This problem doesn’t occur too frequently, but when it does it leaves parents scratching their heads in curiosity. There are a few reasons this can occur and all will require a trip to the dentist for an x-ray and evaluation.

As mentioned in the second section, developing permanent teeth can be affected by a variety of things including high fevers, certain antibiotics and trauma to the baby tooth (transmitting trauma to the underlying permanent tooth). Permanent teeth can also be affected when they are traumatized directly once in the mouth.

How these “damaged” teeth will react really depends on the type and severity of the trauma. Some teeth will still “survive” but may appear malformed or have some kind of distinguishing mark on them. Others may not have been able to tolerate the trauma and eventually “die.” This “death” simply means that the living tissue inside the tooth (called the pulp) are damaged to the extent that they cause death to that tissue. That living tissue, or “pulp” is the nerve and blood vessels which supply the tooth sensation and sometimes, outward color.

When a tooth “dies” or is in the process of “dying,” the entire tooth undergoes multiple changes which can have many effects, many of which differ slightly depending on the individual.

Occasionally, a traumatized tooth may undergo a reaction with the fancy name of “calcific metamorphosis.” Wow-what a word! It simply means that the tooth felt the trauma and reacts to it by laying down extra layers of minerals within the tooth. This layering of extra minerals (which is really just extra tooth structure), results in a “squeezing” down of the pulp or living tissue located inside the tooth. This frequently, but not always, causes death to that living nerve tissue inside the tooth (the pulp).

This death doesn’t always occur, but does eventually in a high percentage of teeth. This strange process of laying down extra layers of tooth actually causes the tooth to turn more yellow that the other teeth. Treating these teeth can be complicated because though they usually do die, they don’t always do so, regardless of how yellow their color becomes.

Typically, if the tooth doesn’t reveal signs of death when the dentist evaluates it, they will choose to do frequent x-rays and re-evaluate at certain time intervals. They will also have the parent keep a watchful eye for any signs of tooth death such as, pain, change in tooth color (grey or further yellowing), swelling, a “bump” on the gum, or a foul odor coming from the child’s mouth.

If the tooth is confirmed to be dead after evaluation by the dentist, then a root canal is usually done to rid the infection that comes with the death. A root canal usually does not hurt, despite popular myth, and is simply the removal of the dead tissue from within the tooth. The tooth is usually numb for the procedure but doesn’t always have to be, depending on the situation. Once the dead tissue is removed, the inside of the tooth is cleaned and sterilized with tooth-friendly substances. The area is then filled with a special rubbery material to seal it off from other possible bacterial invaders.

Unfortunately, this usually will not fix the color change that has occurred, and occasionally it can become more exaggerated. There are several things which can correct the color change, including procedures such as, internal whitening of the single tooth, a veneer or crown. They may also be able to place a simple, tooth-colored filling that is layered on top of the tooth to mask the color. Each of these are too detailed to describe here and require that you discuss the suitable options for your child’s particular circumstance.

Another form of sedation which many parents opt for is “laughing gas”. The medical term for “laughing gas” is nitrous oxide sedation. It is a combination of nitrous oxide and oxygen gases, administered to adults and children through a little mask which fits on the nose. The patient breathes in through the nose and the gas flows through the body allowing a general sensation of overall relaxation. The gas does not put you to “sleep” in the medical definition sense (either general or twilight anesthesia/sleep), but rather can truly allow you or your child to fall asleep during a procedure.

During other sedation procedures, the definition of “sleep” has to do with a temporary nervous system alteration (almost like being paralyzed) and the patient may stop breathing part or all of the time. During non-breathing periods, the patient’s breathing is provided by artificial means and controlled precisely throughout the “sleeping” period of the procedure.

With laughing gas, breathing is never stopped (at least not on purpose) and any “sleep” obtained is by the same means in which we do at night. Most times with laughing gas, the patient stays awake, but is so relaxed, they don’t care what is going on. They can usually carry on a conversation in some form and are very aware of what is going on. However, if their bodies are the type to be sleepy from laughing gas, they may not converse or be very aware at all.

Once the procedure is over, the dentist should allow the patient to breathe pure oxygen for five minutes to flush the remaining laughing gas out of the body. One of the best advantages of laughing gas is that once the gas is removed, the patient is usually fully returned to their normal mental and physical state with no side effects. The patient usually remembers everything about the entire experience unless they fell asleep.

Every person reacts differently to the gas. Some people laugh or become “silly”, but most people just feel relaxed or feel as if they have had a few glasses of wine. The gas only works if the patient breathes it in and the patient can more or less control their level of sedation by how they breathe. The gas dosage is also controlled by the dentist, but both the patient and doctor will both have some control in obtaining the desired effect. Unfortunately, there are some people, children included, that are not affected by the gas at all. This doesn’t occur often but can be frustrating for both the patient and the dentist.

In general, laughing gas is very safe when given appropriately. There are very few medical conditions that make the gas impossible for use. These are rare and your dentist should consult your child’s physician if there is any question. Laughing gas can pose some dangers, just as with any medication given. One of those dangers is overdose on the gas. The maximum percentage of laughing gas that can be given before “overdose” can occur is at ratios greater than seventy percent nitrous oxide.

Almost all nitrous oxide units today are now made so that it is impossible to give more than 70% nitrous oxide. They contain a special internal regulator that will not allow it to give gas at levels higher than 70 percent. Older offices may still have some of the dated laughing gas equipment that allows you to go beyond the seventy percent dosage. If you or your child are seeing a dentist in which the office appears “out of date” with respect to technology or the appearance, be sure to ask if their laughing gas unit has the protective device on it.

Laughing gas is a great first option to consider for your child should they need any form of sedation. If your child is a “screamer” or very apprehensive, you may find that they will refuse to even put the mask over their nose. Exceptionally fearful children may have the same problem, but you can always attempt it and move forward with another type of sedation if unsuccessful. Remember, the goal here it to give children a positive dental experience so they don’t acquire dental phobias as adults. So it will often require a team effort and a lot of patience!