Facial Trauma and Reconstructive Surgery

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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Dental injury.When you were a youngster, did you ever get a black eye, chip a tooth or bruise your cheek? If so, you may have experienced a case (let's hope, a mild one!) of facial trauma. In many situations, however, facial trauma can be severe. Among its major causes are auto accidents, sports injuries, work-related mishaps, falls, and acts of violence. When serious facial injury occurs, it's important that you receive immediate and comprehensive care. That's why oral and maxillofacial surgeons are on call at most emergency and trauma centers.

Facial trauma in general involves injuries to the soft- or hard-tissue structures of the face, mouth or jaws — including the teeth, the bones of the jaws and face, and the tissue of the skin and gums. It can also involve treatment of particular specialized regions, such as the area around the eyes, the salivary glands or facial nerves. Because facial injuries can affect not only a person's ability to carry on basic life functions (eating, vision, etc) but also his or her appearance, there is often a strong emotional component to treatment as well as a physical one. But after completing an extensive training program, oral and maxillofacial surgeons are capable of handling the full scope of facial injuries.

Treatments for Facial Injury

Some facial traumas are relatively minor. A common one occurs when a tooth is loosened or knocked out (avulsed). Many times, if treated immediately, the tooth can be successfully re-implanted in the jaw. If that isn't possible, placing a dental implant is often the most effective way to replace a missing tooth.

Another type of relatively common but more serious injury may involve a fracture of the facial bones, including the cheekbones, upper or lower jawbones, or the eye sockets. In principle, its treatment is essentially the same as that used for a broken arm: place the bones back in their proper position, and immobilize them. But since it isn't possible to put a cast on the face, different immobilization techniques are used. One method involves wiring the upper and lower jaws together to let them heal in the correct alignment; alternatively, plates and screws may be used to permanently reattach the bones.

Severe facial trauma is often a critical condition, since over 60% of these patients also have serious injuries in other parts of the body. In fact, many of the standard techniques used in trauma centers were developed by oral and maxillofacial surgeons during the wars in Korea, Vietnam, and the Middle East. Restoring breathing, controlling bleeding and checking for neurological damage are top priorities. After that, as much of the reconstructive surgery as possible is accomplished in one operation.

Preventing Facial Trauma

Athletic mouthguards.

What's the best treatment for facial trauma? Prevention. Always wearing seat belts, using proper helmets and protective gear when playing sports, and staying out of dangerous situations (like driving while impaired, tired or distracted) can go a long way toward keeping you safe. If you're engaging in athletic activities that carry any risk of facial injury, wear a properly fitted mouthguard — this small piece of protective equipment can save you a lot of potential harm.

But if you (or someone you care for) require a trip to the emergency room for a facial injury, be sure to ask for a consultation with an oral and maxillofacial surgeon, so that you get the best care and the most favorable outcome.

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