How to Handle Tooth Trauma

As children head back to school, it is important to remember that dental emergencies can happen any time, any place. According to the 2013 Delta Dental Children’s Oral Health Survey,1 one out of 10 children ages 10 or 11 have had a tooth emergency such as a knocked-out tooth, chipped tooth or a loosened permanent tooth at home or at school.

A knocked-out permanent tooth is a true dental emergency, and there’s a good chance it can be saved if you know what to do and act quickly. The primary concern should be getting the child in to see a dentist. Time is crucial if you want the dentist to be able to reinsert and salvage the natural tooth. Ideally, a child needs to be seen within 30 minutes of the accident.1

Whether a tooth is knocked out at school or home, here are several steps to ensure it is saved – or at least in optimal condition – by the time the child can see the dentist.

  • First, check to make sure the child doesn’t have a serious head, neck or other orofacial injury (i.e., a concussion, broken jaw, etc.).
  • Don’t worry about replacing a displaced baby tooth. Trying to reinsert it could damage the permanent pearly white coming in behind it.
  • To avoid infection, the tooth should be held by the crown, not the root. The crown is the part of the tooth visible to the naked eye. You want to leave the root intact, and touching it with bare hands could pass bacteria.2
  • Rinse any debris off of the tooth under room temperature water. Don’t scrub the root! Once the tooth is free of loose dirt and debris, try to reinsert it, asking the child to hold it in place using a piece of gauze if necessary. 3
  • If the tooth cannot be successfully reinserted, it needs to stay moist until the child can visit a dentist. Store the tooth in a clean container and cover it with milk or room temperature water to prevent it from drying out. 4 These liquids aren’t ideal but are often the only ones readily available. If you are a school nurse or your child frequently plays contact sports, purchase an emergency bag  handy with a save-a-tooth kit in it (available at most drugstores.) These contain a solution that is better at preserving any live cells on the tooth root until the dentist can put the tooth back into the socket.

In most cases, tooth injuries are not life threatening. But they can have long-lasting effects on the child’s appearance and self-confidence, so it is important to act quickly in the event of a dental emergency.

1Morpace Inc. conducted the 2013 Delta Dental Children’s Oral Health Survey. Interviews were conducted nationally via the Internet with 926 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin error is ±3.2 percentage points at a 95 percent confidence level.

2“Saving a Knocked-Out Tooth.” American Association of Endodontists. http://www.aae.org/patients/patientinfo/references/avulsed.htm. Accessed 2010.

3 “Medical Encyclopedia: Broken or Knocked Out Tooth.” U.S. National Library of Medicine and the National Institutes of Health, February 22, 2010. www.nlm.nih.gov/medlineplus/ency/article/000058.htm. Accessed 2010.

4“Dental Emergencies.” American Dental Association. http://www.ada.org/370.aspx Accessed 2010.

Are Sports Drinks as Harmful to Kids’ Teeth as Soda?

While kids play sports in the summer heat, they will be tempted to gulp down large sugary sports and energy drinks to stay cool. Swigging too many of these beverages, however, can harm a child’s teeth. Delta Dental advises parents to monitor and limit the number of these beverages their children are consuming to help prevent cavities.

Young athletes do need to replace fluids, carbohydrates, protein and electrolytes after hard exercise. But the high sugar and highly acidic content of sports drinks can increase a child’s susceptibility to tooth decay and enamel erosion if too much is consumed.

Like soda, energy and sports drinks contain high levels of acidity and high concentrations of sugar. A study from the Harvard School of Public Health found that 12 ounces of a leading brand of cola and a leading brand of energy drink each contained 42 grams of sugar, while a leading sports drink contained 21 grams of sugar.1 According to a University of Iowa study, a leading sports drink had the greatest erosion potential on both enamel and roots of teeth when compared to leading brands of energy drinks, soda and apple juice.2

Sugar itself doesn’t rot teeth, but rather, the acid that is produced when sugar mixes with certain bacteria in the mouth. Decay forms around the parts of the tooth where the plaque accumulates. The high acid from the drinks themselves can also have an erosive effect on the whole surface of the tooth. Sugary, acidic drinks are particularly damaging when they are sipped frequently throughout the day because they spend a prolonged amount of time washed over the teeth.

Instead of buying the 32 or 64 ounce bottles of sports drink, limit kids to a single 12 to16 ounce bottle. Encourage kids to consume as much water as they do sports drink. Drinking water will help them stay hydrated during outdoor activities and make sure any residual sports drink doesn’t linger on their teeth. Another option is to dilute the sports drink with water to lower the concentration of acidity and sugar. If your kids find water boring, consider adding slices of orange, lemon or cucumber to make it more appealing. Interestingly enough, recent studies suggest that low-fat chocolate milk may be as good as a sports drink at promoting recovery between workouts.3

1 Harvard School of Public Health. How Sweet Is It? Accessed June 2012.http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/how-sweet-is-it/index.html

2 University of Iowa College of Dentistry. Acidic Beverages Increase the Risk of In Vitro Tooth Erosion. Accessed June 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516950/

3 Spaccarotella KJ, Andzel WD.  Building a beverage for recovery from endurance activity: a review. J Strength Cond Res. 2011 Nov;25(11):3198-204.

The Tooth Fairy Loosened Her Purse Strings in 2012

How much are kids getting for lost baby teeth these days? The average gift from the Tooth Fairy was $2.42 last year, up 32 cents from $2.10 in 2011, according to The Original Tooth Fairy Poll® sponsored by Delta Dental.1 The most common amount left under the pillow was $1 (51 percent).

According to the poll, the Tooth Fairy was even more generous with kids who lost their first tooth, leaving more money for the first tooth in 46 percent of homes. On average, the amount given for the first tooth was $3.49.

Leaving gifts from the Tooth Fairy is a great way to help make losing teeth less scary and enjoyable for kids. Delta Dental encourages parents to use the Tooth Fairy as an opportunity to talk about good oral health even before a child loses the first tooth. Caring for baby teeth is important, as they help children chew and speak properly and hold space for permanent teeth.

In 2012, the Tooth Fairy visited nearly 90 percent of U.S. homes with children who lost a tooth. Delta Dental suggests the following ways parents can use the Tooth Fairy as a teachable moment:

• Introduce the Tooth Fairy early on. Kids will start losing baby teeth around age 6. Before this age, parents can teach kids about the Tooth Fairy and let them know that good oral health habits and healthy teeth make her happy. Use this as an opportunity to brush up on a child’s everyday dental routine. Kids not wanting to brush and floss? Remind them the Tooth Fairy is more generous for healthy baby teeth, not teeth with cavities. This will help get kids excited about taking care of their teeth.

• Leave a note reinforcing good habits. A personalized note from the Tooth Fairy could be nearly as exciting for kids as the gift itself. Parents should include tips for important oral health habits that the Tooth Fairy wants kids to practice, such as brushing twice a day, flossing once a day and visiting the dentist twice a year. And, of course, parents should give the Tooth Fairy a special name. After all, Flossie or Twinkle is a bit more exciting than just Tooth Fairy!

• Give oral health gifts. Although the Tooth Fairy left cash for kids in 98 percent of homes she visited, two percent of children received toys, candy, gum or other gifts. Consider forgoing cash and providing oral health gifts instead, like a new toothbrush or fun-flavored toothpaste. For readers, there are numerous children’s books about Tooth Fairy adventures in bookstores or online. The days of jamming a tiny tooth underneath a huge pillow and making the Tooth Fairy blindly grope around under a heavy sleeping head are gone. Special pillows with tiny, tooth-sized pockets attached are now available online, with themes ranging from princesses to ninjas and beyond. Some of the pillows can even be customized with your little gap-toothed child’s name. Or if a parent, er, ahem, the Tooth Fairy, is feeling generous, kids could receive both cash and a new toothbrush.

For more information, visit http://www.theoriginaltoothfairypoll.com. To get a sense of the taste and style choices of the Tooth Fairy and for some fun ideas, parents can follow her on Pinterest at http://www.pinterest.com/origtoothfairy.

New Survey: Kids Need Brushing up on Oral Health

Although cavities are nearly 100 percent preventable, more than one out of four American caregivers reported that their children had a cavity filled in the past year. This was among the findings of a new survey1 of nearly 1,000 caregivers released today by Delta Dental in conjunction with National Children’s Dental Health Month. Among children who had a cavity in the past year, 53 percent had two or more cavities.

The 2013 Delta Dental Children’s Oral Health Survey shows that not only are Americans unaware they can pass cavity-causing bacteria to children, but they also need to brush up on some critical children’s dental health habits, including basics such as brushing and flossing.

Parents and caregivers need to teach good oral health habits to children at a young age to help prevent cavities. Baby teeth are very important. They help children chew and speak properly and hold space for permanent teeth. If a child has healthy baby teeth, chances are he or she will have healthy adult teeth.

These are some of the oral health habits that fall short of what’s recommended by dental professionals:

• Survey shows: Seventy-five percent of caregivers say they share utensils such as a spoon, fork, or glass with a child.
• Delta Dental recommends: Parents and caregivers should eliminate saliva-transferring behaviors – such as sharing utensils and toothbrushes and cleaning a pacifier with their mouths – all activities which can pass harmful bacterial to a child.

• Survey shows: Forty-nine percent of Americans with a child four years or younger report that the child sometimes takes a nap or goes to bed with a bottle or sippy cup containing milk or juice.
• Delta Dental recommends: Parents and caregivers should not put a child to bed with a bottle of milk, juice, sweetened water or soft drinks, which can lead to baby bottle decay. Instead, caregivers should fill the bottle with water.

• Survey shows: For children who have visited the dentist, the average age at the first visit was 3 years old.
• Delta Dental recommends: Children should first visit the dentist within six months of getting the first tooth – and no later than the first birthday.

• Survey shows: Only 58 percent of children had their teeth brushed twice a day and 34 percent of children brush for less than two minutes.
• Delta Dental recommends: Children’s teeth should be brushed twice a day for at least two minutes each time. Parents should assist with this task until the kids are about 6 years old.

• Survey shows: Forty-three percent of parents or caregivers report that their children’s teeth are never flossed, and of children whose teeth are flossed, only 23 percent are flossed daily.
• Delta Dental recommends: Once any two teeth are touching, caregivers should floss, or help the child floss, once a day.

1 Morpace Inc. conducted the 2013 Delta Dental Children’s Oral Health Survey. Interviews were conducted nationally via the Internet with 926 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin of error is ±3.2 percentage points at a 95 percent confidence level.

Top 10 Fright Night Facts

Did you know Americans consumed 24.7 pounds of candy per capita in 2010?1 That’s a lot of sugar to potentially cause cavities if left on the teeth of boys and ghouls too long. After eating candy, Delta Dental recommends a thorough brushing of teeth (or at least a big drink of water).

Since Halloween is a favorite holiday of many Americans, Delta Dental has compiled a list of the 10 best terrifically terrifying truths:

1. Americans purchase nearly 600 million pounds of candy for Halloween each year.2

2. Major pumpkin-producing states like California, Illinois, New York and Ohio helped America grow 1.1 billion pounds of pumpkins in 2010.3

3. Sixty percent of dentists polled for Delta Dental’s Tricky Treats survey said they give out candy on Halloween. Of the dentists who dispense candy, 79 percent choose chocolate, while just 13 percent hand out varieties like hard candy or lollipops. This confectionary choice is no accident. Chocolate dissolves quickly in the mouth and can be eaten easily, which decreases the amount of time sugar stays in contact with teeth.4

4. Americans spent nearly $6.9 billion on Halloween costumes, decorations and “entertainment”.2

5. About 50 percent of Americans decorated their homes or yards, 44 percent dressed in a costume, 34 percent attended a Halloween party and 23 percent visited a haunted house in 2011.2

6. In 2011, the three most popular costumes worn by children were Harry Potter, princess and Green Lantern. Classic characters like Winnie the Pooh, Elmo and the Smurfs were also among the top 10 favorites. Captain America, Green Lantern and Where’s Waldo were popular costume choices for adults.5

7. Nearly one out of four dentists said they do not hand out anything on Halloween, while five percent attack the holiday head on by handing out toothbrushes.4

8. Not everyone gives out candy on Halloween. Ideas include toothbrushes, pretzels, fruit (such as raisins), modeling clay and books.4

9. An estimated 41 million children between the ages of five and 14 went trick-or-treating across the U. S. in 2010.1

10. Candy corn, a popular treat commonly associated with Halloween, was created in the 1880s and popularized by farmers who appreciated its resemblance to kernels of corn. 6

To learn more about what dentists give out at Halloween and get their best advice for keeping kids’ teeth healthy, please visit http://www.trickytreats.org.

1 United State Census Bureau, 2010 Census. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed August 2012.

2 National Retail Federation. Consumers Eager to Have a Frightfully Good Time This Halloween, According to NRF. http://www.nrf.com/modules.php?name=News&op=viewlive&sp_id=1197. Accessed August 2012.

3 USDA National Agricultural Statistics Service.
http://usda.mannlib.cornell.edu/usda/current/VegeSumm/VegeSumm-01-27-2011.pdf. Accessed August 2012.

4 Delta Dental conducted the 2011 Tricky Treats Halloween survey. Delta Dental network dentists were invited via e-mail to participate in the web-based survey. For results based on the total sample of 253, the margin of error is ±6.15 percentage points at a 95 percent confidence level.

5 Sortprice.com. Hollywood Blockbusters & Traditional Favorites Dominate SortPrice.com’s Annual Top 10 Halloween Costume Lists for 2011. http://www.sortprice.com/docs/Halloween-Popular-Costumes-for-2011. Accessed August 2012.

6 National Confectioners Association. Candy Corn. http://www.candyusa.com/FunStuff/CandyType.cfm?ItemNumber=1582. Accessed August 2012.

Sealing a Smile Packs a Preventive Punch

Why is 80 percent of tooth decay found in only 25 percent of children, disproportionately kids from low-income families?1 The answer is multifold and complex, but Delta Dental believes that school-based dental sealant programs are a large part of a workable solution.

Dental sealants are a critical but underutilized component of preventive dentistry. The one-two punch of sealants and fluoride (in toothpaste and water) along with a proper diet can almost totally prevent new tooth decay.

National surveys by the Centers for Disease Control and Prevention (CDC) indicate that only 38 percent of children and teenagers ages 12 to 19 have dental sealants. This number is much lower among children from low-income families and certain races/ethnicities with higher tooth decay rates who would benefit most from sealants.1

Dental sealants can save families time, money and the discomfort of dental fillings. Sealants are thin, plastic coatings applied to the pits and grooves of teeth to protect them from the bacteria and foods that lead to tooth decay. First and second permanent molars are the most likely to benefit from sealants, so it’s best if the sealant is applied soon after those teeth appear, before they have a chance to decay (usually ages 6 and 12).

A sealant is virtually 100 percent effective if fully retained on the tooth, and studies have shown they remain intact 92 to 96 percent of the time after one year and 67 to 82 percent after five years. Sealants should be checked at each regular dental appointment and can be reapplied if they are no longer in place. 2

Sealants delivered through school-based programs have been shown to decrease tooth decay by 60 to 65 percent.3 Using school-based sealant programs at lower-income schools has proven to be highly effective in improving the oral health of those schoolchildren. Studies of children in either Medicaid programs or with private dental insurance show that placement of sealants on first and second permanent molars reduced the need for future cavity fillings.

1 Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. MD: National Center for Health Statistics. Vital Health Stat. 2007 Apr. 11 (248):1-91. Available from: http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf

2 Griffin SO, Kolavic-Gray S, et al. Caries Risk in Formerly Sealed Teeth. Journal of the American Dental Association April 2009 vol. 140 no. 4 415-423.

3 Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on Interventions to prevent dental caries, oral and pharyngeal cancers and sports-related craniofacial injuries. Am J Prev Med 2002; 23(1 suppl):21-54. http://www.thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf. Accessed March 14, 2012.

Top Five Best Oral Health Practices at School

It may seem like a mindless matter, but packing an apple instead of a sugary snack in a child’s lunch this fall can help improve oral health and educational performance. After all, children eat more than 20 percent of their meals at school during the academic year. So Delta Dental, the nation’s largest dental benefits provider, reminds parents to make good decisions when packing a child’s school lunch.

Overconsumption of sugar harms a child’s oral and overall health. Snacks like cookies, candy and chewy fruit snacks mix with bacteria in the sticky plaque that constantly forms on teeth to generate acid, which can wear away enamel and cause tooth decay. While sweets may provide a temporary jolt for kids, that sugar rush soon turns into a crash and kids are left feeling lethargic. That is not the kind of mental state kids need to prepare for an afternoon of classes.

Instead, Delta Dental recommends these top five oral health best practices:

• After breakfast, before leaving for school, make sure your child brushes well with a fluoridated toothpaste. Brushing immediately following a meal helps clean teeth and eliminates halitosis (bad breath).

• Fill a child’s lunch box with healthy lunch food and snacks such as lean meats, whole grain breads, low-fat yogurt or cheeses, apples, bite-size carrots and baked chips or whole-grain crackers. Besides being packed with nutrients, certain fruits and veggies can even help clean the teeth and gums. Make treats a treat. Serve sugary sticky snacks like cookies, cake and brownies and candy only in moderation. Room parents should discuss bringing in healthy snacks along with sugary treats for birthdays and other classroom parties.

• If a child chews gum and the school allows it, chewing sugar-free gum for a few minutes in between lunch and afternoon classes can help stimulate saliva to buffer the acid and help dislodge food particles from the mouth. Gum containing the natural sweetener, Xylitol, is a particularly good option since studies have shown that consistent exposure to Xylitol can reduce cavity-causing bacteria in the mouth.

• Children with braces should try to brush or rinse well with water after lunch. Children who wear removable retainers should clean them well after each meal and rinse out their mouths.

• Before the school year starts, schedule a dental visit to make sure there are no problems to distract a child during the school year. Ask the dentist about sealants as a way to protect children’s teeth from cavities. Sealants – a thin coating of bonding material applied over the chewing surface of molar teeth – act as a barrier to cavity-causing bacteria.

Make Dentist Visits the Rule for Back-to-School

Along with an annual physical, clothes and backpacks, Delta Dental suggests adding a visit to the dentist to your child’s back-to-school list this fall. Dental professionals recommend biannual visits for most children, and the end of summer is an ideal time because it follows a season in which kids have indulged in treats like soda, ice cream and cotton candy.

A dental visit is important because a dentist can diagnose potential oral health problems such as tooth decay or gum disease and apply preventive measures as needed, including teeth cleaning, fluoride treatment, dental sealants, and instruction on good dental hygiene habits. Making sure children get a clean bill of oral health before the school year allows them to return to class flashing a happy and healthy smile. Conversely, untreated dental problems can be painful and embarrassing, and can harm a child’s educational and social development. In 2007, for example, the State of California estimated that seven percent of their more than seven million schoolchildren (504,000) missed at least one day of school because of a dental problem. 1

Unfortunately, access to sufficient dental care is not nearly what it needs to be for children from poor and uninsured families. A study from the Pew Center on the States found that two-thirds of states in the U.S. do not have adequate policies in place to ensure access to proper preventive dentistry, particularly for those children that lack appropriate access to care. 2 Instead, programs like mobile dental units that visit schools and school-based dental sealant programs are playing a critical part in improving the oral health and quality of life of low-income, American children.

Ultimately, good oral health for children starts at home with proper dental hygiene and diet. The daily one-two punch of brushing twice a day with a fluoride toothpaste and flossing once is still the foundation for maintaining healthy teeth and gums. Very young children (ages one to five) are particularly prone to tooth decay and parents should supervise (or actually brush) to make sure they do a good job. A diet light on sugary snacks and drinks and rich in fruits and vegetables goes a long way toward maintaining good oral and overall health.

1(Source: 2007 California Health Interview Survey) UCLA Health Policy Research Brief – Unaffordable Dental Care Is Linked to Frequent School Absences, 2009 Pourat N and Nicholson G. http://www.healthpolicy.ucla.edu/pubs/files/Unaffordable_Dental_Care_PB_1109.pdf

2The Cost of Delay: State Dental Policies Fail One in Five Children. Pew Center on the States. http://www.pewtrusts.org/uploadedFiles/Cost_of_Delay_web.pdf.