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Archives for February 2021

Will a Pediatric Dentist Whiten My 9-Year-Old’s Teeth?

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girl covering mouth

I’m wondering if it makes sense to take my nine-year-old to a pediatric dentist for an evaluation. She’s always been worried about the color of her teeth, but over the past several months, the kids at school have been really unkind to her. The other day a boy in her class told her that wearing a mask was an improvement and she came back home in tears.

We normally all see the same dentist, so I phoned them to ask about doing some teeth whitening. They told me they never do whitening for anyone under age 18 and that no dentist will do it for kids under 16. That doesn’t make any sense to me at all. I’ve had it done and it’s safe. I had no trouble at all.

I’m worried about doing at-home whitening without some kind of dentist supervision, but that’s honestly what we’re going to wind up doing if I can’t find someone who will help. I can’t let her keep going to school and be subjected to this every day. Do pediatric dentists ever do whitening or do we have other options?

Thank you,

Annika

 

Dear Annika,

Kids can be so cruel. Sorry to hear your daughter is dealing with this. Let’s explore some possible solutions.

Chances Are, Your Daughter’s Teeth Are Normal

A survey of 2,495 children revealed nearly one-third are dissatisfied with the color of their teeth. Less than 20% of parents felt the same and just 9% of dentists felt the kids had an unsatisfactory tooth color. In other words, kids are much harder on themselves and often see an issue when the color of their teeth is perfectly normal and expected for their age group.

The challenge may also be that the structure of primary teeth and permanent teeth are different. Whereas baby teeth have a larger pulp area, adult teeth have more enamel and dentin. The dentin, therefore, shows through on adult teeth a bit more, which can make them seem yellow by comparison.

Your daughter’s likely at a stage where multiple primary and permanent teeth are visible when she smiles, so certainly, some teeth may appear darker or yellower than others. That’s true across the board, even of the kids making unkind remarks. None of this will necessarily help when a child is being bullied, but it may offer your daughter some reassurance.

The Problem with Whitening is Usually Sensitivity

Somewhere between one-third to one-half of people who whiten their teeth experience some degree of sensitivity. Adults generally understand the nature of their sensitivity, can manage it, and know it will pass. Kids don’t always have the same benefit and it can be more traumatic.

Adding to this, kids using at-home whiteners are more prone to abusing them. Understandably, if a child is catching flack at school, whether the kids are correct in their accusations or not, a large proportion of children will whiten more often than they should, keep the whitening gel or strips on longer than they should, or use more than they should, increasing the likelihood that they’ll develop sensitivity and other issues.

That said, a very small portion can develop more severe issues like permanent enamel disintegration and pitting. This is usually only seen when whitening products are misused.

Some Pediatric Dentists Might Offer Whitening

There are reports of kids as young as four whitening their teeth, but it’s generally not done in children under six. Your daughter is within a reasonable age for consideration, though each dentist will have his or her own philosophies on the age in which whitening is appropriate. That in mind, you may wish to speak with a pediatric dentist or someone who specializes in cosmetic dentistry. You’re on the right track with working with a professional on this, but you may have to talk to a few before you find someone who will either do it or explain why whitening is contraindicated for your daughter based on her unique needs rather than age. Best of luck to both of you.

 

This blog is sponsored by Dr. Raymond Bolt, an Auburn, AL family dentist offering cosmetic and pediatric dental care.

Anything My Dentist or I Can Do About Numbness After Extractions?

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man holding his jaw after visiting auburn al dentist

I was originally on the fence about whether I needed to see an oral surgeon of it my general dentist here in Auburn should do my wisdom teeth extractions. My dentist assured me I’d do fine and said that my extractions wouldn’t be complicated—that the only reason to see the oral surgeon would be if I wanted full anesthesia. Long story short, I went ahead and had him do it last week but I’m still feeling numb on my lower right side.

When I called and told them this, they more or less dismissed me, saying this “just happens sometimes,” I signed a form saying I understood it beforehand, and to come back in two weeks to have it checked again. I’m more than a little frustrated because I’m having trouble eating and chewing because of it really bothers me that they seemed more concerned covering their backsides about the form I supposedly signed. I may have, but that’s not the point.

Is there something they or I should be doing to get me back to normal faster?

Thanks,

Ruben

 

Dear Ruben,

It sounds like you have nerve damage in your lower right jaw. This will, in all likelihood, heal on its own, but let’s dig into what happened and what your options are.

The Inferior Alveolar Nerve Runs Along the Lower Part of Your Jaw

The image here shows approximately where your jawbone nerves sit, with “B” being the aveolar nerve. Everyone is a little different, so sometimes the nerve can run much closer to the teeth or it might be distanced more. Your dentist should have taken an x-ray before the extractions before deciding how to proceed. The nerve can even been seen on traditional panoramic x-rays as a dark line. Although it’s not the same as a 3-D image, it’s generally enough for the doctor to be able to evaluate the potential for issues during the extractions.

Nerve Damage During a Wisdom Tooth Extraction Falls into Three Categories

There are multiple ways nerve can be damaged during a tooth extraction. Healing is largely dependent on the type of injury.

Bruising

Also referred to as “stretching,” bruising is generally the mildest form of nerve damage that can occur during an extraction. This might be the case if mild pressure was applied to the nerve during the extraction or if swelling put pressure on it. In these cases, the nerve will generally heal in about a month on its own unless the stretching is severe. If a patient is experiencing pain, a doctor might offer some kind of palliative treatment or medication to help with that, but there’s nothing that can be done to restore sensation.

Crushing

It takes more pressure to cause a crushing-type injury. That might happen if downward pressure is applied to the tooth during the extraction or if the tooth breaks and the dentist has to go in and remove fragments, pressing on the nerve in the process. In these cases, the nerve fibers will regrow and heal, but it can take a year or so before sensation is restored.

Severing

The same things that cause crushing injuries can also sever the nerve, as can outright trauma directly to the nerve. However, the nerve will not regrow in these cases and the injury is permanent. On the whole, though, research shows latrogenic paraesthesia (abnormal sensation following medical treatment), is only permanent 25% of the time. And, even then, there are potential treatments such as nerve grafts that may help. Prognosis is best when surgery happens within three months of injury, but people have success much further out too. Many people simply adapt to the situation as well.

Sit Tight and Do Some Soul Searching

Chances are, you’re dealing with bruising. In which case, there may have been nothing the dentist could do to prevent it. The latter two are questionable—dentists are taught techniques to avoid damaging the nerve and many never see a single case of permanent damage their entire careers, but that doesn’t necessarily mean there weren’t extenuating circumstances either.

The main point is that you feel they dismissed your concerns. Their offering you an appointment in two weeks might be them trying to set you at ease though. It’s unlikely anything will be different in two weeks. Again, no change is likely to happen for three more weeks. So, give this some time and see what happens at your next visit and when you hit the month-mark. If you feel they’re still being dismissive, you may want to start looking around for a new Auburn dentist. And, if the numbness is still happening a month from now or you simply want more assurance, you may want to visit an oral surgeon for evaluation. Best of luck to you.

 

This blog is sponsored by Dr. Raymond Bolt, an Auburn, AL dentist specializing in comprehensive family care.