Dental Care and Orthodontia

Dental Care and Orthodontia

Children and teens may be so busy with school, sports, and social activities that they don't find time to brush. Or if they do brush, they may not be doing it properly. Kids also tend to eat a lot of junk food, which usually means sugary foods that can lead to cavities. Continue to impress upon your child how important good dental habits are, and take them for regular dental examinations and cleanings to prevent problems.

This section of Next Step will cover:

• Dental Care and Bleeding Disorders
• Baby Teeth and Permanent Teeth: The Ins and Outs
• Brushing and Flossing
• Braces
• Guarding Against Mouth Injuries

Dental Care and Bleeding Disorders

Good dental health begins with regular dental care. People with bleeding disorders have the same dental issues as everyone else, but complications associated with poor dental care are a little more serious, especially if surgery is needed.

Be sure to schedule regular checkups and teeth cleanings for your child. The dentist can identify problems early and reinforce healthy habits.

Here are some important facts to remember about dental care for a child with a bleeding disorder:

• Notify your dentist about any changes in the treatment of your child's bleeding disorder.
• If your child has a port, he or she may need to take antibiotics prior to dental procedures.
• If your child is on prophylaxis, schedule dental visits on days your child receives factor replacement treatment.
• Before your child has dental surgery or has a tooth pulled (called extraction), work with your Hemophilia Treatment Center (HTC) staff, dentist, and oral surgeon to develop a pretreatment plan to reduce the risk of prolonged bleeding after the procedure.
• Contact your dentist and HTC if your child has prolonged bleeding after a teeth cleaning.

Baby Teeth and Permanent Teeth: The Ins and Outs

The first tooth to come in and the first baby tooth to come out are usually times to celebrate in your child's growth. Keeping a few precautions in mind, this can be true for a child with a bleeding disorder as well.

When a baby's first tooth comes in and when it falls out isn't the same for every child.

Here is a general timetable for these milestones:

• 4 to 7 months: the first teeth (called primary teeth) emerge (called eruption).
• 5 to 6 years: the first tooth is lost (called exfoliation); this can happen as young as 4 years of age or as old as 8.
• 6 to 8 years: the permanent teeth start to come in.
• 17 years: wisdom teeth start to come in.

When teeth come in. As every parent of a teething baby will tell you, incoming teeth can cause discomfort. This doesn't stop with baby teeth. Incoming permanent teeth can cause aches, pain, and soreness.

Here are some tips to help lessen your child's discomfort when new teeth come in:

• Tell your child to chew food on the other side of his or her mouth.
• Give your child soft foods to eat for several days.
• Tell your child not to brush over a new tooth that's bleeding.

Some words of wisdom about wisdom teeth. People with bleeding disorders may experience noticeable, prolonged bleeding when their wisdom teeth come in. They might need an antifibrinolytic agent or nasal desmospressin (DDAVP). Talk to your Hemophilia Treatment Center (HTC) about a strategy for managing and treating this type of bleed. If other teeth aren't in the right position or the jaw is too small for the wisdom teeth to fit, they may become impacted and need to be removed (called extraction). The extraction of wisdom teeth should be planned out with the oral surgeon and HTC.

When teeth come out. If your child has a loose tooth, encourage him or her to not wiggle the tooth with fingers or tongue (as tempting as that might be!). Trying to remove a loose tooth before its ready to come out can irritate the gums, cause bleeding, and injure the tooth socket. It's best to let baby teeth fall out naturally, without pulling, so less bleeding will occur. Some bleeding is not uncommon when a tooth comes out. Bleeding can usually be controlled with simple measures.

Here are some tips to manage bleeding when a child loses a tooth:

• Maintain direct finger-and-gauze pressure for several minutes.
• Have your child bite down on a rolled up piece of cotton or moist tea bag (the tannic acid in the tea constricts blood vessels to help form a clot).
• Don't let your child rinse his/her mouth.
• Give your child soft, cool foods. Avoid hot foods for a couple of days.
• If the bleeding goes on for longer than two hours, call the Hemophilia Treatment Center (HTC) for advice.
  • You may need to give your child factor or the dentist may instruct you to use a prescription medication to help preserve the blood clot once it forms.

Brushing and Flossing

Brushing and flossing are the best ways to keep teeth and gums healthy. They help prevent cavities and gum disease, like gingivitis, which can make gums red, sore, and bleed. To help make the job more inviting, have plenty of oral hygiene supplies on hand, such as soft toothbrushes, colored or flavored floss (or plastic flossers), and good-tasting toothpaste. As your little one becomes an independent brusher, you may need to check that he or she is doing a good job with these tasks. Remember to replace toothbrushes every 3 months, and tell your child not to share toothbrushes to prevent the spread of germs and bacteria.

Flossing should begin as soon as two teeth touch each other. In the beginning, you'll have to do this for your child. As your son or daughter's coordination improves, you can help them learn to floss. To stress the importance of flossing, floss for them regularly until they're able to do it themselves. If your child has a joint problem, such as an elbow bleed, you may need to help them.

Gums may bleed slightly when your child first begins flossing. As plaque, the sticky film of bacteria that forms on teeth and gums, is removed and gums get healthier, bleeding will lessen. Usually this initial gum bleeding doesn't require factor replacement treatment. However, if bleeding continues for more than 20 minutes or stops and then starts again, call your Hemophilia Treatment Center (HTC) or dentist.

Braces

Children and teens with hemophilia can wear braces just like everyone else. In most cases, getting braces does not cause bleeding. Talk with your child's orthodontist about the procedure beforehand. Consult with your Hemophilia Treatment Center (HTC) to determine what kind of pretreatment might be necessary. The orthodontist can take special measures to avoid cutting or irritating the gums when bands and wires are placed on the teeth. Your child should conduct a daily finger check to inspect his or her mouth for wires sticking out and poking the gums. Ask the orthodontist to show your child how to apply dental wax to the brace bracket, which can reduce cutting and irritation of the cheeks, tongue, and gums.

Guarding Against Mouth Injuries

Mouth bleeds are common in children with bleeding disorders. Accidents, falls, and injuries to the mouth, gums, tongue, cheeks, and lips often cause bleeding. Usually these bleeds are minor but can look frightening when the blood mixes with the abundant amount of saliva.

Here are some dental safety tips for children with a bleeding disorder:

• Always wear mouth guards when playing sports.
• Wear mouth guards and night guards to avoid chipped teeth and cut lips.
• Do not get a lip or tongue piercing. Oral piercings are serious health risks in people with bleeding disorders. They can cause bleeding, infection, nerve damage, gum damage, and can crack or chip teeth.