Pediatric Dental Emergency
Toothache: (Pain provoked with food impaction)
When your child feels pain only after a meal and especially after a sweet snack this may be an indication that the child may have a tooth with a deep cavity close the pulp (nerve).
Action: Brush your child’s teeth and remove any food that is trapped into the cavity using either a toothpick or dental floss. Bring your child promptly to the dentist to examine your child and treat the tooth appropriately.
When the pain is provoked by food impaction usually the tooth can be treated simply by a filling. However, if you ignore the symptoms and this provoked pain becomes repetitive, then it will progress to spontaneous pain. Then a more complicated treatment like a root canal may be necessary.
Spontaneous pain / overnight pain:
If the pain is automatic, meaning that it comes without chewing or drinking then things are more serious. It means that the cavity is very deep, in contact with the pulp (nerve) of the tooth and that the whole nerve is inflamed.
Action: Give your child a strong inflammatory medication such as children’s Advil (according to the instructions on the package) and call us.
The treatment of choice in such cases of spontaneous pain may be a root canal treatment which means the removal of the inflamed nerve of the tooth or even extraction of the tooth, depending on several “dental factors”.
Toothache with chewing:
If a tooth becomes painful only with the forces of mastication (chewing), then the tooth may be abscessed. Usually, the abscess appears at the end of the root in the bone and it may not be evident with a naked eye.
Because the abscess is an accumulation of pus (liquid) pain is caused when the patient is chewing because the tooth is moving towards the bone. Also, the tooth may become loose.
Action: You need to call us the same day. An abscessed tooth can spread the infection into the surrounding soft tissue of the face and cause swelling of the lips-cheeks. In children this swelling may expand quickly towards the eye or the pharynx and if untreated it can cause serious infection of the brain or closure of the larynx and suffocation.
We’ll examine and treat your child accordingly but, in cases like these, antibiotics are necessary to stop the course of infection.
First Aid in Case of Dental Trauma:
Before you call your dentist you need to make the following observations:
If your child has an injury to the mouth area, first check for any systemic symptoms like dizziness, vomiting or fainting, as this may indicate a possible concussion. (Watch Video 1)
If your child doesn’t feel well, call your padiatrician or take your child to the nearest medical emergency clinic.
Also, if your child had this injury outdoors, check if his tetanus vaccination is up-to-date.
Check for any swelling or abrasions inside or outside the mouth.
For swelling of the lips or cheeks use an ice pack covered with a cotton towel or a Popsicle for a few minutes to diminish swelling. (Watch Video 2)
If a part of a tooth is missing look to find it. Put it into a zip lock bag with some of the child’s saliva or milk and keep it refrigerated.
This broken part can be reattached to the tooth (only for permanent adult teeth). If the fractured piece is not found, the tooth can be repaired with a white filling, with a very good esthetic result.
Call your dentist!
NOTE: Re-attachment of a broken part can be done only for permanent teeth NOT BABY TEETH
Loosening of teeth
If the injury causes your child’s tooth to become loose, but the tooth is not pushed out of position, then you need to call your dentist and reserve time for your child to be seen.
Depending how loose the tooth is, your dentist may have to immobilize it. It is best to do this the same day of the injury. Call us (905) 726 8213 to reserve the emergency time in our practice.
NOTE: Usually only permanent teeth are immobilized but sometimes baby teeth are also good candidates for immobilization.
Pulpotomies (Nerve Treatment)
In primary teeth, when a cavity (black area on the picture below) is deep and in contact with the pulp (nerve) (red area on the picture) of the tooth then a pulpotomy may be necessary.
In a pulpotomy procedure the superficial part of the pulp (nerve) (middle tooth on the picture) is removed due to its close proximity with the cavity in order to eradicate any possible infection of the top part of the nerve and stop its spread to the radicular pulp (root nerve).
By doing so, we can usually maintain the tooth in the mouth in a healthy condition for several years until it’s normal exfoliation. The success rate of the pulpotomy is 70-80% and a follow up is needed in order to confirm its success.
When a tooth receives a pulpotomy it becomes brittle and it always needs a stainless steel crown.
For a complete and precise dental examination the radio-graphic examination is equally as important and necessary as the clinical exam.
Therefore, during a routine check up, x-rays are usually taken once a year or whenever the dentist considers it necessary.
Many times teeth that look absolutely healthy can have cavities at the contacts with the adjacent teeth This decay can only be diagnosed with an x-ray.
Sometimes these cavities maybe quite deep and close to the nerve of the tooth without being noticeable in the clinical exam.