Kids toothache

Toothaches also called pulpitis, are caused by an inflammation of the pulp inside the tooth. The pulp is part of the inside of the tooth that has tissue and nerves (see Figure 1). A toothache is usually from dental caries, or a tooth cavity. This is often a result of poor dental hygiene.

Toothaches key points

• Pulpitis is inflammation of the dental pulp due to deep cavities, trauma, or extensive dental repair.
• Sometimes infection develops (eg, periapical abscess, cellulitis, osteomyelitis).
• Toothaches may be reversible or irreversible.
• In reversible pulpitis, the pulp is not necrotic, a cold or sweet stimulus causes pain that typically lasts 1 or 2 seconds, and repair requires only drilling and filling.
• In irreversible pulpitis, the pulp is becoming necrotic, the stimulus (often heat) causes pain that typically lasts minutes, and root canal or extraction is needed.
• Pulpal necrosis is a later stage of irreversible pulpitis; the pulp does not respond to hot or cold but often responds to percussion, and root canal or extraction is needed.

Figure 1. Tooth anatomy

Figure 2. Tooth pulpitis

When does tooth decay start?

Decay can start as soon as the tooth appears in the mouth.

Whitish marks on the tooth surface close to the gum line maybe an early sign of tooth decay. At this early ‘white spot’ stage, the decay process can be stopped and/or reversed by the use of fluoride.

If it is left untreated it can quickly progress to become a hole that will need dental treatment. This more advanced stage of decay will have a yellow-brown or black appearance on teeth.

How do young children get dental decay?

Decay is more likely to occur in infants or toddlers who:

• fall asleep sucking a bottle filled with a sugary liquid
• fall asleep sucking a dummy dipped in a sweet substance such as honey
• have prolonged (more than one year) on-demand breastfeeding
• have poor oral hygiene
• have a diet high in sugar, with lots of snacks.

Falling asleep while sucking a bottle or dummy dipped in a sweet substance is particularly damaging to the teeth because less saliva is produced during sleep. Saliva has an important role in washing away the harmful plaque acids.

Frequent snacking can also contribute to tooth decay because there is less time between eating to allow teeth to recover from plaque acid attacks.

Will a dummy or thumb sucking harm my child’s teeth?

No, but they will encourage an open bite, which is when teeth move to make space for the dummy or thumb. They may also affect speech development. That’s why you should avoid using dummies after 12 months of age.

Thumb sucking won’t cause permanent problems, as long as the habit stops by the time your child gets their second teeth, but it can be a hard habit to break.

Discourage your children from talking or making sounds with their thumb or a dummy in their mouth, and don’t dip dummies in anything sweet, such as sugar or jam.

Why do children need fluoride?

Fluoride is an important mineral for all children. Bacteria in the mouth combine with sugars and produce acid that can harm tooth enamel and damage teeth. Fluoride protects teeth from acid damage and helps reverse early signs of decay. Make sure your children are drinking plenty of water and brushing with toothpaste that has fluoride in it.

Is fluoridated water safe for my children?

Yes. The American Academy of Pediatrics, along with the American Dental Association and the Centers for Disease Control and Prevention (CDC), agree that water fluoridation is a safe and effective way to prevent tooth decay.

What is dental fluorosis and will fluoridated water mixed with infant formula increase the risk?

Although using fluoridated water to prepare infant formula might increase the risk of dental fluorosis, most cases are mild.

Fluorosis usually appears as very faint white streaks on the teeth. Often it is only noticeable by a dental expert during an exam. Mild fluorosis is not painful and does not affect the function or health of the teeth.

Once your child’s adult teeth come in (usually around age 8), the risk of developing fluorosis is over.

Should I mix infant formula with fluoridated water?

According to the American Dental Association, it is safe to use fluoridated water to mix infant formula. The risk if mixing infant formula with fluoridated water is mild fluorosis (see below for more information on this condition). However, if you have concerns about this, talk with your pediatrician or dentist.

What if I prefer not to use fluoridated water for infant formula?

If you prefer not to use fluoridated water with formula, you can:

• Breastfeed your baby.
• Use bottled or purified water that has no fluoride with the formula.
• Use ready-to-feed formula that does not need water to be added.

What if we live in a community where the water is not fluoridated? What can we do?

Check with your local water utility agency to find out if your water has fluoride in it. If it doesn’t, ask your pediatrician or dentist if your child is at HIGH risk for dental caries (also known as tooth decay or a cavity). He or she may recommend you buy fluoridated water or give you a prescription for fluoride drops or tablets for your child.

How else can my child get fluoride?

There are many sources of fluoride. Fluoridated water and toothpaste are the most common. It is also found in many foods and beverages. So making sure your child eats a balanced diet with plenty of calcium and vitamin D is a great way to keep teeth healthy. Your dentist or pediatrician may also recommend a topical fluoride treatment during well child or dental visits at various stages of your child’s development.

When should my child start using fluoride toothpaste?

The American Academy of Pediatrics and the American Dental Association recommend using a “smear” of toothpaste on children once the first tooth appears and until your child is 3. Once your child has turned 3, a pea-sized amount can be used.

What causes a toothache in kids?

Most toothaches are a result of a cavity. Sugar and starch in foods are the substances that cause damage to teeth. The bacteria in the mouth feed on sugar and starch and produce an acid that can eat through the teeth that damages the enamel (the surface of a tooth) and causes holes (dental caries or cavities) in the tooth leading to tooth decay. Different types of bacteria are involved in this process that can lead to an infection in the inside of the tooth.

Children who clean their teeth properly are still at risk of tooth decay if their diet is unbalanced. More and more children have tooth decay because of increased consumption of sugar-sweetened drinks (soft drinks, cordials, fruit drinks, juice, sports drinks and flavored milk) and foods (lollies, chocolate, fruit bars).

Healthy choices for food and drink will help look after your child’s teeth. Also avoid putting your child to bed with a bottle of anything other than water, as this can increase the chances of tooth decay.

Which children are at risk for tooth decay?

All children have bacteria in their mouth. So all children are at risk for tooth decay. But the following may raise your child’s risk for it:

• High levels of the bacteria that cause cavities
• A diet high in sugars and starches
• Water supply that has limited or no fluoride in it
• Poor oral hygiene
• Less saliva flow than normal

Stages of tooth decay

1. Demineralization: During this stage, white or light brown spots begin to develop on the surface of the tooth. This usually occurs on teeth in the back of the mouth. Because of the location and shape of these teeth, food can get easily trapped within the cusps of teeth. As food remains, it develops into harmful bacteria. The longer this bacteria remains on teeth, the more likely that demineralization will occur. Although you may experience some dental sensitivity at this stage, side effects are generally minimal. The tooth can be remineralized and strengthened with a deeper dental cleaning, fluoride treatment, and dental sealants.
2. Enamel decay: Although enamel is one of the strongest substances in the body, it is susceptible to damage. As bacteria linger on teeth, they will begin to erode the enamel, causing small holes, known as cavities. During this stage, you may feel even more dental sensitivity or have difficulty chewing on the affected side of your mouth.
3. Dentin decay: The layer directly under the enamel is known as dentin. If enamel decay is left untreated, the cavity will continue to widen and deepen, causing more surface damage to the tooth. At this stage, patients generally experience stronger symptoms, such as intensified sensitivity and tooth pain, making simple tasks, such as biting and chewing uncomfortable. Although a tooth-colored filling can often repair a tooth at this stage, more aggressive treatments, such as a dental crown may be necessary.
4. Pulpitis (pulp decay): Once bacteria penetrate the inner chamber of the tooth, the roots have been compromised. The pulp chamber also houses your nerves. Most patients experience severe, persistent pain that can radiate to different areas of the face and jaw. Conservative treatments include root canal therapy and a crown to protect and strengthen the tooth. In some cases a tooth extraction may be necessary.
5. Abscess growth: Once an abscess develops, the tooth is no longer functional and it can place surrounding teeth and gums in danger of further decay and gum disease. Symptoms at this stage are debilitating and the tooth may need to be extracted.

Kids toothache prevention

Most children want sweets, but you can help to prevent problems by making sure they don’t have a large amount or very often, and particularly not before bed, when saliva flow lessens. Try not to give sweets or sweet drinks as rewards.

The best snacks for your child are fruit and raw vegetables. Try tangerines, bananas, pieces of cucumber or carrot sticks. Other good snacks include toast, rice cakes and plain popcorn.

Dried fruit is high in sugar and can be bad for teeth, so only ever give it to children with meals – for instance, as a dessert – and never as a snack between meals.

Fizzy drinks can contain large amounts of sugar, which will increase the risk of tooth decay. Fizzy drinks (both those containing sugar and sugar-free or “diet” versions) also contain acids that can erode the outer surface of the tooth. The best drinks for children over one year old are plain still water or plain milk.

Even unsweetened juices and smoothies contain sugars and acids. Restrict your child to no more than one small glass (about 150ml) of fruit juice or smoothie each day and only at mealtimes.

Teeth are at most risk at night because there is less saliva in the mouth to protect them. Water is the best drink to give at bedtime, but if you do give milk, don’t add anything to it. Chocolate-flavored drinks and milkshake powder usually contain sugars, which will increase the risk of decay.

A regular teeth-cleaning routine is essential for good dental health. Follow these tips and you can help keep your kids’ teeth decay-free.

From brushing their first tooth to their first trip to the dentist, here’s how to take care of your children’s teeth.

You can help prevent tooth decay in your child with these simple steps:

• Start brushing your child’s teeth as soon as the first one appears. Brush the teeth, tongue, and gums twice a day with a fluoride toothpaste. Or watch as your child brushes his or her teeth.
• For children younger than 3 years old, use only a small amount of toothpaste, about the size of a grain of rice. Starting at age 3, your child can use a pea-sized amount of toothpaste.
• Floss your child’s teeth daily after age 2.
• Make sure children don’t eat or lick toothpaste from the tube.
• Make sure your child eats a well-balanced diet. Limit snacks that are sticky and high in sugars. These include chips, candy, cookies, and cake.
• Prevent the transfer of bacteria from your mouth to your child’s. Don’t share eating utensils. And don’t clean your baby’s pacifier with your saliva.
• If your child uses a bottle at bedtime, only put water in it. Juice or formula contain sugars that can lead to tooth decay.
• Do not allow a bottle containing milk or sweetened liquids to remain in your child’s mouth after they have fallen asleep.
• If you child does need a bottle for comfort or for sleep, only provide cooled, boiled water in the bottle.
• Do not give cordial or juices in the bottle. Water is the best thirst quencher.
• Replace the bottle with a cup when your child is 6 to 12 months old.
• Do not dip your child’s dummy in any sweetened substances.
• Avoid sweet and sticky snacks.
• Talk with your child’s dentist about using a fluoride supplement if you live in an area without fluoridated water. Also ask about dental sealants and fluoride varnish. Both are put on the teeth.
• Schedule routine dental cleanings and exams for your child every 6 months.

Toothbrushing tips

• Brush your child’s teeth for about two minutes twice a day: once just before bedtime and at least one other time during the day.
• Encourage them to spit out excess toothpaste, but not to rinse with lots of water. Rinsing with water after tooth brushing will wash away the fluoride and make it less effective.
• Supervise tooth brushing until your child is seven or eight years old, either by brushing their teeth yourself or, if they brush their own teeth, by watching how they do it. From the age of seven or eight, they should be able to brush their own teeth, but it’s still a good idea to watch them now and again to make sure they brush properly and for about two minutes.

How to help children brush their teeth properly

• Guide your child’s hand so they can feel the correct movement.
• Use a mirror to help your child see exactly where the brush is cleaning their teeth.
• Make tooth brushing as fun as possible by using an egg timer to time it for about two minutes.
• Don’t let children run around with a toothbrush in their mouth, as they may have an accident and hurt themselves.

Dentist visit

Maintaining good oral hygiene involves going to the dentist every 6-12 months. The dentist is able to:

• Recommend cleaning techniques and products;
• Clean plaque and calculus from the teeth;
• Fill cavities that could lead to further tooth decay;
• Administer fluoride treatments;
• Treat mild gingivitis before it turns into periodontitis;
• Take radiographs; and
• Reinforce oral hygiene instruction over long term.

Fluoride varnish and fissure sealants

• Fissure sealants can be done once your child’s permanent back teeth have started to come through (usually at the age of about six or seven) to protect them from decay. This is where the chewing surfaces of the back teeth are covered with a special thin plastic coating to keep germs and food particles out of the grooves. The sealant can last for as long as 5 to 10 years.
• Fluoride varnish can be applied to both baby teeth and adult teeth. It involves painting a varnish that contains high levels of fluoride on to the surface of the tooth every six months to prevent decay. It works by strengthening tooth enamel, making it more resistant to decay.
• From the age of three, children should be offered fluoride varnish application at least twice a year. Younger children may also be offered this treatment if your dentist thinks they need it.

Ask your dentist about fluoride varnish or fissure sealing.

How to brush your child’s teeth

Brush your child’s teeth by placing the tip of the toothbrush bristles towards the gum line and gently jiggling the brush, or moving it in tiny circles over the teeth and gums.

• Repeat the same brushing method on the inside surfaces of all teeth. For the chewing surfaces, use a light backward and forward motion.
• Remember plaque is soft, use the toothbrush gently as there is no need to scrub.
• Jiggle the toothbrush or move in tiny circles on the outside surfaces of the teeth and gums.
• Repeat the same method on the inside surfaces of the teeth.
• Use a light backward and forward motion on the chewing surfaces of the teeth.

What type of toothpaste should I use for my child?

It’s important to use a toothpaste with the right concentration of fluoride. Check the packaging to find out how much fluoride each brand contains.

• Children don’t need to use special “children’s toothpaste”. Children of all ages can use family toothpaste, as long as it contains 1,350-1,500 ppm (parts per million) fluoride.
• Children aged six and under who don’t have tooth decay can use a lower-strength children’s toothpaste, but make sure it contains at least 1,000 ppm fluoride.
• Below the age of three, children should use just a smear of toothpaste. Children aged three to six years should use a pea-sized blob of toothpaste. Make sure children don’t lick or eat toothpaste from the tube.

Your dentist may advise you or your child to use a toothpaste with a higher concentration of fluoride, if you need it.

What are the signs and symptoms of a toothache?

The following are the most common signs and symptoms of a toothache. However, each child may experience symptoms differently. Signs and symptoms may include:

• Constant, throbbing pain in a tooth
• A tooth is painful to touch
• Pain in the tooth that worsens with hot or cold foods or liquids
• A sore and tender jaw in the area of the tooth
• Fever
• Malaise (generally tired and feeling badly)

How is a toothache diagnosed?

The symptoms of a toothache may resemble other medical conditions or dental problems. Always consult your child’s doctor or dentist for a diagnosis. A toothache is usually diagnosed based on a complete history and physical examination of your child and your child’s mouth. Your child’s doctor will probably refer your child to a dentist for complete evaluation and treatment. At the dentist, X-rays (a diagnostic test that uses invisible electromagnetic radiation to produce images of internal tissues, bones, teeth, and organs onto film or captured digitally on a computer) of the teeth may be taken to help in the diagnosis and treatment of the problem.

What is the treatment for a toothache in kids?

Specific treatment for a toothache will be determined by your child’s dentist based on:

• Your child’s age, overall health, and medical history
• Extent of the condition
• Your child’s tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include:

• Antibiotics by mouth may be prescribed
• Pain medications may be prescribed
• Warm salt water rinses to the mouth
• Tooth extraction
• Draining of an abscess, if present
• Root canal (a surgical procedure that involves the removal of the damaged nerve and tissue from the middle of the tooth)

If the infection is severe, the child may need to be treated in the hospital and receive antibiotics through an intravenous (IV) catheter.