hundred percent of my adult patients who are terrified or fearful of the dentist tell me they are so because they had a bad childhood experience. It just shouldn’t be that way! If all of your efforts still prove fruitless, then sedation may be the best option for your child.

Often, yes. Occasionally, no.  Sensitivity to sweets in children (and adults) can mean that there is a cavity lurking.  The presence of sugar in the sweets will cause a chemical reaction within a decaying tooth. This reaction causes that “twinging nerve pain” or sensitivity, which may or may not linger for a little while after the sweet treat.   It is best to take your child to the dentist and let them examine the tooth and take an x-ray if needed to see if a cavity is causing the sensation.

Sensitivity to hot or cold in a child’s tooth (baby teeth or permanent teeth) can be of concern.  A cavity can also cause sensitivity to hot and cold, however if it is, this is usually a sign that the cavity is already large. This can also be a sign of the nerve dying and/or and abscess of a tooth.  Again, the appropriate treatment would be to see your dentist immediately and let them take an x-ray if needed.  If an x-ray is taken and other tests done confirm that the nerve is dying or that an abscess is present, your dentist will discuss options with you.

Options for treatment of cavities or abscesses (dead/dying nerve) may include procedures such as extraction (with or without a space maintainer to hold the space open for the future permanent tooth), baby tooth root canal, filling or stainless steel crown.  The decision for treatment options is made based on the amount of damage/decay in the baby tooth, the length of time until it would normally fall out and position of the underlying permanent tooth.   Of course, we want to do our best to try to save baby teeth, particularly if it will help the child avoid braces in the future.  But all of these things must be taken into consideration in order to make the best decision for the child.

Occasionally in children, but most often in adults, this sensitivity can be caused by an area where the gum has receded away from the tooth.  You don’t see this too often with children, simply because the baby teeth are actively changing form each day, and they don’t have the sensitive roots that adult teeth have.  It is quite uncommon for gums to recede in children or even in teenagers (unless they have braces).  So, the bad news is that it is likely a cavity causing the pain.

These sensations can also be normal and transient.  Your dentist will likely use a combination of diagnostic procedures to evaluate the offending tooth.  If nothing obvious can be found that explains the source of the pain, they  may opt to “watch” the tooth.  What this means is, they will ask for your help in monitoring your child’s symptoms at home and call if things change (for better or for worse).  Either way, your dentist may decide to take a new x-ray in a few weeks to see if there are any changes.

Teeth are strange in that sometimes they give symptoms disproportionate to their experienced “trauma.”  For example, when eating a chip or popcorn or some crunchy food item, occasionally a piece may break off and get lodged beneath the gum without you or your child even noticing.  The area may then become tender and feel like a toothache, hot and cold sensitive or become painful on chewing.  A trip to the dentist may show nothing and then the sensitivity goes away in a few weeks.

A tooth can also be traumatized by biting into something hard which can cause the ligament which holds the tooth in to be “bruised.”  This may cause biting sensitivity for a week or two which may also go away on its own.  There are many examples of these situations but most commonly, symptoms are actually due to the presence of a cavity or an abscess.  So, always have your dentist check the area rather than assuming there is nothing really wrong.

Of course, we already discussed earlier in the When should I first take my child to the dentist? post that your child should start seeing the dentist early and we also learned that they should go for check-ups and cleaning every six months. At the check up appointment, the dentist may want take a few x-rays.  There are many different types of x-rays that are considered acceptable for a child, and it really depends on what the dental team is looking to evaluate.

Generally speaking, usually around three or four years old, check-up x-rays (also called bite wing x-rays) may be taken if the child does not have spaces or has limited spaces between the baby teeth or if decay is suspected in an area between the teeth. Children at this age have very small mouths, and so typically all is needed are two of these films (understand that this may vary depending on the child).  These films are done every year to eighteen months, again depending on the child.  There really isn’t a minimum age requirement for these check-up x-rays, it is really dependent on the spaces between their teeth and the visibility between them.  These x-rays are done to look for cavities in between the teeth, thus the reason they may not be necessary to take if the child has adequate spaces between their teeth.  If spaces are present, the dentist can usually see the tooth directly without the use of x-rays.

At around age 5 or older, your dentist may choose to take another x-ray called a panorex or “panoramic film.”  This film does not look for cavities but rather is a tool for evaluating possible missing teeth, disorders of the jaw including cysts, tumors (cancerous and non-cancerous) and a myriad of other things.  It may also be used to aid in orthodontic evaluation in the future.  This is a film that is typically done every three to five years or even less depending on the use for the x-ray.

There are other x-rays sometimes done for other reasons.  One more commonly done x-ray is called a “P.A.”, which stands for a periapical x-ray.  It is just a fancy dental word for an x-ray that shows the entire tooth, including the root and the surrounding bone and is usually done on children to evaluate a possible abscess or to determine the length of time until a permanent tooth will erupt.  This is an acceptable x-ray for children at any age if the dentist has a concern about a specific tooth.

Another film that a parent may encounter at the dentist is called an occlusal film.  This is a film that may be taken of either the upper or lower teeth and is meant to see a better three dimensional view of erupting teeth or pinpoint pathology within the jaws.  This kind of x-ray is not done that often, but is very important when trying to determine very specific details that would otherwise not show up.  It is usually only done if the dentist has a very specific reason for taking it.

One question I am frequently asked regarding x-rays and children are about the relative danger to the child.  In general, x-rays in moderation are considered to be safe when precautions are taken to minimize radiation exposure.  This is the same for adults.  In fact, we are often taught in school that we receive more radiation exposure from the sun on a single day then we do in a set of yearly x-rays.

For children, it is especially important that the areas sensitive to radiation are covered during x-rays.  These areas include the thyroid/neck area as well as the reproductive areas of the child.  This shielding is done with a lead apron.  Dental offices are also required to undergo annual testing and evaluation of the radiation equipment (this varies by state) to be sure they are in compliance with state radiation regulations.  In addition, most states require that the staff taking x-rays have completed a regulated x-ray dental safety and technique course in order to take x-rays.  These certificates will usually be posted for patients to see.

The answer I am going to give you is going to sound ridiculous at first, but if you listen to my reasons, you will see exactly why we recommend the following:  In general, a child should first see the dentist when their first tooth comes in.  There are two reasons for this.  The biggest one, at least the one they teach us in dental school, is because teeth exhibit many possible signs of underlying bodily diseases that may otherwise not be discovered until a much later time.  There are many genetic disorders and syndromes that show their signs first in the teeth before in any other part of the body.  A few examples include ectodermal dysplasia, amelogenesis and dentinogenesis imperfecta and many more. While most of these disorders are indeed somewhat rare, I think common sense tells us that the sooner we can catch them, the better opportunity we have to treat them.

In addition to this, parents must remember a long used phrase about children: “Kids are NOT little adults.”  Now, I am sure this makes complete sense to you when you think about the daily things, like why kids think it is fine to eat mac n’ cheese for every meal or why they still can’t put their shoes on the right feet at 10 years old.  Or how they can have 103 degree fever and still be functional when us adults would be bedridden and begging to be put out of our misery.   So, this phrase is applicable in many areas, but is particularly true in the world of dentistry.

One thing parents need to know about their kid’s teeth is that children’s teeth are “softer” than adult teeth and therefore decay at a much faster and easier rate.  Not only are they more susceptible to decay, their nerve tissue within the tooth is much closer to the outside of the tooth than an adult.  This makes it much more likely that they will need a “child root canal” or extractions, even with the presence of only small amounts of decay.  So, with this in mind, we can see how an early trip to the dentist can minimize problems which may have otherwise become huge problems by waiting.

Another important thing to know is that those baby teeth which seem so unimportant are actually a blessing in disguise.  As you will read in subsequent chapters, those little teeth will help pave the way for the future position of the permanent teeth.  Extracting them prematurely can cause many cosmetic and functional problems which can be very costly later on.

While I am a dentist, my most challenging job is being a mom.  That is why I actually feel that this next reason for going to the dentist at an earlier age is one of the most important. I have rarely seen a child in this age range that is eager and excited to hop up in a large, squeaky chair, in an unfamiliar place and open their mouths for a total stranger wearing latex gloves and a scary mask.

To top it off we expect them to open willingly and let us come at them with large, sharp instruments. Yikes!  If they scream just sitting on Santa’s lap, what makes us think they will be excited about going to the dentist?  If we take our children young enough and make it a fun place without all the scary stuff first, then their visits will be an experience to look forward to rather than fear.  So, the mom side of my persona always wants me to create fun and wonderful experiences for my kids and the kids I treat.  The earlier they start seeing the dentist, the less fearful they will be.

I usually suggest that you bring them in with you when you have your own cleanings done every six months (provided you, yourself are not a big chicken).  This will reinforce that you are not scared and get them familiarized with the office so that they are comfortable with the surroundings.  Eventually, the child will recognize your dental office and look forward to coming with you because they always get a toothbrush, a sticker and a sugar-free lollipop!  The biggest miracle of all is, that after a few times, you’re little one will actually beg the dentist to look at their teeth and will ask them to be cleaned.  Easy as taking candy from a baby (which, by the way, your baby shouldn’t have candy in the first place-but we’ll talk about that more later)!

If you, as a parent, are a dental-phobe, then have your spouse or someone else take your child so that they ALWAYS begin their dental journey with nothing but a positive experience.  Keep in mind that if someone other than the child’s legal guardian takes the child, you will need to give the caretaker some form of written and/or verbal consent for treatment.  The laws vary by state, so be sure to inform yourself and also keep good communication with the dental office staff about treatment and finances involved in your child’s care.

If your child is still uncooperative despite all efforts, or your current dentist is not great with kids, then I would highly recommend seeing a pediatric dentist.  This kind of dentist sees only children and has the entire office set up for kids, from music, TV, giant kid-friendly murals, puppets and most importantly…sedation.

My general feeling about sedation is that if it is necessary to help your child have a great dental experience, then strongly consider it.  If you have to consider sedation as an option, please be sure to discuss with your dentist all of the risks involved with this type of chosen sedation.  While sedation is a great opportunity to complete your child’s dental care with ease, there are risks you should be aware of.  Though rare, there is the possibility of accidental death as a result of sedation and so the procedure should be considered only if truly necessary.  Due to the wide variety of sedation options and the fact that selection of the type of sedation varies by child,  I will not go into specific details.  Just inform yourself well and use that information to aid in making your decision.

By and large, the number one complaint I hear from my adult patients who are terrified to go to the dentist is that they had a traumatic childhood dental experience.  If we start out positively as a child, then we will have no reason to fear the dentist as an adult.  Going to the dentist regularly will become a desired, regular occurrence, like birthdays or  holidays.  Okay, okay, maybe I am exaggerating a little, but they still can be fun experiences for kids!

These bi-annual check-ups and cleanings allow us to catch problems while they are small, thereby keeping most dental procedures extremely conservative for both kids and adults.  I know it may seem hard to believe, but going to the dentist really can be an enjoyable (not just a tolerable) experience.