Traumatic Dental Injuries: Children’s Cases

Dealing with injuries in children’s teeth is a little different than with grown adults; their incoming adult teeth have not fully come through and developed a strong, established root.

The apex, or tip of the root (way down/up in the gums), in a tooth that has not yet matured in a child’s mouth, has a far larger opening than a mature tooth. The reason why this opening is wider during the young stages is so that nutrients can more easily enter the tooth to help it develop strength and health as the child grows up. Compare it to an ice cream waffle cone, where the crown of the tooth is where the scoop of ice cream goes, and the apex is the pointy part at the bottom. If you were to bite a hole in the bottom of the cone, it would leave an opening… and ice cream would drip out.

Well, the anatomy of a tooth is similar. In a still-developing adult tooth, the hole is just much wider, and the walls of the root canal are thinner. As the child and his teeth mature, the apex opening grows smaller, the walls thicker, and the tooth becomes nice and sturdy.

If an injury were to occur to these young adult teeth, special care is needed if the health of the tooth is to be preserved to its full potential. One of two kinds of procedures may be needed: apexogenesis or apexification. I will cover these in future posts.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Traumatic Dental Injuries: Further Treatment

Besides fracturing immature adult teeth, the aforementioned dislodging or knocking out completely are some things that young people have to endure sometimes, unfortunately. However, modern dentistry has so much more to offer now than it ever did, thanks to science, technology and really, really smart people; so the level of treatment, restoration, or therapy only depends on the severity of damage done. The good news is that something can always be done.

If a young adult tooth were to be minorly dislodged (which means moved out of its natural position, remember?), extensive treatment may not even be necessary. The tooth may be only monitored over a period of time, possibly with minor adjustments made here and there, to ensure it continues to grow and develop normally. A tooth severely dislodged, surgery may have to be performed to restore stability and strength. In both of these cases, though, the tooth’s natural potential for strength will never be reached because of the injury, no matter what kind of treatment is performed.

If this immature tooth has been knocked out completely, if it can be put back into its socket and stabilized within one hour and watched closely by a dentist for a few weeks, chances are good that it can be saved. Changes in the tooth’s appearance and feeling will be monitored as well, and if any signs of decay or infection arise, then measures — particularly apexification — may have to be taken to keep it alive and well. If the tooth has been out for longer than an hour, it has probably dried out and must be filled with medication, put back into the socket, and re-stabilized as a “dead” tooth.

In either of those cases, the tooth is likely to not last as long as the others, in which case other options (say, an implant) will have to be discussed with the endodontist.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Traumatic Dental Injuries: Avulsed Teeth

An avulsed tooth means it has fallen out — or been knocked out — completely. Even though it has been separated from your mouth, the tooth can still be saved if you act quickly. Try not to touch the root part of the tooth when you pick it up, and use only water to rinse it off if it is dirty. You must see a dentist immediately to try and put it back into its socket. Until that time, the more moist you can keep the tooth (i.e. by keeping it in a glass of water or milk with a pinch of salt), the better your chances will be of saving the tooth. Otherwise, if the tooth becomes infected or dies, an artificial tooth will probably have to replace it.

If, however, your dentist was able to salvage your real tooth and put it back into your socket, and design a splint to hold it in place for a while as it heals and re-stabilizes in your mouth. A root canal may be required to avoid or eliminate infection. The length of time the tooth was out of your mouth and the way the tooth was preserved will influence the decisions made on how your treatment will be carried out.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Traumatic Dental Injuries: Dislodged Teeth

To have a dislodged tooth means the tooth has been moved from its natural position. Either it may have been pushed further into its socket, in which case the tooth will look “shorter” than the rest around it; or it will have been pushed partially out of its socket, which means it will be hanging down further than the rest of your teeth. Both cases may cause extreme discomfort and pain, and a trip to the dentist or endodontist is required to reposition and re-stabilize the tooth. Depending on whether the tooth’s pulp is affected, a root canal may or may not be needed. The dentist will closely monitor the progress of the tooth’s healing and the recovery process until regularity is restored.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Traumatic Dental Injuries: Chipped Or Fractured Teeth

Describing a chipped or fractured tooth as an injury is pretty self-explanatory. This kind of injury can range from a minor chip to a split extending from the crown/cusp to the apex (tip of the root), requiring a simple filling or full-on root canal and restoration treatment, respectively. If the tooth’s pulp is exposed, sterility and speed of repair are crucial in preserving the tooth’s life and health, and to prevent infections that lead to more difficult problems. A root canal is often called for because cracks in the teeth do, in fact, affect the pulp if they are large enough, and in either case the strength of the tooth overall is diminished. Sometimes part or all of the tooth must be replaced if its original durability and function are lost.

Dr. Boyajian, West Los Angeles

Healthy Gums, Healthy Body

Lately, numerous amounts of questions have arisen on the topic concerning the connection between oral health and overall health. Does the former really affect the latter? How is someone possibly at risk for heart disease or low birth weight babies if the apparent problem is only in his/her mouth?

Our bodies are not a jumble of different mechanisms forming one walking, talking unit. Each of the body’s systems — the nervous system, the cardiovascular system, the endocrine system, etc. — work in unison to keep us living in steady homeostasis! If one system fails or malfunctions, it gradually leads to another system losing its ability to function properly, and it spirals downward from there.

Inflamed parts of your body can lead to further inflammation or infection in other parts. Periodontitis is the body’s response to harmful bacteria left in your mouth. Periodontitis — ahem gum disease, if severe enough and untreated long enough, will, in fact, set off other inflammatory mechanisms in your body, leading to such things as diabetes, cardiovascular (heart) disease, and preterm and low birth weight babies. And gum disease is common — it can happen to anyone.

Don’t ignore the significance of this link. Good oral hygiene is serious!

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Interdisciplinary Oral Health Care

Another extremely important trait that The Pankey Institute develops in its dentists’ methods is consultation of fellow dentists or other specialists in order to get the best possible input, and thus make the wisest, most beneficial decision for the patient in certain cases. Dentists don’t know everything! This is why he/she may refer you to an endodontist (tooth-innards specialist) if the insides of your teeth — the pulp, nerve, etc. — are infected; or maybe an orthodontist for braces; or a periodontist for gum disease or dental implantation. A dentist practicing general dentistry may not have the expertise an oral surgeon might… and so on.

All of these experts schedule extra time — outside of daily office appointments and patients’ time spent in the chair — to compare opinions, knowledge, and information… “teaming up”, if you will. This is called Interdisciplinary Dental Care. Interdisciplinary Dental Care is extremely valuable for bringing you the best possible results.

And taking a second… or third… or twentieth… approach to a certain problem is never a bad idea, right?

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Comprehensive Co-Discovery Examination

As postgraduates at Pankey, they teach us how to develop a comprehensive style of dentistry, which means a lot of time is spent gathering a patient’s information — dental history, past dental experiences, current state of oral health, questions/concerns/desires/needs, etc. — and forming customized solutions that cater perfectly to these factors. A patient may come in for a complete comprehensive examination to see where he/she stands orally. The patient is very involved in the process of discovering which kind of treatments or improvements are most wanted or needed; this allows both the patient and dentist to form a sturdy relationship, bringing a source of ongoing assistance and the best of dental treatment to the patient.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

The Pankey Institute

This institute is well-known in the dental field for its excellency and quality of continued dental education; namely, a school to refine dental skills and produce professional, well-rounded practitioners. We are trained to develop a comprehensive style of dentistry, treating each individual patient with the utmost care and concern, always on the lookout for his/her best interests and specific needs.

This comprehensive approach is what brings you the friendly, professional experience from the time you walk in the door and speak with the receptionist to when you exit with your long-lasting, functional pearly whites. Finding the balance between professionality, top-notch quality, and warm personalities in a dental office are important for bringing you the best dental experience possible, lasting for generations… and, in my practice, this is priority.

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com

Back to the Basics

Last week we had a staff meeting in the early afternoon, and we talked about gum disease.

I’ve blogged about this before… but did I really make the point clear about what gum disease is? Do YOU know exactly what it is? Let me explain in simple English:

There is a space or small gap in between your gums and your teeth, right where you see the gums meet your teeth (where you are supposed to floss). When bad bacteria are not cleaned out of these gaps — or “pockets”, as we call them — the gums may swell up, start hurting, or turn red and sensitive. The spaces grow bigger, slowly deepening and separating from the tooth. The tooth is also slowly being eaten away by this bacteria and its acidic waste. After a while, if nothing is done about it, this turns into a serious infection that can and will cause loose teeth, tooth loss, and many other painful complications that could have been easily avoided.

Brush and floss your teeth!

Dr. Boyajian, West Los Angeles

www.dentalwellnessarts.com