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In the past, orthodontics was routinely an early teen event that began once all of the baby teeth were gone and permanent teeth were in. Recent advances in the understanding of a child development as well as modern materials have re-evaluated the time for orthodontic treatment to an earlier age. It is now recommended by the American Association of Orthodontists that every child should receive an orthodontic evaluation by age 7. But Why?

Common Orthodontic Problems Found At Age 7

1. Buck Teeth. Do the upper front teeth stick way out of line?

2. Deep Bite. Do the upper teeth cover the lower teeth?

3. Underbite. Do the upper teeth fit inside the arch of the lower teeth?

4. Open Bite. Do only the back teeth touch when biting down?

5. Crowded or overlapped teeth. Do the teeth have too much or too little space in certain areas?

6. Misaligned front teeth. Do the spaces between the upper two front teeth and lower two front teeth not line up?

7. Crossbite. Do the lower teeth fit properly inside the upper teeth?

8 .Missing teeth. If there are baby teeth that never developed, there will not be a permanent tooth to follow. Jaw x-rays may also find that certain permanent teeth are not  presently formed or are unable to come down on their own.

9. Extra teeth. When there are double teeth, extra teeth or malformed teeth.

Generally, orthodontic treatment does not begin at age 7 but it is good to get a head start to avoid any complications down the road. However, early orthodontic treatment may be necessary before age 7 if the following appear:

-Problems Speaking

-Proper Chewing Is Difficult

-Abnormal bite development

-Clicking or popping in the jaw

-Permanent teeth that are erutping into the mouth crowded or overlapped

-A thumb sucking problem

-A teeth grinding problem

-Issues biting cheeks or biting into the roof of the mouth

Benefits Of Early Orthodontic Treatment

Early orthodontic evaluation provides both timely diagnosis of problems and increased opportunity for more effective treatment. Early intervention gives the ability to guide growth and development, preventing more serious issues later. When orthodontic intervention is not necessary, an orthodontist can carefully monitor growth and development and begin treatment when it is ideal.

Early orthodontic treatment is also referred to as interceptive treatment or Phase I treatment. Some of the most direct results of interceptive treatment include the following:

-Creating room for crowded, erupting teeth

-Creating facial symmetry through influencing jaw growth

-Reducing the risk of trauma to protruding front teeth

-Preserving space for teeth that are coming in

-Reducing the need for tooth removal

-Reducing Phase II treatment time with braces

Phase II orthodontic treatment begins when all of the permanent teeth erupt and usually involves a full set of braces and not just a localized treatment plan.

Orthodontic Conclusion

While not every child will need early orthodontic treatment, it is best to know in advance what the options will be going forward. It is important to remember, orthodontics is not strictly a cosmetic endeavor, bite alignment is the ultimate goal. The issues presented above can all be corrected fairly easily if done in a phased approach. However, allowing this early intervention time to pass can complicate treatment requiring more extreme measures (i.e. teeth removal or surgery) to fulfill the same goal.

Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.