MY CHILD'S GUMS BLEED...SHOULD I BE CONCERNED?

Dental pain with children can result from a variety of sources, and any child can be affected at some point in their childhood. Let’s discuss common sources of dental discomfort and how to best respond for your child.

1. CAVITIES

Referred to as caries by dental professionals, cavities (aka tooth decay) are certainly a common cause of dental discomfort. They result from a process involving a few different variables coming together to harm teeth. As we eat carbohydrates and sugars, certain types of oral bacteria digest the sugars and make acidic byproducts, causing tooth demineralization (tooth decay). Due to the ubiquitous nature of processed foods in our grocery stores and convenience stores, it is not astonishing that caries are the most common disease affecting young children today.

• How to know— How do you know if a cavity is behind your child’s discomfort? A cavity can have many appearances and fly under everyone’s radar until it becomes visually evident and problematic. Often it manifests as a white, yellow, or brown spot (or hole), unless it is between teeth, in which case only dental x-rays may detect it. Sometimes a tooth that has fractured indicates the presence of a cavity, (over time, a cavity was present and growing, eventually undermining the now-broken tooth structure and causing the break). If mealtime consistently causes your child discomfort, a cavity may be the cause. Pain or discomfort may also manifest when your child is brushing, sleeping during the night, at random times, or it can come and then seem to go away for a while (fooling everyone that it’s no longer a concern, when it is!).
  
  
• What to do— To soothe your child’s tooth-related discomfort, only give them room-temperature food and drink (avoid hot or cold), and consider the use of a straw if drinking from a cup causes discomfort. Natural or herbal remedies include clove oil (especially for deep cavities irritating a tooth’s nerve), vanilla extract, peppermint tea, and crushed garlic paste. At-home fillings (purchased from the store) may provide limited, temporary relief. Over-the-counter pain medications are often effective at relieving dental discomfort (i.e. children’s Tylenol or Motrin). Visit your child’s pediatric dentist to discuss options in addressing the cavity. 
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2. BABY TEETH NEARING “EXFOLIATION”

Another common cause of dental discomfort is a baby tooth nearing exfoliation (falling out), when a permanent tooth will take its place. When this occurs, the roots of a baby tooth beneath the gums shorten at the same time the permanent tooth is developing and moving toward the surface of the gums.

• How to know— The ages of 8 to 13 present with the replacement of posterior baby teeth, and these are the usual culprits behind discomfort related to baby teeth nearing exfoliation. There may be discomfort chewing, brushing, or flossing. The gums in the area may be red and sensitive. Bleeding may occur when the baby tooth nearing exfoliation gets bumped.
  
  
• What to do— In this case, an over-the-counter numbing gel (i.e. Oragel) may be helpful. If the baby tooth is already wiggly and your child is willing, see if they can wiggle it out on their own. If the discomfort does not resolve within a few weeks, seek professional intervention. Children should not have to endure dental discomfort without help. In-office extractions to facilitate continued normal growth and development in this situation are quite routine and often surprise both parents and kids with how simple the procedure is, so visit your pediatric dentist. 
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3. FOREIGN OBJECT STUCK BETWEEN TEETH

At times, a piece of food (i.e. popcorn, meat, leafy greens, bread, etc.) stuck between teeth or wedged into the gums can cause discomfort. Be mindful that children sometimes develop unexpected habits. Hair ties/hair bands, pieces of plastic, hair, fabric, pencil lead, and more have been found in kids’ gums and teeth. This can be an elusive problem because it may not come to mind as a possible source of the child’s pain.

• How to know— If you can visualize what’s going on, then you’re halfway there. If not, and discomfort remains, it could very well be as simple as something your child ate that is stuck in their teeth.
  
  
• What to do— Brushing and flossing with your child as you normally would often resolves this issue. If this doesn’t do the trick, consider tying a knot in the floss, then flossing and pulling the knot through the location between the teeth and the gums. Rinsing with water or a waterpik for children, or the careful use of a toothpick, may prove successful at dislodging the uncomfortable food or foreign object. If at-home efforts fail to resolve the issue, schedule an appointment with us. 
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4. MISSING FILLING

On occasion, a filling can break so part, or all, of it falls out. If this is caused by a secondary cavity that snuck in around the filling, it needs prompt professional attention. Sensitivity can occur because the underlying inner tooth structure is now exposed.

• How to know— This can be difficult to determine, unless visually identified within the mouth.
  
  
• What to do— Feeding your child room-temperature food and drink will help avoid sensitivity if present. Consider natural or herbal treatments (discussed previously). At-home fillings (purchased from the store) may provide limited, temporary relief. For pain relief, over-the-counter pain medications are usually effective (i.e. children’s Tylenol or Motrin). Take your child to the dentist promptly. 
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5. DENTAL TRAUMA (DAMAGE TO TEETH)

There are numerous dental injuries that can occur with children– a minor bump to a tooth which may cause aching for a couple days; broken tooth structure; a luxation (the tooth is hit so hard it gets pushed out of position); an avulsion (the tooth is knocked completely out). For kids age 6 and under, the mouth is the second most common body part to sustain injury and repeated injuries to the same part of the mouth are not uncommon.

• How to know— An accident affecting the mouth is usually obvious, as a child (usually in distress) alerts the parent. However, the following two aspects of dental trauma are less well-known: (a) A minor amount of blood in the mouth mixed with saliva can look like a lot of blood and cause alarm. (b) Many dental injuries go unnoticed because they can occur while children are away from home or are themselves unconcerned about the injury and neglect to mention it to their parent.
  
  
• What to do— Depending on the dental injury, prompt action on your part can alleviate pain for your child and drastically influence the future health of the damaged tooth. First things first– hopefully you already have an established dental home for your child with a local pediatric dentist, and have the office’s emergency number handy. In the event of a dental emergency, know that it often seems worse than it really is. In the long-term, your child should be okay, as should their smile. Tend to your child’s comfort and try to stay calm. If a tooth breaks or falls out, collect the tooth structure and store it in a plastic baggie with milk. Visit your child’s pediatric dentist right away and bring the tooth with you.

There are undoubtedly more possible sources of dental discomfort with children than what has been discussed in this article. Dental pain can disrupt daily life for a child, even the daily routine of the whole family. Do remember that some children may neglect to vocalize they have discomfort in their mouth. Be proactive to prevent oral conditions from affecting your child. Gain a valuable ally and consultant for your child’s health by connecting with a local pediatric dentist and establishing care. Regular dental visits for kids enable parents to (a) detect issues early on, (b) spark enthusiasm for oral health, and (c) receive child-specific guidance.

If your child is experiencing dental pain, call today to schedule an appointment at Sunday Pediatric Dentistry, and stay tuned for part two in this blog series: “5 Additional Causes of Dental Discomfort and What You Can Do.”

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REFERENCES:

1 Poti, Jennifer M, et al. Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households? The American Journal of Clinical Nutrition. 2015. https://doi.org/10.3945/ajcn.114.100925. Accessed 12/13/2021.

2 The State of Little Teeth, 2nd Ed. American Academy of Pediatric Dentistry. 2019. https://21o6rc1uk27m4b8lc61u64ou-wpengine.netdna-ssl.com/wp-content/uploads/2019/02/StateofLittleTeeth.2ndEdition.pdf. Accessed 12/13/2021.

3 Toothache. Cleveland Clinic. 2020. https://my.clevelandclinic.org/health/diseases/10957-toothache. Accessed 12/13/2021.

4 Day, Peter F, et al. International Association of Dental Traumatology Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition. Endorsed by the American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry. 2020. https://www.aapd.org/media/policies_guidelines/e_injuries.pdf. Accessed 12/13/2021.

5 Petersson EE, Andersson L, Sorensen S. Traumatic oral vs non-oral injuries. Swed Dent J. 1997; 21:55–68.

6 Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. Dent Traumatol. 2008; 24:603–11.