Winter Park Dentistry-Pediatric (baby) tooth trauma
Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our video podcast. Today’s episode is about Baby Tooth Trauma. Our special guest today is Dr. Kelly Mansour, she’s a pediatric dentist, studied at the University of Florida, die hard University of Florida undergrad, dental school specialty, everything everything. This is kind of a little bit of a personal topic for me, because out of all the years I’ve been practicing there’s only a few times that I get parents or patients of mine calling me absolutely hysterical at 3 in the morning, eleven o’clock, all hours of day, my patients have had my cell phone number since the day I started practicing, it’s on the recorder, and I’ve never had any issues with that, except parents calling me freaking out.
And I have to share a little bit of a story to bring us into this topic. Just a few days ago, about three days ago, my assistant called me up, her name is Julie, and she texted me, I’m looking at the phone right now and reading it, it’s 7.30, she says “question: my son fell” – she has a 2 year old son – “and knocked his tooth loose, it’s his lower front teeth, and they’re pretty loose”, and then she said “do you think I should bring him in to see you?” and I said “okay, I’ll meet you at the office in 30 minutes”. 5 minutes goes by and Julie texts me back and says “I tried to get my son in the car, he’s kicking screaming and he tried to bite me”, and I replied “oh, well, if he’s biting you, that’s usually a good sign that he doesn’t need to come to the dentist, don’t bother” and I shut my phone off for the night. So Kelly I need to ask you, did I just commit malpractice, am I going to jail for this? These questions come up all the time, and it’s such a used topic that I’d really like for you to give some insight as to baby tooth trauma. Tell us a bit about what you tell parents when you see their kids having a tooth knocked out and a tooth loose or something like that.
Dr. Kelly Mansour: So we see trauma, probably just about every day in our practice, it’s very common. Oral injuries in children are probably the second most common in injury. With that being said, we get phone calls just about every day about a child running, a parent wasn’t looking for one second, and they fell… That’s the way a lot of the time we get a first time patient, their first visit is usually because of trauma. But when we get these phone calls, whether I’m on call or staff answers them in the office, we always want the parents to stay calm. However, if they are able to assess the situation, they can communicate with us about what exactly is going on. Most are able to do that, and clean them out and really see what they’re looking at so we can address the situation, whether it’s something that we need to see at the office that day, or if it’s something that can be seen the following day.
Dr. Ramzi Matar (Winter Park Dentistry): So, tell me. Mostly with baby teeth, I guess the first question is, what’s the age range where kids, boys, girls, I’m not sure if there’s gender difference, when they’re dealing with the front teeth, what are the tooth fairy years when their baby teeth are in their front?
Dr. Kelly Mansour: Sure, so the baby teeth in the front, they typically come in, the lower ones, around 6 to 8 months, and then they would keep the baby teeth in the front until they’re about 8 to maybe 9 years of age.
Dr. Ramzi Matar (Winter Park Dentistry): So you have between 6 months and 8, 9, and that’s when the baby teeth are in the front of their mouth in the most part. And then you said you can help assess, so tell me, what are the sort of severity levels, what are you asking, what do you ask in parents?
Dr. Kelly Mansour: Sure, the first thing we want to ask is to make sure whenever they have injury, we want to make sure they don’t have a head injury. The teeth will come second if there’s head injuries, in those type of situations, we may attempt to seek emergency care, whether it’d be at a clinic or at the hospital. But if the patient’s feeling fine, then we can assess the teeth. We ask a parent what’s going on, particularly with baby teeth injuries, we’re asking about were they able to stop the bleeding, did the teeth look like they moved in another position, did it go up, down, out of the mouth, pushed forward or backwards, are they able to communicate with the parent what’s going on, eating and drinking while asking about those questions, if that’s something that they’re able to do, and what their tolerance is. Injuries can range from something as simple as a concussion, so it’s maybe just a little bit tender, to avulsion, which would be the most severe injury.
Dr. Ramzi Matar (Winter Park Dentistry): So bottom line, if a parent’s watching this, if they suspect a head injury, forget the teeth, get to the ER, for sure. What about the lip. I get that question a lot. Like a torn lip, is that managed by you, a plastic surgeon, where does that manage? Do you saw up lips yourself?
Dr. Kelly Mansour: We do place stitches, but I would feel most comfortable telling a parent, if it’s a laceration that needs stitches and the bleeding cannot be stopped, I would be more comfortable sending that patient to a pediatric plastic surgeon, or that type of treatment, because that is an aesthetic view, and we want to make sure that they’re getting the best treatment.
Dr. Ramzi Matar (Winter Park Dentistry): Okay, meaning you don’t want them to get scarred on their lip. So, injuries, ER for sure, a lip, again, if it’s late at night, you’re probably going to the ER, sounds like possibly a matter of if you can find a pediatric plastic surgeon. So now you said, depends on where teeth are. Obviously, I was giving that example of Julie, because her son’s teeth were just kind of loose, I asked her this week, it’s getting better, so I kind of new it wasn’t a huge deal, but what are the two things that need to be addressed, in, out, totally out, sideways? Which ones, if a parent’s watching this, that they should say “okay, this is pretty serious”?
Dr. Kelly Mansour: Most baby injuries, the ones that need immediate attention, luxation injuries, teeth that are maybe partially avulsed, so maybe we’re seeing a bit of the root exposed. If they’re pushed backwards, in a position where they’re unable to close their mouth, because they have a traumatic occlusion. Those are the instances where we would want to address the trauma pretty quickly. [We don’t re-implant baby teeth] but we can reposition the tooth the tooth, or if we move the tooth the patient would feel a lot more comfortable. But most other type of primary tooth injury, such as avulsion, the whole tooth is accounted for, but you don’t necessarily need to see them that same day. Concussions, teeth a little bit loose, those are all types of injuries that could be seen the next day, if these are traumas that happened after hours.
Dr. Ramzi Matar (Winter Park Dentistry): So if the kid is biting, and he’s hitting his other tooth, and he can’t chew because every time he chews, that front tooth is hitting, he’s crying and he can’t eat anything, that’s high priority. If it’s totally out, it’s not that much a priority, I really would have thought it was backwards. So you said something interesting, you don’t re-implant baby teeth. That leads us into what do you guys normally do, a baby tooth you don’t put it back in? In general?
Dr. Kelly Mansour: Right. The reason we don’t re-implant a baby tooth is because they’re so close to the developing permanent tooth, and that’s really our biggest concern. So by re-implanting the baby tooth, you could injure the developing adult tooth, which they’re going to have forever. So there are some aesthetic things that we can do to replace baby teeth that have gone off in the front, but we do not put them back in their mouth.
Dr. Ramzi Matar (Winter Park Dentistry): So if a tooth is lost, now you manage it with some sort of prosthetic, I assume, something that comes in like a bridge, or some sort of… I mean you don’t do veneers or stuff like that, or maybe bonding, is that kind of what you’re looking at?
Dr. Kelly Mansour: Sure. Whenever a patient loses a baby tooth in the front, the only reason to replace it would be for prosthetic reasons, so we’re able to pediatric bridges and things like that, but the only concern for it, is more of an aesthetic issue.
Dr. Ramzi Matar (Winter Park Dentistry): Not eating, talking, speech, these are development, these are not an issue on front baby teeth?
Dr. Kelly Mansour: Right. Not necessarily. There might be some transient delays but typically there’s no long-term speech issues.
Dr. Ramzi Matar (Winter Park Dentistry): See, I would have thought otherwise! I would assume parents would say “gee, I don’t want my kid to…” you know, elementary school photos, the only thing is to put some white in or something like that. And then I do know of course, with adult teeth, and that’s going to be another episode, developed tooth trauma is far different. So then how about this one; you’ve seen, we’ve all seen, I’ve certainly seen, the baby tooth that turns black, looks like a zombie tooth or something like that. Why is that, and where does that come from, can you prevent it, and how do you manage it?
Dr. Kelly Mansour: That’s good question. We see that all the time. Discoloration is very common after injuries to the baby teeth, and just because the tooth turns dark doesn’t necessarily mean that tooth needs treatment. The reason is why it turns dark is the hemorrhaging from trauma, that’s getting trapped in the tubules. Sometimes you’ll see the tooth turn very dark, soon after the injury, and the tooth might lighten back up. They can be very funny that way. Other colors that you might see are a pink color, and that’s really a sign of internal resorption, another color you might see is a yellow color, and that might be a sign of pulp canal obliteration, which is a sign that the tooth is still alive, almost a natural root canal for a baby tooth. Because of that pulp canal obliteration it has a more yellow tone.
Dr. Ramzi Matar (Winter Park Dentistry): So either way, it sounds like discoloration, whether it be pink, yellow, dark, you just leave it alone, you don’t mess with it, you don’t treat it. Aesthetically maybe, if the parent wants to put some bonding on it or something like that, but it’s not like a sign of a serious problem for that kid?
Dr. Kelly Mansour: Well it needs to be evaluated to make sure there’s no infection present, and the best way to determine whether or not there’s an infection present is a clinical exam, if you see a sinus tract or a root canal getting dark too, now obviously that’s the sign of an infection.
Dr. Ramzi Matar (Winter Park Dentistry): What’s a sinus tract?
Dr. Kelly Mansour: It’s almost like a little pimple, a pustule or whatever.
Dr. Ramzi Matar (Winter Park Dentistry): A pimple, yeah, I know what you’re talking about.
Dr. Kelly Mansour: Another way to evaluate a tooth that’s getting dark is an x-ray of a tooth, looking for a sign of an infection on the root. Just because your child doesn’t complain of pain, and the tooth is dark, doesn’t necessarily mean that there’s not an infection.
Dr. Ramzi Matar (Winter Park Dentistry): Okay, great. But these are all things that can be managed the following Monday or the next day. We’ve kind of taking care of the big players, but this is what parents can expect, ad discoloration, and of course it’s common sense you need to get to a pediatric dentist, have them look at it, take an x-ray, because you said something I feel that’s important, it’s the adult tooth that has to be sort of watched out for. And if there’s an infection or something like that, it sounds like you would take out a baby tooth, sacrifice a baby tooth so that the adult tooth doesn’t get discolored or have problems or stuff like that. It sounds like it’s all just temporary, social issues until they’re 8 or 9 years old, then they’re going to get their adult teeth anyway and they’re back to good. I do have one more question, I have to brag on you a little bit; I heard a rumor that you were the female Gator mascot, Alberta, for 4 years, correct?
Dr. Kelly Mansour: That’s right.
Dr. Ramzi Matar (Winter Park Dentistry): Now here’s the thing with that. This was in the years the Gators were kind of on top of the heat back then, so you had some pretty happy cheerful crowds. So here’s my question. Currently, I don’t think the crowds are as happy, so would you prefer to be dealing with a hysterical parent with their child who just had trauma, bleeding, the parent’s flipping out, or would you rather be Alberta now, dealing with the just as hysterical fans when they’re losing 43 to 0 to I don’t know who it was, Mississippi State. Both would be pretty troublesome spots to be in, what’s your preference?
Dr. Kelly Mansour: Well, I would probably say I would deal with a parent. But I’m still a Gator fan.
Dr. Ramzi Matar (Winter Park Dentistry): Well listen, Dr. Mansour I really appreciate it, very good bottom line stuff, I think every parent can benefit from watching this, hopefully somebody learned something here. Please if you have questions, comments, post it on the YouTube channel, I’ll constantly try to answer them, or probably better yet try to send them over to Dr. Mansour to answer for you, thank you so much.