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/

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/?

Recovering from oral surgery

 

By: Delta Dental

 

😁 Let us work together to help you get back to your normal routines after an oral surgery.

These tested guidelines will help ease your recovery! The Oral Surgery DC Team

 

Oral surgery may be required for a variety of reasons. You may have an impacted tooth trapped in the jawbone or a tooth that is poorly positioned and damaging neighboring teeth. It is especially common to have these types of problems with growing wisdom teeth. Oral surgery is also necessary for the placement of dental implants and for a few types of gum treatments.

After surgery, it is normal for the area to be tender for the first few days but, in most cases, over-the-counter pain relief is enough to ease any discomfort. You should avoid aspirin because it thins the blood and can make your mouth bleed. In some cases your doctor may suggest prescription painkillers. Whatever your method of pain relief, be sure to start taking it immediately after surgery – don’t wait until pain sets in. It’s far easier to prevent pain than to make it go away.

Here are some steps you can take following surgery to promote the healing process:

Do’s

  • Take it easy on the day of your surgery. If you want to lie down, and for the first night following surgery, keep your head propped up with pillows if possible to limit excess swelling and bleeding.
  • Apply ice packs to your face for 15 minutes on and then 15 minutes off to reduce swelling.
  • After the bleeding stops, you can eat soft foods. Stick to a liquid or soft food diet for the first day or two. Examples include soups, yogurts, fruit milkshakes, smoothies and mashed potatoes.
  • If you’ve been given antibiotics, take them as prescribed and make sure you finish the course.
  • Keep your mouth clean. While you may be advised not to rinse for the first 24 hours, after this initial period you should gently rinse four times a day using warm salt water (one teaspoon of salt in a glass of warm water). Be sure to rinse after every meal and snack, making sure that the water removes any bits of food around the surgical area. In some cases your dentist may recommend a chlorhexidine rinse to kill bacteria and keep the mouth clean.
  • Follow a balanced diet. In particular, eat foods rich in vitamins A and C, which contribute to the healing process. A vitamin C supplement may also be helpful. According to the Academy of General Dentistry (AGD), getting plenty of vitamin C is one way oral surgery patients can ensure timely recovery.

Don’ts

  • Don’t overexert yourself. Don’t bend over or do heavy lifting or strenuous exercise for two to three days after surgery.
  • Avoid hot food or drinks until the numbing wears off. You cannot feel pain while you’re numb, and you may burn your mouth. Also take care not to accidentally chew your cheek!
  • Don’t chew hard or crunchy foods, such as carrots or popcorn, in the area of the surgery for six to eight weeks.
  • Don’t brush or floss teeth in the surgical area until advised to do so by your dentist. Then, be sure to do so carefully.
  • Try not to smoke for as long as possible after surgery, but at the very least for the rest of the day. Smoking can interfere with the healing process and the sucking motion can dislodge blood clots that are forming as part of the healing process.
  • Avoid alcohol for 24 hours, as it can delay the healing process.

In most cases, if you follow the after-care instructions your dentist gives you, you will heal quickly and without complication. However, you should contact your dentist immediately if you experience any of the following:

  • the dressing on the surgery site becomes displaced
  • excessive bleeding
  • excessive swelling
  • pain so strong that medications cannot control it
  • fever or a reaction to medication.

 

Sources: https://www.deltadentalins.com/oral_health/oral_surgery.html