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Teething - The eruption and cutting of teeth especially the primary teeth.

Teething can be a very difficult time for parents and child. The child will experience some level of discomfort and most parents cannot bear to see their children hurting at all. Not to mention the possible loss of sleep for baby and parents.

Signs and Symptoms of Teething

By age 2 and 1/2 most children have all 20 of their primary teeth. During the process of teeth erupting into the mouth, your child may experience some signs and symptoms. These can include the following:

-Excessive Drooling. Many babies drool so much during the teething process that it is hard to even begin to keep them dry. Teething stimulates drooling and it begins for most babies at about 10 weeks of age.

 -Rash on cheeks or chin. The rash development is linked to excessive drooling. If your baby is drooling excessively, they may develop a dry skin rash around the mouth, and on their chin due to contact with the excessive saliva. Drying the skin around the mouth frequently will help prevent the rash. Use of a gentle skin cream will help moisturize the rash, helping it to heal faster.

 -Coughing. Sometimes the drool will make babies cough for no apparent reason. The baby is actually gagging a little on the excessive drool. The baby should be monitored if this persists and also check to ensure there are no other signs or symptoms of cold, allergies, or flu present.

-Chewing or Biting. As the teeth begin to push through the gums it can cause some discomfort for the baby. Babies learn very quickly that counter pressure will sooth that discomfort. That is why they enjoy chewing on things, especially cold, around this time. This can also be a tough time for mom if she is breast feeding.

-Discomfort or Pain. Every baby will be affected differently. Some experience terrible pain and others barely anything. The first teeth to erupt usually cause the most pain or discomfort. Most babies eventually get used to the pain or discomfort and it is not as severe after the initial tooth eruptions.

 -Irritability. Babies will become irritable during this time as their sleep is affected by chronic discomforts. The same could be said for some parents!

 -Refusing to Feed or Eat. The suction of feeding can cause babies discomfort during this time. Teething babies sometimes become fussy about feedings and become even angrier when they get hungrier and hungrier. Talk to your pediatrician about possibly offering solid foods to baby during this time if they are not already on them. The chewing will relieve some of the discomfort.

 -Development of Diarrhea. This has caused some division among pediatricians but some parents report the development of diarrhea during the teething process. Either way it is important to keep your baby hydrated during the teething process. Speak to your pediatrician if the diarrhea persists.

-Development of a Low grade fever. The fever is believed to be due to the inflammatory process in the body. As the teeth erupt, the babies gum tissue becomes inflamed and this inflammation can sometimes produce a low grade fever (less than 101 degrees F). Treat as you would any other low grade fever but if it persists call your doctor.

-Poor Sleeping Habits. The teething process does not only happen during the day, it can spill over into the evenings. The teething discomfort can disrupt nap time as well as night time sleeping.

-Gum Hematoma. Teething can cause bleeding under the gum tissue, which looks like a bluish lump. It is not anything to be worried about and can heal faster with the help of a cold compress.

-Ear pulling; cheek rubbing. Teething babies may tug on their ears or rub their cheeks or chin. The reason for this is that these areas all share the same nerve pathways. Discomfort in the mouth can travel to other areas in and around the face. Be on the lookout for an ear infection as well. Babies who have ear infections have similar symptoms.

Relief From Teething

There are some things parents can do to make their babies feel better. They include:

-Chewing. As mentioned earlier, chewing soothes teething babies. Some good choices might be rubber teething rings and rattles for them to chew on. Another good option is a frozen, wet washcloth to let them chew on. Our babies liked cold, peeled carrots, they are large,  impossible to swallow or chew, but taste good and are not too hard. The cold will relieve the discomfort.

-Rubbing. Your finger rubbed firmly on baby’s gums, or a wet washcloth, can provide the same soothing counter pressure. Your baby may not like it at first because it might initially hurt, but the counter pressure will bring relief.

-Pain relief. If all of the above do not work to relieve the teething discomfort you may want to turn to some sort of pain relief. Acetominophen (Tylenol) is an excellent choice, but as always, check with your pediatrician before using any medications. Some people like to use topical numbing agents, like Anbesol, but babies tend to get very upset with the feeling it gives.

Conclusion on Teething

Teething can be a difficult time for both parents and baby, but armed with good educational information, you can get through it as easily as possible. Follow the tips above to keep you and your baby happy and comfortable.

 

Dry socket (also called alveolar osteitis) is an extremely painful dental condition that can occur after removal (extraction) of a permanent adult tooth.

Having a tooth removed is generally not something anyone looks forward to. Most people understand there will be some level of discomfort following the procedure.  Many are given a prescription for pain medication before leaving their dentist. Most people in fact do not even need to get the prescription filled. However, when a patient experiences what is called a dry socket the pain can become quite intense and linger for days.

Very few people are affected by dry socket. The development of Dry socket after a tooth extraction occurs in only about 2-3% of patients. For those who experience dry socket it can be a very scary experience. Fortunately dry socket is treatable.

A dry socket occurs when the blood clot at the site of the tooth extraction has never fully formed, has broken free, or has dissolved before the wound has had a chance to fully heal. The blood clot is the protective layer for the underlying bone and nerves, it begins the process of healing so that gum tissue and bone can refill the area. When the clot is gone the bone and nerves are now exposed to the outside air, food, fluid, and anything else that enters the mouth. This can lead to a dry socket with sharp, aching pain that can last for 5-6 days, and in the case of a patient taking fosamax type drugs the pain can last for weeks.

A dry socket is considered the most common complication following tooth extractions. It happens more frequently with extraction of impacted wisdom teeth, in patients with poor blood flow to the socket, (smokers, patients taking fosamax), delayed healing (diabetics ).  The pain begins to build and develop about 2-4 days following the procedure.

Signs and Symptoms of Dry Socket

Signs and symptoms of dry socket may include:

-Sharp, aching pain within 2-4 days after a tooth removal.

explanation of dry socket

Graphic explanation of dry socket…image courtesy of Dental Care Matters

-Partial or total loss of the blood clot at the tooth extraction site. You would be able to visually notice a deep hole or space where tooth used to be, that weeps fluid when pressed vs a blood clot overlaying the site.

-Bone that is visible upon visual examination in the socket

-Pain that radiates from the socket to your ear, eye, temple or neck on the same side of your face as the extraction

-Abnormally bad breath or a foul odor emanating from your mouth. This will coincide with having a bad taste in your mouth as well.

-If you have swollen lymph nodes around your jaw or neck, this is a sign of infection and you need to be seen by your dentist immediately.

Over the counter medications by themselves will not control the symptoms. Your dentist or oral surgeon will need to begin treatments to lessen pain and allow for healing to take place.

Treatment of Dry Socket

Taking a nonsteroidal anti inflammatory drug (NSAID – aspirin or ibuprofen) can help to ease the pain but probably will not be enough to take it away completely. When the pain persists you should call your dentist immediately. The dentist may prescribe you a stronger pain medication to allow the pain to subside for you or give you anesthesia in the office to relieve some of the symptoms for a little while anyway.

paste for dry socket

Paste for Dry Socket

What will your dentist need to do for the dry socket? Your dentist will need to numb and clean the tooth socket. This will allow for  removal of any debris from the space where the tooth once was, and allow for rebleeding into the site. The dentist may then fill the socket with a medicated dressing or a special paste to promote healing and soothe the symptoms. Patients with dry socket dressings generally need to come back to be seen by the dentist every day until the pain subsides. The dressing needs to be changed daily. Warm cloth on the outside of the face also helps promote blood flow.

An antibiotic may also be prescribed at this point to prevent an infection from forming. At home care will include rinsing with salt water and being careful what you eat and how you eat it, ( avoiding the side where the dry socket is ).

The site will usually heal completely following treatment in 1-2 weeks.

Who is most likely to get a Dry Socket?

Some patients will be more likely than others to get a dry socket after a tooth extraction. These include the following:

-Smokers. Patients who smoke have twice the chance of developing dry socket over those who do not. Smoking also is believed to slow the healing process.

-Poor Oral Hygiene. Those with poor oral hygiene will have an increased risk due to the amount of bacteria in the mouth. Will be difficult to maintain a sterile field when removing tooth.

-Having wisdom teeth (3rd molars) extracted. Increased trauma to area during procedure is one of the indicators for increasing the possibility for the development of dry socket. 3rd molars tend to be more difficult to remove especially if they are fully or partially impacted.

-Previous history of dry socket. If you have had dry socket previously, you are more likely to develop it after another extraction.

-Use of birth control pills. Contraceptives which contain estrogen effect the blood clotting system of the body. So we see an increased incidence in dry socket in patients on oral contraceptives.

Rinsing and spitting a lot or smoking after having a tooth extracted also can increase your risk of getting dry socket. These activities will increase chances of the blood clot becoming dislodged.

Following the removal of a tooth it is very important to follow all instructions given to you by your dentist. If you are unsure of anything you must ask or call back. At first sign of pain or discomfort call your dentist to be sure it is not something more serious. As always, maintain a regular schedule visiting your dentist, as well as keeping an open communication with your dentist. This will make you feel comfortable asking questions and knowing you are getting the proper information to care for your oral health.