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Emily Hahn, DDS (Guest):   I'm Dr. Emily Hahn. I’m a pediatric dentist at St. Louis Children’s Hospital, and I am a Mom Doc.

Melanie Cole, MS (Host):   Welcome. This is Mom Docs, the podcast from St. Louis Children’s Hospital. Today we’re talking about common tooth and mouth injuries, something that so many parents go through. Dr. Hahn, I'm so glad you could join us today. What are the most common dental injuries that you see?

Emily:   The most common dental injuries that we actually see are those little guys who are toddling around. Those guys tend to hit their upper lip when they're learning to walk or those toddlers that jump off of things randomly. The most common thing we see is actually a maxillary frenum tear. What that means is that little piece of skin tissue that holds the lip to the upper part of the mouth, that tears. The good news is that there's not really any intervention needed. The bad news is that it can look like a bloody mess because blood mixed with spit looks like blood unfortunately.

Host:   Yikes. Mouths tend to bleed for a little longer than sometimes like a finger would or something. So if parents notice that most common injury, what do they do?

Emily:   The best thing you can do is apply pressure. So you want to get a wet rag and you just want to apply pressure and give a big hug while you're doing it. I always say that. The biggest and most important thing is to not put something dry on that area. You want to make sure that you don’t disrupt any blood clotting. So you want that to be wet when you put that there. The great news is yes, the mouth is very vascular, but because of that it heals very, very quickly especially in kids. So you want to apply pressure for maybe five minutes, make sure that is wet. It may be saturated with spit as well. Then just let it be. I would also recommend if it’s okay, if your child can, to take some ibuprofen as well just to help with swelling.  

Host:   What a great piece of advice Dr. Hahn. You answered my question about how long does it take for dental trauma to heal, especially in children. So let’s talk about some of the other things. Sports specifically because children are playing sports and they bump into each other. There's equipment, but does it always work? Tell us about the sport with the most dental injuries, what you see.

Emily:    So the sport that actually has the most injury is baseball, which I don’t think people necessarily think directly of. But because of bats and balls, that is what is the most common incident. Baseball actually accounts for the most within that seven to twelve year old age group while basketball is the most frequent for kids who are 13 to 17.

Host:   So then what’s considered dental trauma in kids around those age groups?

Emily:   So basically anything where trauma. So trauma would be as minimal as bumping your tooth all the way to completely hitting your mouth and the tooth comes out root and all. It’s a wide range.

Host:   So it certainly is a wide range. What is a parent or a coach or someone on the sideline to do? Our kids are running around playing soccer, they lose a tooth. If it’s a baby tooth, okay, but if it’s an adult tooth then what?

Emily:   So the first thing to let anyone know is if a whole tooth comes out it is a dental emergency and time is of the essence. The first thing I would recommend is actually getting that tooth into a cup of milk. If we can get it into milk, it is more likely to survive. That is our end goal. What’s interesting is the younger the child is, the more likely that tooth is to survive. So if we can get that tooth back in the mouth, great. If that’s something you are uncomfortable with or a coach is uncomfortable with, if we can get that tooth into milk that would be ideal. The reason why we don’t want that tooth to go into water—and this is getting into the science of things—but we don’t want the cells that surround that root to get damaged. Milk is the best thing for that.

Host:   Another great piece of advice. What about a chipped tooth Dr. Hahn?

Emily:   So a chipped tooth is interesting. So there's two different variations of tooth chip. So one is complicated, when we chip the tooth and the nerve is exposed. Unfortunately the younger the child is the more likely for that nerve to be exposed. For older kids, it’s less likely for the nerve to be exposed. However I recommend getting to a dentist within the next day. It’s not something we recommend going to an emergency room for, but you definitely want to call your dentist and get an x-ray to see what the next steps are.

Host:   So Dr. Hahn, a way from some of those acute injuries for a bit. As our kids are brushing their teeth and they get bleeding gums and they maybe get a little bit worried, are these harmful to our children?

Emily:   Bleeding gums mean that your gums are actually agitated. It’s gingivitis. It’s soreness. What that likely means is they're not always getting where the tooth meets the gum well when they brush their teeth. So what my recommendation is to get that bleeding to stop, brush better, brush more often, and brush more frequently. It’s not how hard you brush. It’s making sure that you get the bristles of the toothbrush to touch in between the tooth and the gums. By doing that, that bleeding should subside over two weeks. If it does not I highly recommend going to the dentist, but we would definitely go through appropriate oral hygiene to make sure those gums become healthier.

Host:   Well then a quick question about oral hygiene for our kids. Are they supposed to be flossing?

Emily:   Absolutely. So it depends on—Everyone asks when should we start flossing. My answer is start right away. The big thing is desensitization. We want it to become a habit as early as possible. Many baby teeth have space in between them. So it’s not something that we have to do to prevent cavities necessarily, but we do want them to get acclimated and familiar with that product. So I recommend for younger kids use those floss sticks because it’s not always easy to floss your child, but I recommend flossing as soon as possible.

Host:   So when what about if our kids have braces? Because we know that that’s the orthodontist, but sometimes your dentist is who you would call. What is wires come loose or their in sports and they injure themselves? Should they be wearing mouth guards? What do kids do if they’ve got braces and they're in sports.

Emily:   I definitely recommend braces, and some does the American Academy of Pediatric Dentists. With braces they should be using a mouth guard. There's a variety of kinds that you can have. At that time there's a medium level that you can buy as drug stores or anything over the counter called a boil and bite mouth guard. By using that, that should protect that.

Host:   So what else would you like us to know about dental trauma, tooth injuries, things that can happen to our kids that you see all of the time that we should know how to deal with.

Emily:   The best thing I can say is the importance of frequent dental visits and having a dental home. It is very important to get those x-rays to know what baseline is. So you want to make sure that you go to the dentist every six months so that you do have someone as part of your health team that knows what state your child’s mouth is before the injury. By having that team member, as I tell people, it’s very important so that when something bad happens you already know who to call.

Host:   Well that is great advice. Do you have any final thoughts just on basic dental hygiene for our children and getting them to practice good oral hygiene?

Emily:   I think the best thing that I can say is start with that first tooth and, like I said, I encourage you to have a dentist or a pediatric dentist if you can find one that you like on your team. Find that person to answer those questions. That’s the number one thing. The second thing is use fluoride right away. Start with that so that we can reduce the likelihood of cavities.

Host:   Great advice Dr. Hahn. Thank you so much. So much usable information that parents can use and take right now. Thank you again for joining us. That wraps up another episode of Mom Docs with St. Louis Children’s Hospital. For more information on Sky View Pediatric Dentistry, please visit skyviewpediatricdentistry.com to get connected with one of our providers. For more advice like this and articles, please check out the Mom Docs website at childrensmd.org. Please remember to share this show. Subscribe, rate, and review this podcast. Share it with your friends and family on social media so that we all learn from the experts at St. Louis Children’s Hospital together. I'm Melanie Cole.