Parent / Patient Education
POST OP CARE
To help you provide continuing care at home for your child following their appointment, the following information is offered to assist you.
Many of the dental procedures require numbing medicine so that the work can be completed painlessly. If the treatment was done on lower teeth, your child’s tongue, teeth, lip and cheek will be numb. If the treatment was done on upper teeth, your child’s teeth, lip and cheek will be numb. the numbness normally lasts approximately two hours. If your child chews, sucks or plays with the areas that are numb they may cause trauma to the area. This trauma can cause severe swelling and bleeding. Please watch your child carefully for two hours after the appointment and remind them to stop any behaviors causing trauma. It is wise to keep your child from chewing or eating until after the numbness has disappeared.
Most of the bleeding should have subsided prior to leaving the office. The gauze provided to you should be placed in the mouth at least thirty minutes after the extraction. Make sure your child is biting down on the gauze, rather than chewing it. If the bleeding stops and then restarts, have your child stop their activities, rest quietly for thirty additional minutes and bite on gauze again. Remember that a little bit of blood and a little bit of saliva combine to make it appear that your child is bleeding much more than is actually occurring. If the bleeding still continues after the above procedure and you are able to see bright red drops of blood dripping every 1-2 seconds, please contact the office immediately.
The most common cause of swelling is a bite to the area that was numb for treatment. Your child did not realize that they were biting on their lip, cheek or tongue. If you notice swelling, place ice on the area, administer over-the-counter pain medication and watch for signs of infection (redness, drainage, fever). Contact the office as necessary, particularly if your child is having difficulty swallowing or breathing.
STAINLESS STEEL CROWNS
The gums can often be sensitive for several days after the placement of stainless steel crowns. This is to be expected and over-the-counter pain medications should be administered as needed. Acetaminophen and ibuprofren can be administered as directed in the office. Brushing must continue despite bleeding or soreness so that food impaction does not cause an infection. Administering pain medication thirty to sixty minutes prior to brushing time can be helpful. Expect the gums to bleed when brushing or eating for several days.
Diet restrictions must be enforced so that the cement holding the crown around the tooth remains strong. Avoid sticky or chewy foods (gum, raisins, starburst, gummy bears, etc.) for as long as the crown is needed in the mouth.
Space maintainers require careful attention and inspection by the parent. Look to make sure the appliance does not move when your child eats or brushes. If so, the appliance needs to be evaluated by the dentist. Additionally, sticky foods (gum, raisins, starburst, gummy bears, etc.) must be avoided as long as the appliance is in the mouth.
If you notice a permanent tooth coming in underneath the space maintainer, an appointment is necessary as soon as possible to evaluate the continued need for the appliance.
SEDATION OR GENERAL ANESTHESIA
The medications your child received take six to eight hours to wear off completely. Keep your child resting comfortably at home (no shopping, daycare, vigorous physical activity) for the remainder of the day. Offer plenty of liquids to drink (if sleeping, wake your child every hour and encourage a few small sips of drink). Administer over-the-counter pain medications as directed at the office. Begin with a soft diet (puddings, mashed potatoes, macaroni and cheese, yogurt, etc.) and advance as your child tolerates or requests. Contact the office with any additional questions.
Home care is imperative if you want to maintain a healthy, beautiful smile. Establishing habits for your child at the youngest age helps create behavior that keeps teeth in their healthiest condition.
From the very first meal your baby consumes it is important to establish dental care. After the bottle or nursing, use a damp piece of gauze, washcloth or gum cleanser to gently wipe their gums, tongue and cheek. This helps acclimate your child to dental cleansing, as well as removes residual liquid. This is especially important once their teeth erupt and if they are fed during the night when saliva production decreases and cavity risk increases. Never allow your baby or child to take a bottle or cup to bed with anything other than water in it.
You can also reduce the risk of your child developing cavities by avoiding the placement of any item in their mouth that has been in someone else’s mouth just prior to your child’s mouth (i.e. a pacifier that fell on the floor and was “cleaned” off with your saliva, a spoon that was put in your mouth to check the temperature of the child’s food and then given to the child). The bacteria that cause cavities do not exist in a newborn’s mouth and are acquired from the people around us. Limiting the chances of cross contact reduces the bacterial exposure to your child.
Chewing gum with the ingredient xylitol has been shown to reduce cavities in children. Additionally, research has found that parents chewing gum containing the sweetener xylitol have children with decreased rates of cavities. Xylitol can be found in many common gum products and it is listed as an ingredient when present. Chewing a xylitol-containing gum once or twice a day for fifteen minutes is effective.
CHILDREN AND ADOLESCENTS
Teeth should be brushed twice a day for two minutes at each brushing. Children need supervision with their brushing up to age ten. If you wouldn’t allow your children to bathe themselves, they shouldn’t be allowed to brush alone. The toothbrush should have soft bristles and should be used to scrub in small circles along the gumline and along all of the surfaces of the teeth. Motorized toothbrushes do not work any better than manual toothbrushes but your child may be willing to brush longer with an motorized toothbrush, so they should be encouraged to use a motorized toothbrush if they increase brushing time.
Flossing should be done daily, preferably in the evening. If your child has teeth that touch together (i.e., you cannot see pink gum tissue in between two teeth), those teeth need to be flossed. The floss should be twelve to eighteen inches long. An easy way to get the right length is to have your child hold the floss end between two fingers and stretch the floss out until the length touches the elbow. The floss should be wrapped around the middle finger of each hand so that the thumb and first finger can be used to guide the floss gently between the teeth. Flossing aids are available to make flossing easier for children.
If your child can effectively spit, it is appropriate to use a toothpaste containing fluoride. Most children can effectively spit by the age of four. If your child is unable to spit, use a children’s toothpaste without fluoride or a gum cleanser. At no time should a large amount of toothpaste be placed on the brush. The ideal amount of toothpaste is the size of a pea. Any larger amount may cause your child to ingest too much fluoride. Excessive quantities of fluoride can damage the enamel development of permanent teeth and are highly discouraged.
Fluoride rinses are helpful in preventing the formation of cavities in between the teeth. Children that cannot spit should not be given fluoride rinses. Many over the counter products are available and come in many child pleasing flavors.
Fermentable carbohydrates (sugars and starches) are required for the cavity-causing bacteria to attack the tooth surface and cause cavities. There are many hidden sources of fermentable carbohydrates in childhood diets and efforts should be made to monitor the intake of these substances.
The only two things we have to drink that won’t cause cavities are white milk and water. All other substances have acids and/or sugars that put our teeth at risk. Limits should be placed on the number of times each day your child is allowed to drink juice, soda, sport drinks, lemonade, tea, etc. Each time a sip of these drinks is consumed, your child is at risk for developing cavities for approximately thirty minutes. This is the time required for the saliva to buffer the sugars and acids and return the natural balance of the mouth back to normal. If your child wishes to consume these types of beverages that place the teeth at risk of getting cavities, please try to limit these to meal time only. More saliva is produced when food is consumed and meal time is a limited time frame that establishes a shorter time period where the teeth are at risk. Encourage water and white milk as the beverages of choice in between meals.
Watch your child’s diet for hidden exposures to fermentable carbohydrates. Raisins, yogurt, ketchup, instant oatmeal, and fruit snacks are some of the biggest offenders in childhood diets. These items have high levels of fermentable carbohydrates and place the teeth at risk for disease. Nutrition labels will list the sugar grams in serving amounts. Four grams of sugar is equal to one teaspoon of table sugar. Careful observation of nutrition labels will quickly determine where the sugars in your child’s diet are very high and should be reduced.
Trauma is the number one cause of dental emergencies for children. Should your child suffer trauma to the mouth, lips, chin or teeth please contact the office as soon as possible so that an evaluation can be done. If your child loses consciousness as a result of an injury to the head and dental injury is apparent, please proceed to your nearest emergency room.
If your child’s permanent tooth is knocked out, find the tooth and rinse it gently with plain water. Do not scrub it or clean it with anything. Try to hold it by the crown only (try not to touch the root). If possible, try to place the tooth back into your child’s mouth, either in the socket where it belongs or between the cheek and gum (cover lightly with a piece of clean gauze or paper towel to prevent swallowing of the tooth). If unable to place it back in the mouth, put it in a container with milk, saliva or plain water. Contact your dentist as soon as possible. The sooner the tooth can be treated, the better chance the tooth has for surviving the trauma.
If your child’s baby tooth is knocked out, do not attempt to replace it or worry about trying to protect it. Do find the tooth and save it in case your child needs to have an emergency evaluation. The doctor will want to see how much of the tooth was lost. Baby teeth do not survive trauma well and are better left for the tooth fairy.
If your child develops swelling in the mouth, please contact the office for evaluation. Over the counter pain medications should be administered for pain relief until treatment can be obtained. Should the swelling cause difficulty in swallow or breathing, proceed to your nearest emergency room.
From birth until the age of two, your child will gradually gain their primary (baby) teeth. Primary dentition consists of ten teeth on the top and ten teeth on the bottom of their mouths. These teeth are important in determining where the permanent teeth will be placed and aid in the chewing of food, as well as speech. Primary teeth are very white in color and should function in the mouth until the age of six. Yellow or brown discoloration as well as bright white spots on these teeth are often indicators of cavities and should be evaluated as soon as possible by your dentist. It is very important that primary teeth are kept in place until they are lost naturally. Regular dental care helps achieve this goal.
Around the age of six, the front primary teeth begin to loosen and will be replaced by the permanent incisors. At the same time, the permanent six year molars will erupt through the gums in the back of your child’s mouth. After the eight primary incisors are lost, most patients will not lose any more teeth until age ten or so. Then the primary molars will be replaced by the permanent premolars. This time is critical for the observation of the growth of the permanent teeth so that intervention can be prescribed as needed for braces (orthodontics). Final eruption of the wisdom teeth (third molars) can start as early as age fifteen or sixteen and can be delayed for some people into their twenties.