Pain Relief for Wisdom Teeth Removal

By: Adeola Abisogun, Livestrong

 

🙂 Pain may occur after a wisdom tooth removal. To avoid this and prevent any complications, follow your dentist’s guidelines for a best dental experience! The Oral Surgery DC Team

 

Having your wisdom teeth removed is a common procedure, but some risks are involved. These risks include pain, temporary swelling and bruising and some less common complications. Pain relief for wisdom teeth removal is best managed by following your dentist’s instructions, which may include over-the-counter or prescription medication, comfort measures and ways to avoid preventable painful complications.

Over-the-Counter Medications

Simple extractions are performed for wisdom teeth that are not completely buried under gum or bone tissue, are positioned relatively straight compared to the other teeth and are easy for the dentist to loosen and remove. Simple extractions involve a minimal amount of trauma to remove the tooth, so postoperative pain can often be managed with over-the-counter pain medications. Nonsteriodal antiinflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) are typically recommended for relief of mild or moderate pain. These medications have the combined benefits of relieving pain and reducing inflammation. If you have a health condition that prevents you from taking NSAIDs, your dentist or oral surgeon may recommend acetaminophen (Tylenol) or a prescription medication.

Prescription Pain Relievers

When wisdom teeth are difficult to loosen and remove, a surgical extraction may be performed. In these cases, postoperative pain can be more prominent and bruising or swelling may occur. Over-the-counter pain medications may not be adequate, so prescription-strength medications are often recommended. For moderate to severe pain, commonly prescribed pain relievers include prescription-strength ibuprofen (Motrin) and combination medications, such as codeine and acetominophen (Tylenol No. 3), hydrocodone and acetaminophen (Vicodin) and oxycodone and acetaminophen (Percocet). When taking these or any pain medications, it is important to follow specific dosage and safety instructions.

Comfort Measures

It is normal to have some discomfort or pain after having wisdom teeth removed. Avoiding alcohol, hot liquids and spicy foods and eating a soft diet in the days following the procedure can make the healing process more comfortable. Using warm salt water as a gentle mouth rinse for 24 to 48 hours after the procedure can have a soothing effect. Icing a swollen area at home can also help reduce swelling and pain. Place an ice pack wrapped in a thin cloth or towel on the swollen area for up to 15 minutes at a time.

Considerations

Some postoperative complications can lead to an unexpected increase in pain. Pain that increases 2 to 4 days after the procedure may indicate the development of a complication. Pain relief for these complications can include prescription pain medications and specific additional treatment. For example, antibiotics would be used to treat an infection or a special medicated dressing would be used for a complication known as dry socket. Before taking any medication, make sure your dentist or oral surgeon is aware of any medical conditions you have. Pregnancy, gastrointestinal problems, liver or kidney disease, high blood pressure or drug allergies are a few examples of conditions to pay special attention to before taking any new pain medication.

Source: https://www.livestrong.com/article/294960-foods-to-eat-after-wisdom-tooth-is-pulled/

Sedation Dentistry: Anesthesia Administered by a Medical Doctor

By: iCare Oral Surgery

 

🙂 Sedation dentistry is a relaxing dental procedure you should not be afraid of. Don’t hesitate to discuss your fear with your dentist so he can give you options for a better dental experience. The Oral Surgery DC Team

When your oral health care involves oral surgery, the thought of sitting in a dentist’s chair and having major work done can be daunting. There is a way to conquer the nerves. Sedation dentistry not only makes it possible for oral surgeries to be completed efficiently, the sedation is intended to ease a patient’s mind, allowing you to “sleep” through your dental repairs and wake up with a brand new smile. Sedation dentistry is a deep state of relaxation. You will wonder why you ever had any anxiety about the dentist when under anesthesia.

Types of Sedation Dentistry

Sedation DentistryIt is understandable to be leery of anesthesia in any form, but knowing that you are heading into an oral surgery without having to be fully awake for it can be a relief for many patients. Deep and moderate sedation is available for patients of all ages. Oral sedation, IV sedation, and laughing gas are common types of sedation dentistry. You and your oral surgeon will discuss the options together to determine what is best for your individual situation, needs, and overall health.

Some sedation will put the patient into a conscious but euphoric state that allows for relaxation and comfort. You will still be able to hear your oral surgeon and respond to any comments he may have, but you will be calm. Other types of oral sedation create a drowsy condition – some patients will fall asleep, others will be awake but groggy.

What Procedures Call for Sedation Dentistry?

Nearly any dental procedure, from dental cleanings to getting a cavity filled, can warrant the use of sedation dentistry, especially for the incredibly anxious patient. In general, sedation dentistry is used to make oral surgeries more tolerable in all ways. Because some oral health procedures require more than one dental appointment, sedation dentistry can make the process far more tolerable.

Here are just some of the instances when sedation dentistry is called upon:

  • Dental implants: Perhaps you have missing or loose teeth due to an accident or periodontal disease. You may have ill-fitting dentures and are ready to trade them in. In some situations, patients are receiving All-On-4 dental implants for their entire jaw. Whatever the reason for getting dental implants, these surgeries can be accelerated for you and simplified for your oral surgeon with the use of sedation dentistry.
  • Sleep apnea treatment: Obstructive sleep apnea is a serious condition that blocks airways, contributes to lack of oxygen to the brain and prevents the sufferer from getting a good night’s sleep. Soft tissue can be reduced by being surgically removed from the back of the throat and soft palate to help prevent sleep apnea from occurring.
  • Bone grafting: If you are not prepared to get dental implants and are still living with dentures, it may be necessary to undergo bone grafting to help improve the fit of the dentures. This procedure is done under sedation.
  • Wisdom teeth extraction: Depending on the position of your wisdom teeth, this procedure can be more than just pulling teeth out of the gums. Third molars may be impacted, under the gum line, or partially showing. Sedation dentistry makes the removal of wisdom teeth an easy-to-navigate rite of passage.
  • Corrective jaw surgery: A misaligned jaw may require the repositioning of the bones of the upper and lower jaw, whether to increase the size of the airway to relieve sleep apnea sufferers, or to get a mouth ready for orthodontic treatment. Without question, this orthographic surgery requires sedation.
  • Emergency dentistry: In situations where a patient is so distraught after an accident, fall, or injury, sedation dentistry is able to relax them while repairs are being made to their teeth or mouth to reduce interruptions or delays in treatment.

Are You a Candidate for Sedation Dentistry?

Before you undergo any type of oral surgery or sedation dentistry, your surgeon will review your full medical history. It is important to confirm that you have good overall health so that your dentist knows your body is able to handle any type of sedation.

This is also the best time to discuss any anxiety or fears you do have about the procedure you’ll be undergoing. When you are aware of the exact steps that will be used to administer the sedation and complete your oral surgery – from the tools used to the sounds the tools will make – that can ease your mind. However, there are also plenty of patients who would rather not know anything that is happening, in which case sedation dentistry is really a wonderful option to “remove” you from the situation for a little while.

When you are scheduled to undergo multiple restorative dentistry treatments at one time, including oral surgery, sedation dentistry is a given. This choice allows your dentist to work as efficiently as possible and prevents patients from focusing on time spent in the dentist’s chair.

 

Source: https://icareoralsurgery.com/sedation-dentistry/

Needle Phobia and Fainting

 

By: Dental Fear Central

 

😱 Do you feel anxious at the sight of needles? There is something you can do and your dentists can help you, too! The Oral Surgery DC Team

 

“I faint at the sight of needles.”

If you faint at the sight of needles, you may have what is called a blood-injury-injection (BII) phobia, where you get very anxious when seeing blood or an injury or when receiving an injection. It has been estimated that about 75% of people diagnosed with BII phobia report a history of fainting.

But in a study by DeJongh and his colleagues 1, only 37% of people with BII phobia reported having fainted in phobic situations in the past (and none of them actually fainted during dental treatment while taking part in the study). So it is unclear how common fainting really is.

What causes fainting?

Fainting due to blood-injury-injection phobia is the result of a sudden drop in blood pressure and heart rate. This type of fainting is called vasovagal syncope. It can also be triggered by emotional distress, straining to have a bowel movement or heat exposure. Vasovagal syncope is the most common type of fainting.

Psychologists don’t know exactly why some of us experience a drop in blood pressure when we see blood or have an injection. One theory is that it’s an evolutionary mechanism – back in the distant past when someone was coming at someone else with a sharp stick, a genetic variation allowed some individuals to faint in response. Because a person who had fainted looked dead, they might have survived attacks by other warriors during battle. Also, the drop in blood pressure might have helped those who were wounded to avoid bleeding to death. Survivors then passed on the “fainting gene”.

Vasovagal syncope is harmless and requires no treatment. But it’s possible you may injure yourself when you faint, for example by hitting your head (unlikely if you’re sitting in a dental chair at the time!).

If you experience fainting, your GP may want to refer you to a cardiologist to rule out heart problems as the cause.

The Mayo Clinic website has these tips for preventing vasovagal syncope:

If you feel like you might faint, lie down and lift your legs.

This allows gravity to keep blood flowing to your brain.

You can probably see where this is leading…

What your dentist and you can do:

“Fainting – it does happen. I would say a handful of my patients come over faint every year. This tends to happen just after giving local anaesthetic, especially when they have not eaten. Normally, I spot the signs and lay the patient either flat or with their feet slightly raised. I cannot recall the last time a patient actually properly passed out. These days I tend to give local anaesthetic with the patient reclined (if they are ok with that) and keep a close eye on them for the next few minutes.”

Lying down helps because the blood can flow to the brain more easily. It is much harder to faint when you are lying down. So if you are concerned about fainting, and don’t mind lying down, ask your dentist to give you the local anesthetic while lying down.

“I tend to have vasovagal reactions from dental injections – I actually fainted on one occasion. I realized, after starting to go to my current dentist, that lying flat – or beyond 180 degrees (especially during injections) significantly lessens the vasovagal response. At least I know that, in that position, it is nearly impossible to faint which lessens one of my fears.”

What you can do:

If lying down on its own isn’t enough (or you hate the idea of lying down), you can learn a technique called Applied Tension. Ideally, to learn it, you would work with a therapist, because this will make it easier to get ideas for exposure exercises. But you can also learn it on your own. Read through all the instructions first before you start practicing.

Step 1: Find a comfortable place in your home where you can be alone without anyone interrupting. Sit in a comfy chair or lie down on a sofa or a bed. Focus on the muscles in your legs, arms and trunk. Now tense those muscles (make them contract). Hold the tension until you feel a warm feeling or a “rush” in your head. This usually occurs after 10 to 15 seconds. Then, relax and rest for about 30 seconds. Repeat this four more times.

Step 2: Repeat step 1 five times per day (this means doing it 25 times per day altogether). Do this everyday for one week. This may seem like a lot, but the better you get at this technique, the easier it will be when you put it to work in a stressful situation. You want to practice enough that it becomes automatic.

Don’t overdo it, though. If you are getting headaches it could mean that you’re tensing too hard. If this happens, do the tensing exercise less often or don’t tense the muscles as hard.

Step 3: It will be very helpful for you to know the physical symptoms you experience just before you faint. These will be different for different people. You may feel

  • light-headedness
  • clamminess
  • hot or cold flushes
  • nausea
  • or other symptoms (everyone is unique!)

If you can recognise the early warning signs, you can then start applied tension to reverse the fainting process and stop the faint before it happens.

Step 4: Now it’s time to practice applied tension while exposing yourself to things that make you feel faint. This exposure starts with “easier” things like looking at a picture of a toy syringe or a drawing of a syringe, for example. As you master each situation, you move on to more difficult things. This is where a psychologist comes in handy, because they can help with suggestions for exposure exercises, and with creating an exposure hierarchy. An exposure hierarchy means that you have a variety of scenarios that may make you faint (these could be thinking about a situation, looking at a drawing or photo of the feared situation, watching a video, or actually doing it for real).

If you’re not just practicing for dental injections, but for an injection in the arm (for example because you want to go on holiday to an exotic destination and need a vaccine), you’ll need to relax the arm where the injection will be given while tensing all of the other muscles in your body. This will require some extra practice.

 

Source: https://www.dentalfearcentral.org/fears/needle-phobia/fainting/

What Are the Common Side Effects of Dental Implant Surgery?

By: Coastal Jaw Surgery
🙂 Dental implants are proved and tested to be safe. There may be some minimal side effects within a week after the surgery. Read more about the common side effects! The Oral Surgery DC Team

Tooth loss is a dental complication that can have a significant impact on a person’s oral health. Whether a single tooth has gone missing or multiple teeth have been lost, the effects on adjacent teeth can be serious. Missing teeth can jeopardize oral functions, compromise the aesthetics of the smile, and even weaken the jawbone. Because of the many disadvantages of tooth loss, it is important that patients address this problem as soon as possible. Implant dentistry offers the strongest and most durable treatment for missing teeth. Dental implants are surgically implanted screws that anchor a full range of dental restorations to closely mimic the natural teeth. Dental implant surgery is associated with some possible side effects. At Coastal Jaw Surgery, we discuss possible dental implant surgery side effects with our patients so that they are fully prepared for their recovery period.

Side Effects

Dental implant surgery is minimally invasive and has been shown to be an overwhelmingly successful treatment option for missing teeth. Still, because it is a surgical procedure, patients should expect to experience some side effects in the days following treatment. These side effects are often minimal and should resolve within a week after surgery. Below are the most common side effects of dental implant surgery:

Pain: During dental implant treatment, anesthetic will be used to ensure that the patient does not feel any pain. However, in the days after surgery, it is common for the patient to experience some pain or discomfort. The gums directly around the implant site will probably feel sore and tender. This discomfort may extend to the jaw or face as well. In some cases, pain medication will be prescribed. If no medication is prescribed, then over-the-counter medication can be used to control pain. It is important to note that aspirin can increase bleeding, so patients should be sure to use an aspirin-free medication, such as ibuprofen.

Swelling: Swelling is a natural reaction after any type of surgery, so patients should expect to experience some inflammation after dental implant treatment. This swelling is most likely to affect the gums around the incision site and the facial tissues that are closest to the treatment area. Swelling should subside on its own, but patients can use an ice pack to help minimize swelling and relieve any discomfort that may be felt.

Bruising: Bruising is another common side effect of dental implant surgery. Most commonly, patients will experience bruising in the gums and jaw bone around the implant site. This bruising will probably be internal, so it may not be visible. Some patients may also experience noticeable bruising on the cheeks.

The side effects of dental implant surgery are temporary and should diminish on their own. If a patient’s symptoms are not improving, or are getting worse, report this to our dentists immediately. Severe side effects may be a sign of infection or other complications.

Source: http://www.coastaljaw.com/common-side-effects-dental-implant-surgery/

 

Cavities: How and Why Do Dentists Fix Cavities for Children?

By: 123 Dentist

 

😞 Kids are not safe from cavities. This condition should receive immediate treatment before it causes pain to your child. The Oral Surgery DC Team

 

Though children are using a set of teeth they will eventually lose, that set of teeth needs to survive until the adult teeth guide them out of the gums, which helps ensure the adult teeth grow incorrectly and with enough room. That’s why oral hygiene is important as soon as a baby’s teeth begin to come in, and teaching oral hygiene should begin at a young age. Despite your best efforts to ensure good dental hygiene, sometimes kids end up with cavities. Cavity care for children is very similar to cavity care for adults because preserving tooth health is the most important aspect.

Baby Teeth Get Fillings

Though baby teeth aren’t permanent, they are the only teeth your child will have for several years, until the adult teeth come in. To preserve your child’s oral health, your dentist will opt to drill out the cavities in baby teeth and fill or crown them accordingly. The primary teeth help the adult teeth to come in properly, so losing primary teeth before they’re ready to come out isn’t good for your child’s permanent teeth.

Filling for Tooth Decay

As with adult teeth, baby teeth fillings are made out of either white composite or metal. The other filling and crown materials, like gold and ceramic, are rarely as fillings for children. Metal fillings are a popular choice because they take less time to put in, and because they’re less expensive than composite fillings. Though your kid might not like the look of a metal filling, choosing a cost-effective option for a tooth that will eventually fall out is usually the smart move. Your dental insurance may also dictate what kind of fillings your child can get.

Your dentist will drill the tooth decay from your child’s baby teeth as necessary. Depending on how much damage the cavity has caused, the dentist will then fill the tooth or create a crown. Kids should continue using good oral hygiene when caring for fillings or crowns, whether those repairs have been done on baby teeth or on permanent teeth.

Decay Can Recur

Though your dentist works very hard to remove all the tooth decay, sometimes it is a recurring issue. Teeth with cavities between them, even with decay removal and fillings, have a better chance of cavity recurrence than teeth with cavities on exposed surfaces. When decay comes back, the dentist will need to replace the filling to take care of the new decay and re-fill the tooth.

Trauma and Other Issues Also Require Fillings and Crowns

Tooth decay is just one reason kids need fillings. If trauma has happened to the tooth to cause a crack, a filling is necessary as well. Other issues include incorrectly shaped teeth, underdeveloped teeth, and teeth which have chipped. Dentists often opt for crowns on both front and back teeth instead of fillings in these instances, as the crown can provide more complete correction to the damaged or misshapen tooth than a filling could.

Sometimes Extraction Is Necessary

Preserving baby teeth is an important part of dental care for children. The reason revolves around maintaining the right amount of space for the adult teeth to come in. However, sometimes your dentist will have no choice but to pull the baby tooth early. If the decay is so advanced it’s causing gum issues or pain for your child, extraction becomes the best option. Many dentists fill the gap where the extracted baby tooth was removed with a prosthetic to maintain the correct space for the adult tooth to come in.

Kids Sometimes Get Laughing Gas

When children are having cavities filled, dentists sometimes opt to use nitrous oxide, commonly called laughing gas. If you’ve ever experienced this gas at the dentist before, you may remember the sensation that it provides. For some children, nitrous oxide reduces anxiety and distracts them from the pain associated with both getting that Novocaine shot in the gums and getting a tooth drilled. Nitrous oxide doesn’t work for all kids, and your dentist may opt to go with an orally administered sedative, instead. And of course, as with many things, not all dentists offer nitrous oxide, so it’s best to check beforehand.

The Number of Fillings in One Sitting Depends on the Kid

When dentists fix cavities for kids, sometimes they do all the cavities at once and sometimes they do only one at a time. The reason for this has to do with the kids, not the cavities. Some children are fine sitting in the chair for long periods of time, while others are not. Dentists want the best outcome for the kid, and if that means making multiple appointments to fill cavities, then that is what will happen. Providing quality oral care to a crying child is very difficult for both the kids and the parents.

If you’re anxious about your child’s first filling, our dentists will put you at ease. We develop a treatment plan that is right for you and your child, with an aim to preserve the baby teeth until the adult teeth come in. The most important thing you can do as a parent is to keep teaching your kids about proper oral hygiene and continue scheduling regular professional teeth cleanings to minimize fillings and more invasive care.

Source: https://www.123dentist.com/cavities-how-do-dentists-fix-cavities-for-children/

How Safe Are Dental X-Rays?

By: 123 Dentist

 

🙂 As long as dental x-rays are used properly together with necessary safety precautions, its effect is extremely safe. Discuss the use of this device with your dentist so he can evaluate the factors if you need one. The Oral Surgery DC Team

 

Dental x-rays are a common diagnostic procedure that is considered extremely safe. Digital dental x-rays have very low doses of radiation, producing just a fraction of what you are exposed to in other imaging procedures. If you’re worried about whether you need dental x-rays, or wondering if you should forego this procedure due to other medical conditions, it’s helpful to dive a little deeper into what dental x-rays involve, why they’re performed, and how they’re best handled.

When these x-rays are performed properly with adequate safety precautions in place, there’s very little cause for concern. A routine examination with four bitewing x-rays exposes you to roughly the same amount of radiation you will experience during one to two hours on an airplane.

Who Needs Dental X-Rays

Dental x-rays are used diagnostically to help dentists see issues that are otherwise nearly invisible to the naked eye. Adults receive dental x-rays so dentists can better identify and treat various issues. Using these x-rays, your healthcare provider can see:

  • Areas of decay, including those in between teeth or under a filling
  • Bone loss associated with gum disease
  • Abscesses, which are infections at the root of the tooth or between the tooth and gum
  • Tumors
  • Changes in the root canal

Without an x-ray, many of these problems could go undiagnosed. With an x-ray as a reference, dentists are also better equipped to prepare tooth implants, dentures, braces, and other similar treatments.

Dental X-Rays and Children

Many parents are concerned about the impact of dental x-rays on children. Children are more sensitive to radiation. However, the amount of radiation in a dental x-ray is still considered safe for a child. As children’s jaws and teeth are continuously changing, it’s important to keep an eye on their development. These x-rays perform many important purposes for young patients. They help dentists to:

  • Make sure the mouth is large enough to accommodate incoming teeth
  • Monitor the development of wisdom teeth
  • Determine whether primary teeth are loosening properly to accommodate new permanent teeth
  • Identify decay and gum disease early

It’s important for children to visit the dentist regularly, and to get x-rays as recommended by the dentist. The exact schedule for these x-rays will vary depending on the child’s individual needs.

Dental X-Rays During Pregnancy

Pregnant women are generally advised to avoid dental x-rays. Though the radiation is minimal, it’s best to avoid all exposure when possible for the health of the developing fetus. For this reason, it’s important to tell your dentist if you are or may be pregnant.

However, there are some instances where pregnant women should still have dental x-rays performed. If you have a dental emergency or are in the middle of a dental treatment plan, you may still need x-rays during your pregnancy. Discuss the issue with your dentist to determine the best way to proceed. It’s crucial that you balance both your dental and prenatal health. Women with periodontal disease are at a higher risk of adverse pregnancy outcomes, so you shouldn’t neglect your teeth during pregnancy.

Your dentist can take greater precautions, such as using a leaded apron and thyroid collar, for all x-rays taken during your pregnancy if the procedure is deemed necessary. Keeping your dentist informed at all times is the best way to proceed.

Safety Precautions with Dental X-Rays

There are many things that your dentist can do to minimize the radiation from x-rays. Taking a single image rather than multiple images decreases exposure significantly. You can also speak to your dentist about using the lowest radiation setting possible, particularly for children. Leaded coverings can protect certain parts of your body from radiation.

Determining Whether X-Rays are Necessary

The best way to minimize radiation exposure from dental x-rays is to make sure these are only done when necessary. There is no set schedule for dental x-rays. Rather, it’s left to the healthcare provider to make an informed decision as to whether the patient needs x-rays with their examination. Factors that your dentist will consider include:

  • Age
  • Stage of dental development
  • History of oral health
  • Risk factors for various conditions
  • Presenting symptoms

One study revealed that performing a careful clinical evaluation of the patient can reduce the need for x-rays as much as 43 percent without any increase in the rate of undiagnosed diseases. So, if you’re concerned about exposure, ask your dentist to perform a visual examination before ordering x-rays. But keep in mind that there are several issues that there are many conditions that would likely only be diagnosed through x-rays.

To further minimize your need for x-rays, if you have x-rays from a previous dentist, make sure to transfer these to any new provider to eliminate the need for repeat procedures.

Dental x-rays are considered extremely safe. However, it’s important to understand the purpose of any procedure that will expose you to radiation. Don’t hesitate to discuss the need for dental x-rays with your dentist to better understand how he or she can help protect and improve your oral health.

Source: https://www.123dentist.com/how-safe-are-dental-x-rays/

More Preschoolers with Cavities Requiring Dental Surgery

 

By: Melanie at Parenting.com

 

😞 The increase in the number of preschool cavities is very alarming. As parents, we need to ensure they practice good oral hygiene even before the erosion of his teeth. Learn the effective ways on how to keep your child cavity-free. The Oral Surgery DC Team

What’s worse than going to the dentist? Taking your kids to the dentist—especially to find that they’ve got multiple cavities before they’re in kindergarten. The New York Times reports that a rise in the number of preschool cavities has led to a rise in the number of preschoolers requiring extensive dental work (often necessitating general anesthesia). Um, I guess not going to the dentist is actually worse than going.

Plus: The Link Between Sippy Cups & Cavities

As a mom of 2- and 4-year-old boys, I found myself squirming as I read the article, which led with a 2-year-old Seattle boy’s root canal, fillings and crowns, done to repair 11 cavities (kids that age have just 20 teeth in total). The Times reports that dentists nationwide are seeing more preschoolers from all socioeconomic backgrounds with 6 to 10 cavities or more, with a level of decay often necessitating general anesthesia because such young children have a hard time tolerating such extensive dental repairs while awake. (I’d have a hard time doing so too!)

While the number of preschool cavities is rising, dentists say that such tooth decay (and its painful treatment) is mostly preventable. Constant snacking, too much juice or other sugary beverages, drinking bottled water instead of fluoridated tap water and simply not knowing that kids so young should see a dentist are behind many of these cavities.

Plus: How to Keep Your Kids Cavity-Free

We checked in with Lawrence Limb, DMD, a pediatric dentist in New York City, to get his take on whether this is as serious and widespread a problem as it seemed after reading the Times’ report (hint: it is) and his suggestions for how parents can help prevent tooth decay in the littlest of kids.

In babies, Dr. Limb said that parents can usually get away with wiping the gums prior to the eruption of teeth to reduce the amount of bacteria on the gum pad. “As the teeth erupt (around six months), start introducing a toothbrush after each feeding,” he suggests. The American Academy of Pediatric Dentistry (AAPD) recommends using a “smear” of fluoridated toothpaste and a soft, age-appropriately sized toothbrush until age 2, and then a “pea-size” amount for kids ages 2 to 5. And while brushing after each feeding might be ideal for dental hygiene (albeit a lofty goal) while babies are at home, he acknowledges that for those in daycare or young children at school, brushing a minimum of twice a day should suffice.

Plus: Taking Care of Preemie Teeth

Of course, brushing a young child’s teeth isn’t as easy as brushing one’s own. But Dr. Limb points out that giving up on brushing or not doing a thorough job will lead to cavities and fillings down the line—which are vastly more painful than the temporary discomfort (or all-out tantrums) associated with brushing. If your child is particularly resistant to teeth brushing, Dr. Limb reassures that, “Kids do grow out of it as traumatic as it may seem. Treating the teeth [when there are cavities] is much more traumatic and difficult for the parent, patient and dentist.”

Plus: How to Know If Your Child Is Getting Enough Fluoride

So, think you’ve got it covered because you brush your children’s teeth twice daily? How ‘bout flossing? “Flossing is as important as brushing,” says Dr. Limb. “It’s not easy to do as a parent, but it’s necessary,” especially between the back molars, which kids will need for chewing until 10 to 12 years of age, and which are at the highest risk of developing dental caries (cavities).

And no need to wait until all of your child’s teeth are in to make a first visit to a dentist. The AAPD recommends seeing a pediatric dentist once the first tooth emerges, or no later than the child’s first birthday. Surprised? I was too—especially since my kids’ pediatrician hadn’t recommended making that first trip until age 2 (which in all honesty seemed really early to me even then). But, Dr. Limb explains that that first trip is important in terms of helping to establish not just proper oral hygiene but also getting parents to be more mindful of their children’s diet and nutrition and their impact on dental health. Following that first visit, Dr. Limb and the AAPD recommend check-ups every six months.

Not concerned about potential cavities because your child’s teeth look fine and he seems happy? Dr. Limb explains that cavities are often found in the back teeth (which are tough for parents to see well) and adds that many kids never experience any kind of oral pain unless there is a significant amount of decay—so don’t assume that your kid’s teeth are healthy just because he hasn’t complained to say anything is hurting. Additionally, dentists can find and treat cavities at a very early stage, using local anesthesia and a DVD for distraction, instead of the heavier duty sedation required for long, multiple procedures.

Adds Dr. Limb, “There are risks with general anesthesia or any kind of sedation with a child. Any conscientious doctor will always be concerned. In my office we try to treat children while awake. [These procedures] also place a great amount of financial liability on the parent—but can be easily avoided. As dentists, we really try to drive home the fact that these things can be avoided—[cavities] are treatable, but prevention is the best treatment overall.”

Dr. Joel Berg, director of the Center for Pediatric Dentistry at the University of Washington and Seattle Children’s Hospital, explained to TIME.com why treating cavities in baby teeth is so important, especially when those teeth will fall out anyway: “’We have to fix cavities to treat the overall health of the child. We see kids coming into emergency rooms with swollen faces from untreated cavities. Kids are not good at reporting tooth problems and this can lead to other orthodontia problems later and even trouble paying attention at school.’”

To help prevent cavities in the first place, Dr. Limb and other dentists recommend:

  • seeing a dentist regularly
  • drinking fluoridated water (bottled water generally has little to no fluoride)
  • eating a balanced diet
  • reducing the frequency of snacking
  • paying attention to proper oral hygiene (including regular brushing and flossing)
  • avoiding sharing utensils or putting your child’s pacifier in your mouth, as tooth decay can be contagious

 

Has your child had any cavities yet?

 Source: https://www.parenting.com/blogs/show-and-tell/melanie-parentingcom/kids-cavities

Top 3 Reasons for Kids Dental Surgery

By: Main Street Children’s Dentistry & Orthodontics Dentist

 

👩‍👧  Even children are not free from dental surgery if their oral hygiene is neglected. Guide them to a healthy oral routine and this will be avoided. The Oral Surgery DC Team

Your child’s dental health is determined by their dental habits. It’s important for kids to learn good oral hygiene when they’re young so they can grow up with a healthy smile. If your child’s smile is neglected or isn’t well protected, they may require dental surgery to treat their pain and problems. In order to avoid that scary scenario, you must help your child develop a healthy dental hygiene routine with regular visits to a pediatric dentist.

The Trouble of Tooth Decay

Did you know that the leading cause of kids dental surgery is tooth decay? Commonly known as cavities, tooth decay can develop for a variety of reasons, but it is typically the result of improper dental hygiene or a diet deficient in nutrients. That’s why experts in family dentistry advise parents to practice these dental health guidelines at home:

  • Help with Hygiene: Make sure that your child brushes and flosses their teeth in the morning and at night before bed.
  • Say No to Nighttime Sugars: Only give your child water to drink before bed. Giving kids sugary foods and drinks before bed without brushing afterward can lead to tooth decay.
  • Switch from Sweet Bottles: Don’t fill your child’s bedtime bottle with milk or juice because these beverages are filled with sugars and acids that can stick to your child’s teeth overnight and cause them to decay. Fill their bottles with water instead. And pediatric dentist experts say that sleeping with a bottle can affect a child’s dental development, so try to wean your child off of bedtime bottles as early as you can.

The Issue of Infection

When tooth decay is left untreated, it can spread inside of the tooth and cause an infection. This can be extremely dangerous for children and may require an emergency root canal. Even worse, if the infection has spread to the point that a root canal couldn’t control it, an expert in family dentistry may need to extract the tooth to prevent the infection from affecting other teeth.

The Drama of Tooth Trauma

Since so many kids play sports or are active in physical activities, it’s rather common for a pediatric dentist to treat children for tooth trauma. When the trauma is severe, it can do so much damage to the tooth that it needs to be extracted. Such extractions require kids dental surgery, which is frightening for children and parents. To prevent these scary accidents, children should wear a mouth guard when they’re playing sports or engaging in physical activity.

Source: https://www.mainstreetsmiles.com/news-and-articles/top-3-reasons-for-kids-dental-surgery/

Is Dental Sedation Safe For Kids?

By: Jenny Green, Colgate

 

👩‍👧  Parents play an important role during the dental sedation procedure. Prepare your child and follow the guidelines to gain positive results. The Oral Surgery DC Team

 

Safety is parents’ top consideration when it comes to their child receiving dental sedation. Dentists may recommend sedation for long, complex procedures and for patients who are especially young or nervous. Sedating a patient is normally a very safe procedure, and parents can help reduce the risks and stress level for their child before, during and after the treatment.

Types of Sedation

Oral sedation, nitrous oxide and intravenous sedation are the major types of sedation dentists provide. According to the Children’s Hospital of Pittsburgh of UPMC, oral sedation is taken by mouth or through the nose as soon as the patient arrives at the appointment, as the medicine usually takes up to 20 minutes to work. Oral sedation doesn’t put patients to sleep, but it helps them stay calm and relaxed.

Nitrous oxide, or laughing gas, also helps children remain calm. A mask delivers a mixture of nitrous oxide and oxygen, and within five minutes, the patient relaxes and experiences euphoric feelings. At the end of the procedure, pure oxygen is given to the patient to clear out any remaining nitrous oxide.

Intravenous sedation is delivered through a needle inserted into the patient’s vein. The American Society of Dentist Anesthesiologists explains that nitrous oxide is used to send the child to sleep before a needle is inserted, usually into a vein on the back of the child’s hand. A tube is also inserted into the patient’s throat to aid breathing.

Before Sedation

The American Academy of Pediatric Dentistry advises parents that children tolerate sedation and other dental procedures best if the parents understand what is happening and help prepare the child. Parents must restrict food and drink before sedation, and it’s especially important that parents follow these guidelines closely for key safety reasons, as sedation poses the risk of stomach contents being vomited and inhaled into the lungs. Dressing the child in loose-fitting clothing also helps because it allows dental assistants to attach monitors quickly and without fuss. Parents must provide a full medical history and tell the dentist if the child is receiving any prescriptions, over-the-counter medication or herbal supplements.

At the Dentist’s Office

Parents can help their children stay relaxed by being calm and encouraging, according to the Children’s Hospital of Pittsburgh. Try bringing along a comfort item for the kid to hold, such as a favorite toy or stuffed animal. Holding the child’s hand and talking or singing gently are other good comfort tactics. Parents should also avoid bringing other children to the appointment so that they can focus their full attention on the child receiving care.

Safety Checks

For dentists, ensuring the patient’s safety is paramount during dental sedation. While sedated, the patient’s blood oxygen level, blood pressure, temperature, and heart rate are closely monitored. A patient who requires general anesthesia may be referred to the dental hospital, such as that at the University of Maryland School of Dentistry.

After Sedation

At the Children’s Hospital of Pittsburgh, parents are usually asked to be present while their child wakes up after sedation. The child may be confused or fussy and may feel nauseous. Two adults should accompany the child or teen on the way home — one to drive and one to check the child’s breathing. Longer-lasting aftereffects of sedation include loss of physical coordination, dizziness, sleepiness, and nausea, so going back to school or daycare is definitely not an option on the day of the procedure.

For the first few hours after the procedure, parents should give the child only soft foods. If the child experiences vomiting, severe pain, severe bleeding or fever, parents should contact the dentist immediately. When the mouth has healed, the child may continue caring for his teeth as normal, brushing twice a day with a fluoride toothpaste, such as Colgate® Kids 2in1.

Dental sedation is a safe and fuss-free procedure with the right preparation and proper care after it’s over. By communicating clearly with your child’s dentist, you’ll provide the best possible experience for your child.

 

Resource: https://www.colgate.com/en-us/oral-health/procedures/anesthesia/is-dental-sedation-safe-for-kids-0415

Complications During and After Surgical Removal of Third Molars

By: Oral Health Group

💉 There are recent studies which identify risk factors during and after removal of third molars. Complications may arise, therefore, thorough planning and surgical skills are very important. The Oral Surgery DC Team

 

INTRODUCTION
Third molar surgery is one of the most common procedures performed in oral and maxillofacial surgery offices.1-6 Nevertheless, this procedure requires accurate planning and surgical skills. With surgical procedures in general, complications can always arise. The reported frequencies of complications after third molar removal are reported between 2.6 percent and 30.9 percent.1 The spectrum of complications ranges from minor expected sequelae of post-operative pain and swelling, to permanent nerve damage, mandibular fractures, and life-threatening infections. Minor complications are generally defined as complications that can recover without any further treatment. Major complications can be defined as complications that need further treatment and may result in irreversible consequences.5,6 Although impacted third molars may remain symptom-free indefinitely, they may be responsible for significant pathology.7 Pain, pericoronitis, development of periodontal disease on the second molar, crown and/or root resorption of the second molar, caries in third or second molars and TMJ-symptoms are associated with retained third molars.2 More significant pathology such as fascial space infections, spontaneous fracture of the mandible, and odontogenic cysts or tumors may also occur.2

There are numerous recent studies, which identify risk factors for intraoperative and/or postoperative complications.1,5,6,8-15 Common intra- and postoperative complications and side effects associated with third molar removal are summarized in Table 1. For the general dental practitioner, as well as the oral and maxillofacial surgeon, it is important to be familiar with all the possible complications. This improves patient education and leads to early recognition and management. In this review, complications are considered rare or unusual if the incidence is commonly quoted below 1 percent. The aim of this systematic review is to remind us of the unusual complications associated with third molar surgery.

METHOD AND MATERIALS

Studies were found using systematic searches in Medline and the Cochrane Library electronic databases between 1990 and the present. Additionally, hand searching of key texts, references, and reviews relevant to the field was performed. Keywords included the terms “third-molar,” “wisdom tooth,” “complications,” “unusual,” and “rare.”

Data were included if the following criteria were met:

1. The study had to deal with intra- or postoperative complications associated with the removal of third molars.

2. The date of publishing had to be between 1990 and 2013.

3. The text had to be published in English or German language.

In order to gather all the important studies, the references from the found studies were double-checked.

RESULTS
There are many studies reviewing permanent inferior alveolar and lingual nerve injuries and mandibular fractures during and after lower third molar removal. Several other studies/reports include inflammatory processes, unusual abscess formations and displacement of teeth in different spaces. An overview is shown in Table 2. All of these complications are considered major.

Furthermore, there are single case reports that describe extreme events, such as asphyxial death caused by postextraction hematoma, life-threatening hemorrhage, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. The reviewed case reports are presented in Table 3.

The main patient age among the cases was 28 (SD 12.7) years. In the majority of the cases, the complication occurred after third molar removal of the lower jaw. A second surgical intervention was needed in nearly all cases. In order to find the cause of the complication, computer tomography (CT) or magnetic resonance imaging (MRI) was need all of the cases. In the majority of the cases, the first surgical procedure was described as complicated and the intervention was reported as extensive or lengthy.

DISCUSSION

Permanent nerve damage
Permanent inferior alveolar or lingual nerve damages is extremely rare, but in general, well-known risks associated with third molar surgery. Injury of the lingual or the inferior alveolar nerves during removal of lower third molars is among the most common causes of litigation in dentistry.16 A close anatomic relationship between these nerves and the third molar places them at risk for injury. The incidence of these extremely rare complications vary among the studies and are difficult to be determined exactly due to the small study populations. The incidence of permanent inferior alveolar nerve lesions ranges from 0 percent17,18 to 0.9 percent;19 the usual accepted rate is about 0.3 percent.20,21 The complication rate for temporary lingual nerve damage is around 0.4 percent22 and for permanent lingual nerve damage, it is even lower.2,20

Mandibular fracture
Immediate or late fracture of the mandible is a rare event, but a major complication.23 The reduction of bone strength may be caused by physiologic atrophy, osteoporosis, pathologic processes, or can be secondary to surgical intervention.24 There is no valid data on the incidence of mandibular fractures and the risk factors are not clearly understood.24 Libersa et al., found an incidence of 0.0049 percent.25 In a study by Arrigoni & Lambrecht, 3980 third molar removals were analyzed.8 This group detected a complication rate of about 0.29 percent. The peak incidence occurs in patients over 25 years, with a mean age of 40 years.24-26 Due to a greater masticatory force, men may be more likely to have late fractures.25 Intraoperative fractures may occur with improper instrumentation and excessive force to the bone during tooth removal. Most late fractures occur between two to four weeks after surgery during masticating.51,62

Unusual inflammatory processes and abscess formation
In the reviewed case reports, extensions of the inflammatory processes to atypical regions of the brain and cervical region are discussed. In one case, a subperiosteal abscess of the orbit appeared in a 57-year-old man following the uneventful extraction of the left maxillary third molar27 which might have been caused by extension of infection via the pterygopalatine and infratemporal regions to the inferior orbital fissure. Another group presents a subdural empyema and herpes zoster syndrome (Hunt syndrome).28 In this case, a 21-year-old man had all four third molars removed. An abscess involving the right pterygomandibular and submasseteric spaces and extending to the infratemporal fossa was found. Although antibiotic therapy and drainage was initiated, he developed severe frontal headache and vomiting with a Glasgow coma score of 13. Magnetic resonance imaging (MRI) showed a subdural collection in the right temporoparietal region. He had emergency craniotomy and subdural drainage.28 Burgess reported a case of epidural abscess of a 20-year-old woman after extraction of a wisdom tooth.29 First, she was diagnosed with a musculoskeletal neck sprain resulting from posture during the operation. Three days later, the patient presented with an increased right-sided neck pain and sensational numbness to the right arm. Nine days after surgery, an epidural abscess to the right side of C4/C5 vertebrae was seen in the MRI29. In another case, a brain abscess developed after removal of the right lower third molar of a 26-year-old man. He needed emergency neurosurgery and antibiotic treatment for eight weeks.30

Displacement of third molars and instruments
Accidental displacement of impacted third molars, either a root fragment, the crown, or the entire tooth, is not common during extraction, but is nevertheless a well-recognized complication that is frequently mentioned in the literature.31-33,58 However, there is only limited information about its incidence and management. Displacement of mandibular teeth/roots usually occurs when it is located lingually, or when the lingual cortical plate is fenestrated and if surgical technique is poor.32 When a root fragment “disappears” during extraction, its retrieval should not be attempted. Immediate referral to a specialist should be arranged.34,35 Upper third molars can be displaced into the infratemporal fossa.38,39,52,56 Further reports describe third molar displacement into the submandibular space,33,38 the sublingual space,39,40,60 the pterygomandibular space,35,41 the lateral pharyngeal space42,43 or into the lateral cervical area. In one case, the symptoms started after two months. The patient experienced recurrent inflammatory swelling in the right submandibular space. Over a period of 14 months, the same dentist supervised treatment with antibiotics. After extensive imaging procedures and surgery the tooth was located beneath the platysma muscle.44 Parts of dental equipment or burs can also be lost in the adjacent tissues. A 35-year-old woman had severe trismus, swelling, and pain three weeks after removal of tooth 48. A 20 mm long diamond bur was found in the submandibular space.33

Further unusual complications
Airway compromise was described by Moghadam & Caminiti.45 A 32-year-old man experienced swelling of the soft palate due to postextraction hemorrhage after he had undergone extraction of teeth 18, 38, and 48 at his dentist’s office. Computed tomography revealed a hematoma in the submandibular and lateral pharyngeal spaces which resulted in deviation of the oropharynx and constriction of the airway at the level of the oropharynx. The patient was intubated for two days and was treated with antibiotics and high-dose steroids.45 Funayama et. al.,46 report a case of asphyxiation caused by a postextraction hematoma in a 71-year-old man. Respiratory arrest occurred 12 hours after treatment. The hematoma involved the submandibular, lingual and buccal spaces leading to severe narrowing of the oropharynx. Wasson et. al., reported a case of severe hemorrhage during the removal of an impacted third molar in a 60-year-old male patient. Over 2L of blood loss occurred prior to obtaining control, using embolization of the facial and inferior alveolar arteries.57 A single case report by Goshlasby et al., discussed the development of a right-sided retrobulbar hemorrhage after the removal of an impacted maxillary right third molar. The resulting hematoma caused right periorbital swelling and ecchymosis with evidence of proptosis. The maxillary incision was extended and the hematoma was drained and bleeding was controlled. It was believed that a branch of the posterior superior alveolar artery was injured during the extraction and bleeding tracked into the orbit via the infra-orbital fissure.53 Severe intraoperative or postoperative hemorrhage is one of the few life-threatening complications in which a dentist may have to initiate management.45

Thoracic complications are very rare, but have been reported in the literature.47,48,49,55,61 Sekine et. al.,47 reports on a case of extensive subcutaneous emphysema with a bilateral pneumothorax during removal of the left lower third molar in a 45-year-old man. As with many cases of emphysema, an air turbine dental handpiece was used.47-49 Recognition of mediastinal emphysema following surgical extraction is difficult because there are no absolute clinical symptoms and signs.48,49

Benign positional paroxysmal vertigo was described in one case after the removal of all third molar teeth.50

CONCLUSION
Third molar surgery is a very common procedure, but is associated with many attendant risks and complications. Fortunately, significant complications are rare, but need to be diagnosed and managed early in order to reduce morbidity, and perhaps, mortality. For the general dental practitioner, as well as the oral and maxillofacial surgeon, it is critical to be familiar with all potential complications associated with this procedure. OH

Source: https://www.oralhealthgroup.com/features/complications-during-and-after-surgical-removal-of-third-molars/?