Pearly Whites

My brother-in-law was in a bar on a cruise ship.  A woman from "coal-mining country" liked him so much she exclaimed, "Ain't you pretty- you got all your teeth!"  Teeth are important for good looks, and good health.  Listen to this week's guest columnists: Drs. Libby Going and Rati Venkatesh, Family Practice residents at the University Hospital and Clinics here in Lafayette.  In the Pediatric Emergency Department, we see lots of coughs, fevers, injuries of all sorts, and concerns about kid's teeth.  While infrequent, parents sometimes come to ask about tooth care.  And we see lots of visits for tooth and mouth trauma. We saw a precious two year-old girl recently, with big brown eyes a red bow in her hair, and a runny nose.  She was bubbly and fun but when she smiled, her teeth took away some pizazz.  They were brown stubs, an obvious case of "bottle rot."  Her parents had been putting her to bed with a bottle, the milk sitting in her mouth all night, destroying her teeth. Dental care is important early in life.  Start good habits for both baby teeth and permanent teeth.  Even before baby has teeth you should gently clean his gums with a wet washcloth.  When you see that first tooth and document it in the baby book, it's time to start cleaning that tooth.  Use a soft baby toothbrush and a very tiny smear of toothpaste. When you celebrate that first big birthday, baby enjoys her first cake, and you get that picture with icing all over her face and high chair.  Then it's time to schedule a dentist appointment.  The first visits to the dentist are for a check-up, and to get the child used to the dentist. Dental visits aren't the horror we feared when we were kids- children should learn early that dentistry is pretty painless. What your child eats is also important for healthy teeth.  Sippy cups filled with juice or milk (or worse, soda!) lead to tooth decay.  Limit juice or milk to meal time only, with water offered the rest of the day.  And again, no bed time bottles after you have gently brushed those pearly whites. Falls, sports injuries, and plain horsing around cause all sorts of injuries, but one of the scariest is a knocked-out tooth.  There's screaming, blood, and an ugly gap.  What to do depends on whether it's a baby tooth, or a permanent one.  Baby teeth usually start coming out in the first two years, and fall out on their own about age 6.  They are then replaced by the permanent teeth, which need to last the rest of the child's life. The best way to handle knocked-out teeth is prevention.  Mouth and face guards are very important for sports at risk for tooth injury- those with regular impacts, sticks, and flying objects- like football, baseball, hockey, softball, and lacrosse.  Cheering too- cheerleaders are often flying objects themselves! What to do when a tooth gets popped out?  If it's a baby tooth, don't worry, just call your dentist.  Your kid may have a gapped-tooth picture for awhile, but her permanent tooth should grow in fine.  If it's a permanent tooth, that's more trouble.  It's important to get that tooth back in so it won't die, but take root and live. First, pick up the tooth by the whitest part (the crown)- don't touch the root.  If it's dirty, rinse it for 10 seconds only.  Then match it to it's hole and push the root into the socket.  Have your child bite down on a cloth to hold it in place, and call your dentist.  Put that tooth in with the outside facing out- backwards teeth make for future orthodontic trouble. Scared to put that tooth back in?  Many are, with all that blood and crying.  Have your kiddo spit into a cup, and put the tooth in the saliva.  Or put it in milk.  Then immediately see your dentist.  Teeth re-implanted within one hour have better chances of surviving. Mouth and dental emergencies can be scary, so it's important to have a dentist by the first birthday.  Then you have an expert to call when things get hairy, and you can keep your child's smile pretty.