Whitening Traumatized Teeth

Your child won't keep his or her first teeth forever, but that doesn't mean those tiny pearly whites don't need conscientious care. Maintaining your child's dental health now will provide health benefits well into adulthood, as primary (baby) teeth serve some extremely important functions.

Kids developing jaws and teeth.

For one thing, primary teeth serve as guides for the eruption of permanent (adult) teeth, holding the space into which these new teeth will erupt. The crowns (tops) of the permanent teeth actually push against the roots of the baby teeth, causing them to resorb, or melt away. In this way, the adult teeth can take their proper place.

What's more, your child's primary teeth will be there for most of childhood, helping your child to bite, chew and speak. For the first six or so years, he or she will be relying on primary teeth exclusively to perform these important functions. Until around age 12, your child will have a mix of primary and permanent teeth. You will want to make sure those teeth stay healthy and are lost naturally — when it's time.

Your Child's First Teeth

Kids mouth anatomy.

Your child's 20 baby teeth will begin to appear usually between six and nine months, though in some cases it may start as early as three months or as late as twelve months. The two lower front teeth tend to erupt first, followed by the two upper ones, these teeth are called the central incisors. Then the neighboring teeth called lateral incisors will erupt too. The first molars come in next, followed by the canines (eyeteeth). And finally, the last teeth to erupt are the two-year molars. Sometimes your baby can experience teething discomfort during this process. If so, there are courses of action to help make your child more comfortable.

Your infant's gums should be gently wiped after each feeding with a water-soaked gauze pad or damp washcloth. As soon as the first tooth erupts, establish a daily brushing routine with a small, soft-bristled toothbrush and no more than a thin smear of fluoridated toothpaste. Your child may need your help with this important task until about the age of 6.

Your Child's First Dental Appointment

Age one dental visit

The American Academy of Pediatric Dentistry recommends that your child see a dentist by his/her first birthday, or as early as the first tooth erupts. Though this may sound early, learning proper pediatric oral hygiene techniques, checking for cavities, and watching for developmental problems is extremely important.

There are a number of forms of tooth decay that can affect babies and small children. Early Childhood Caries (tooth decay) can develop rapidly, progressing from the hard, outer enamel layer of a tooth into the softer, inner dentin in six months or less.

Most of all, it's important for your child to have a positive experience at the dental office as he/she will be a regular visitor for years to come.

Pediatric Dental Treatments

There are a variety of dental treatments offered to prevent tooth decay in children, or to save or repair teeth when necessary. They include:

Topical Fluoride — Fluoride incorporates into the enamel of teeth, making it harder and more resistant to decay. Although there is a small amount of fluoride in toothpastes and in some drinking water supplies, a higher concentration can be applied professionally to your child's teeth for maximum protection.

Dental Sealants — A plastic coating can be applied at the dental office to prevent cavities by sealing the little grooves on the chewing surfaces of back teeth known as “pits and fissures.” These little crevices become the perfect environments for decay-causing bacteria. Immature tooth enamel is more permeable and therefore less resistant to tooth decay. Dental sealants are easy to apply and provide years of protection (Watch Dental Sealant Video).

Root Canal Treatment — Perhaps you have had a root canal treatment yourself, to save an injured or severely decayed tooth. Well, sometimes children need root canals, too. In children these are called pulpotomies or pulpectomies. As mentioned above, baby teeth are important guides to the permanent teeth that are already forming beneath your child's gums. Therefore, saving them from premature loss can help prevent a malocclusion (“mal” – bad; “occlusion” – bite) that requires orthodontic treatment.

Bonding — Chips and minor fractures to front teeth — common childhood occurrences — can be repaired with tooth-colored bonding materials. These lifelike resins made of plastic and glass can be used on baby teeth as well as permanent teeth and last until the youngster has completed facial growth (Watch Bonding Video).

Orthodontic Concerns

Orthodontic Problems.

By around age 7, most malocclusions have become evident. Interceptive orthodontic treatment around this time can help direct proper tooth positioning and/or jaw growth, eliminating or simplifying the need for later treatment. There are many orthodontic problems that can be detected early and are examples of why a trained professional should evaluate your child during his/her growth and development.

Sports & Your Child's Teeth

If your child is active in sports, a custom-made mouthguard is a highly recommended safeguard. According to the American Dental Association, an athlete is 60 times more likely to suffer dental harm when not wearing one of these protective devices. A custom mouthguard is made specifically for your child using a model of his or her teeth. This will offer greater protection than an off-the-shelf model. It's an investment that pays off highly in the form of reduced pain, suffering — and dental expenses down the road!

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Doctor whitening traumatized teeth.Teeth whitening is one of the most popular cosmetic dental treatments — and it's easy to see why. Having whiter teeth can make you look years younger, and the procedure itself is among the most conservative (and cost-effective) cosmetic treatments dentistry offers. Sometimes, however, achieving a pleasing, even shade of lightness can be challenging; this is particularly true when a tooth that needs to be lightened has been subjected to an injury (dental trauma) in the past.

Dental trauma encompasses any damage to the tooth that's caused by an external agent, whether accidental or intended. It may be due to a fall, a sports injury — or even a past orthodontic procedure. According to some studies, around a quarter of Americans aged 6 to 50 years old have experienced some traumatic dental injury, with most occurring before age 19. Traumatized teeth may react to whitening procedures differently from undamaged teeth, which can make them difficult to treat. However, several effective treatments are available.

Diagnosing a Discolored Tooth

The first step in the process of lightening a traumatized tooth is a thorough exam to find out what's causing the dark staining — and one of the first things we will determine is whether or not the tooth's pulp is “vital,” or alive. This is readily revealed by radiographs (x-rays) or other tests. If the tooth is still vital, external bleaching can often yield satisfactory results — even if it's just one tooth that needs to be whitened. In-office treatments or take-home trays are effective, but office procedures generally take much less time to produce good results.

In many cases, however, discoloration of a traumatized tooth is itself an indication that the nerves in the tooth's pulp have died. In this case, before whitening treatment can start, a root canal procedure will be necessary to remove the dead or dying tissue and prevent infection. It can also happen that a tooth that appeared normal will begin to discolor many months (or years) after a root canal has been performed. In either situation, it may be possible to whiten a non-vital tooth with a procedure called internal bleaching.

Whitening From the Inside Out

Whitening traumatized teeth.Because a non-vital tooth's stains are intrinsic (inside, rather than outside, the tooth), we need to put the bleaching agent itself inside the tooth. Internal bleaching is a routine procedure, here's how it works:

Access to the pulp chamber (the small passageway in the tooth's center) will be gained by making a small hole in the back of the tooth. Then, any debris from the chamber will be removed and rinsed away, and a special cement will be added to prevent the bleaching agent from leaking into the tooth's roots.

Next, some bleaching agent (commonly sodium perborate) will be placed in the empty pulp chamber, and temporarily seal it in. At this point, you can get up and leave the office… which is why this procedure is sometimes called the “walking bleach” technique. However, you'll return in a few days for another round of bleaching; it may take up to four visits to get the degree of lightening you want.

When the tooth reaches the desired color change, a more permanent restoration will be placed on the tooth to seal that little hole — usually a tooth-colored filling material of composite resin. Many times, this relatively conservative procedure will give your tooth all the lightening it needs. If it's not enough, the tooth can be bleached externally as well, or you can even consider a veneer or crown. The goal is to recommend the most appropriate cosmetic dental procedure, and get you the best possible results.

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