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Tooth or consequences: what to do in a medical emergency.


A dentist friend tells thestory of a client who called in panic when her son fell off his bicycle and knocked out one of his teeth.

"Put the tooth under thetongue and bring him into the office as soon as possible," the dentist instructed her.

A short time later, withthe tearful youngster in his office, the dentist lifted the boy's tongue and looked under one side, then the other. No tooth could be found. "Have you swallowed your tooth?" he asked.

"No," the mother spokeup. "How could he swallow it? It's right here." And she removed the tooth from under her tongue.

Although humorous, the storypoints out how seriously muddled people can become in emergencies. When dental accidents happen, acting quickly and correctly can make an important difference.

Dental emergencies can take severalforms, ranging from the excruciating pain of an abscessed tooth in the middle of the night to multiple fractures of the jaw resulting from an automobile accident.

Dr. Mark Jaspers, the head of theDepartment of Oral and MAxillofacial Surgery at the University of Minnesota School of Dentistry, notes that the most common dental emergencies are ordinary toothaches and soft-tissue infections. "often, when the wisdom teeth are coming in, there will be a flap of gum tissue over the crown of the tooth during eruption. It's farily common for this flap of skin to become infected and inflamed," he says. The resulting pain can be severe, and if the infection spreads to other facial tissue, the problem can be serious.

"At the first sign of unusual pain,people should call their dentist. If the problem is particularly severe or complicated, the family dentist may call in a specialist, but as a rule, general dentists are pretty well-equipped to handle most emergencies. The important point," Jaspers stresses, "is that putting off a visit to the dentist's office only leads to more problems."

Before you get to the dentist, youcan take a few steps to alleviate pain. In the case of toothache or infection in the mouth, keep the patient's head elevated to lower the blood pressure and rinse his mouth thoroughly with warm salt water to cleanse the affected area. Minor painkillers, such as aspirin, acetaminophen, or ibuprofen, may be helpful as well. Dentists advise against the once-common practice of crushing aspirin around the tooth, because aspirin, an acid, can burn the gums and harm the teeth.

Physical injury to themouth from such incidents as falls, automobile accidents, or contact sports is another frequent cause of dental emergencies. When teeth were broken 30 years ago, dentists typically cauterized the nerve and the blood vessels and dismissed the patient. Recently, however, a variety of new materials and techniques has made it possible for the dentist to restore a broken tooth to normal, often in a single visit.

Bonding is a technique inwhich composite resins, or tooth-colored plastics, are painted onto the surface of the tooth. Dried with a special light, the composite is then shaped and polished until it matches the patient's other teeth. Bonding is widely used to repair chipped and broken teeth, to mask various dental defects, and to narrow gaps between teeth. The process is fast and panless. With proper care, the bonding will last three to five years, and it can be replaced.

A related procedure uses porcelainlaminates to rebuild the damaged tooth. More complicated and costly, laminating is irreversible. The resulting restoration is much stronger than composite resin, and the color of the tooth is more stable.

Several types of crowns also helpdentists repair broken teeth. Stainless steel, ceramics, and gold are all used to reconstruct the surface of the tooth. Several visits to the dentist are necessary and the cost is higher than that of other tooth repairs, but the result is a nearly normal tooth that will last many years.

When it comes to whole missing teeth, dentists are oftenable to work a minor miracle: implanting the tooth back in the mouth, where it remains vital and functional. But for the process to be successful, the patient must act quickly, following these steps:

1. Pick up the tooth (with clean hands) by thecrown--do not touch the roots if you can avoid it.

2. Gently rinse the tooth in water or milk.

3. Replace the tooth in its socket, if you can. If not,place the tooth under the patient's tongue or next to his cheek. If for some reason you can't place the tooth in the patient's mouth, keep it in a glass of water or milk or wrap it in a moistened paper towel.

4. Get the patient (and the tooth) to a dentist within 30minutes, if possible. (Virtually every dentist will see an emergency case immediately.)

If the original tooth is usable, your dentist may be able toreposition the tooth and secure it in place. Many dental specialists are also able to perform dental implants, a procedure in which a small metal post is inserted in the jawbone and an artificial tooth is built up and mounted on the post. This technique is not recommended in all cases, but when appropriate, it has been very successful. Replacing teeth that have been knocked out is especially important in children to maintain the natural spacing of teeth in the jaw and to help prevent orthodontic problems later in life.

The age of the patient has much to do with the long-termprognosis for a replaced tooth, says Dr. James Jensen, associate dean at the University of Minnesota School of Dentistry and an internationally known endodontist. "A permanent tooth placed back in the mouth of a child, when the bones and other tissues are still growing, may last many years. The older the patient, however, the greater the probability that the tooth will be resorbed or rejected by the body. if a tooth that's been replaced in an adult last more than two or three years, I'd consider the patient lucky."

Jensen notes that dental emergencies resulting from contactsports are decreasing in frequency. "I can remember one two-week period 20 years ago when I saw 20 to 25 kids who had dental injuries from hockey sticks. Dentists and coaches have promoted mouth guards and helmets, and they have really saved a lot of teeth.

"Dentists have been able to prevent a lot of dentaldisease with fluoride," Jensen says, "but there's not much we can do to prevent dental emergencies. Mouth guards and good advice are about all we have to offer."

The advice?

1. Don't chew on pencils, hairpins, or other hard objects.

2. Don't use toothpicks with strong pressure.

3. Don't bite on such hard substances as ice, popcornkernels, unshelled nuts, or plastic.

4. Avoid grinding your teeth.

5. Remember that acid weakens teeth. Such practices assucking on lemons and chewing vitamin C tables or aspiring should be avoided.

6. When participating in contact sports or otherdangerous activities, wear a custom-made mouth guard.

7. Wear seat belts when riding in automobiles.

Following this advice and cautioning children to playsafely are about all than can be done to prevent dental accidents. When accidents to occur, your family dentist can do much to restore your teeth and give you something to smile about once again.
COPYRIGHT 1987 Saturday Evening Post Society
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Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Author:Born, David O.
Publication:Saturday Evening Post
Date:Apr 1, 1987
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