Common pediatric dental problems.

PART FOUR

Though children with some disabilities may be more prone to certain dental problems (see "Special Children are at Greater Risk," August 1994), they must also deal with the more common dental problems of childhood. This article will help parents recognize and obtain appropriate treatment for some common pediatric dental problems:

* A dark (blackish-bluish) front primary tooth may indicate a change in the vitality of its nerve, usually due to a past history of trauma to the tooth. Your dentist should be consulted.

* Facial or gum swelling most often indicates an abscessed (infected) tooth. This is usually caused by a deep cavity, or occasionally is related to past trauma to the tooth with subsequent nerve damage. In primary teeth, the usual treatment is extraction; in permanent teeth, the normal treatment is tooth pulp therapy, more commonly known as a "root canal." Your dentist should be consulted immediately to help prevent the spread of infection.

* Cavities, or dental decay, must be treated in both primary and permanent teeth.

* An over-retained primary tooth is a "baby tooth" that is still in position when a permanent tooth is erupting into the same space. The over-retained tooth should be removed immediately, so the permanent tooth can take its rightful position.

This problem occurs most commonly with the lower front teeth, but it can also happen with the upper front teeth. Older children (ages 7-13) may retain primary teeth in the molar and cuspid region. The presence of baby teeth in the middle teenage years indicates a potential problem such as a congenitally absent permanent tooth or an impacted permanent tooth.

* If a primary tooth is accidentally knocked out of the mouth, leave the tooth out and seek care immediately. Bring the tooth to show the dentist. If the tooth is intruded (pushed up into the gum) due to an injury, it can often be left to re-erupt, but must be carefully monitored.

* If a permanent tooth is accidentally knocked out of the mouth, prompt treatment is essential. The longer the tooth is out of the mouth, the less likely it is that treatment will be successful. Handle the tooth by the top (crown), not the root portion. Try to stick the tooth back into the socket--normally, it will fit quite well--and hold it firmly in place until help is obtained.

If you are unable to replant the tooth in the socket, place it in milk. If milk is not available, have the child hold the tooth in his mouth or place it in water. Do not store the tooth in the child's mouth if there is a possibility he will swallow it.

The dentist will attempt to replant the tooth. The dentist will replace the tooth in the socket and keep it stabile by splinting it to adjacent teeth for several weeks.

* If primary or permanent teeth are displaced (knocked to the side but not out of the socket), reposition them as soon as possible and seek professional care immediately.

* Vague pain in gums may be caused by canker sores. These are very common in children and can occur in any soft tissue area. Medication can be given to relieve pain. Avoiding hot and spicy foods and drinks will diminish discomfort.

* Fractured permanent incisors (front teeth) require prompt treatment. Children with some disabilities are more prone to accidents that can fracture teeth. Seizure disorders and poor motor coordination can lead to falls. If the incisors protrude, they are more likely to be damaged.

Fractured incisors can be restored with a bonding technique or crown. If the nerve is exposed, it will be removed or treated before the bonding treatment is undertaken.

* Erupting wisdom teeth (third molars) may sometimes cause pain. An infection called pericoronitis may occur if the tooth does not erupt fully. If this occurs, swelling will occur in the face and/or gums. Immediate care is necessary to prevent the spread of infection.

* Bruxism, the grinding or gnashing of teeth, occurs more frequently in children with disabilities. Bruxism usually occurs when the child is sleeping, but some children may also grind their teeth throughout the day. This habit, continued consciously or unconsciously over a period of time, can cause tooth abrasion and loss of tooth structure. In permanent teeth, bruxism can lead to periodontal disease (bone loss) and/or a temporomandibular joint disorder (TMJ) in which the upper and lower jaws are out of alignment resulting in headaches and facial pain. However, most of the time, bruxism will not cause such problems.

Bruxism can be diagnosed at a routine dental visit. Treatment may include bite adjustments or a biteguard appliance. However, treatment is usually not necessary and the habit is outgrown.

Steven P Perlman, D.D.S., M.Sc.D., specializes in dental care for children with disabilities. In addition to his private practice, he teaches pediatric dentistry al the Boston University Goldman School of Graduate Dentistry and serves as vice president of the Academy of Dentistry for Persons with Disabilities. Dr. Perlman is clinical director of the Special Olympics "Special Athletes, Special Smiles" program. He lives in Swampscott, Massachusetts.