Nurses’ Notes this issue

Dental Emergencies P.2

Dental Sealants P.2

Help for Halitosis P.3

Is Teeth Whitening For You? P.3

Teen Teeth Trouble P.4

Eat Your Way to Dental Wellness P.5

Dear Dentist P.5

Dental Crossword P.6

2012 SUMMER

RISD

Good dental habits are especially important to develop at an early age. Usually by 3 years of age all 20 primary

(baby) teeth have erupted and by age 7 the permanent teeth have begun to emerge. Children should brush twice

daily with a soft-bristled, age appropriate toothbrush. If fluoride-toothpaste is used, the child should avoid swallow-

ing it, because the fluoride can cause staining of permanent teeth before they emerge. Floss once daily. By age

12 most primary teeth have fallen out and an orthodontist should be consulted for bite problems and teeth that are

not straight.

Good oral hygiene isn’t just for kids though…as we age, our teeth and gums need careful attention to avoid gum

disease. It is estimated that 50% of adults over age 30 have gingivitis (early gum disease). Gingivitis is

caused by bacteria found in plaque that adheres to the teeth, along the gum-line. Warning signs of gingivitis in-

clude bleeding gums; red, sore gums; swollen, shiny gums; and bad breath. If left untreated, gingivitis can de-

velop into periodontal disease, a more severe gum disease in which the gums recede and the teeth become loose

and fall out.

To maintain good oral hygiene and avoid gum disease, it’s important to visit the dentist

regularly and clean your teeth effectively. Professional cleanings by the dentist are rec-

ommended every 6 months. The American Dental Association warns that “untreated

dental disease can lead to serious health problems: infection, damage to bone or nerve,

and tooth loss. Infection from tooth disease can spread to other parts of the body and

may even lead to death”. Some people (such as those with heart conditions) are at risk

for developing infections when dental work is done and may need to take measures to

prevent complications.

Teeth become increasingly sensitive with age, as enamel wears. An anti-sensitivity

toothpaste can help with the problem, but if sensitivity continues, it is important to see a

dentist. Damaged teeth caused by cracks and fractures can cause sensitivity and can be repaired by crowns,

which strengthen the tooth. If a tooth needs to be removed or is missing, implants and bridges are used not only

for cosmetic purposes, but also for maintaining the structure and alignment of the mouth and to prevent gum prob-

lems.

To avoid complications of eroding teeth and gums, the expenses they incur, and the untimely inconvenience of it

all, it is important to maintain good dental care habits throughout a life-

time.

Sources:

“Oral Health Topics” from the American Dental Association

“Peridontal Disease” from the Oral Health, U.S, 2002 Annual Report

Jennifer Sahadi RN, BMP Christa McAuliffe Learning Center

A Lifetime of Dental Health

“Oral and Dental Health at Any Age” from the Colgate Oral

and Dental Health Resource Center

Page 2

Dental Emergencies

How would you handle a dental emergency? Below are some types of dental emergencies

and how to treat them.

Knocked-out tooth. Knocked-out primary (baby) teeth should not be replanted (placed back

in the tooth socket) while knocked-out permanent teeth need immediate attention. A perma-

nent tooth that is knocked-out should be held by the crown, which is the part that is usually

exposed in the mouth, and gently rinsed with water. Be careful not to handle the root of the tooth. The tooth should then be placed back

into the tooth socket facing the correct way or placed in a small container of milk, saline solution, or contact lens fluid. The tooth should

not be placed in water, juice, or disinfectants. Another option is placing the tooth inside the cheek like a lozenge. It is important to get to

the dentist right away. With each minute that passes, more of the cells on the root of the tooth die. Teeth that are replanted within 1 hour

of being knocked out have the highest chance of being saved. The tooth will be replanted and joined to the surrounding teeth for 7-10

days. If the tooth re-attaches to the jawbone, it will then require root canal therapy. Permanently lost teeth should always be replaced to

avoid problems such as difficulty chewing and speaking, as well as to avoid shifting of position among remaining teeth.

Abscess. An abscess is an infection of the space between the tooth and gums. Tissue damage to the gums and possible tooth loss may

occur. If left untreated it can become a very serious condition affecting other parts of the body as well. If you notice a “pimple-like swelling

on your gum”, call your dentist immediately and schedule an appointment. They are often times painful, so to help ease the pain until your

appointment you can rinse your mouth with salt water (½ teaspoon of salt in 8 ounces of warm water.) Even if the pain subsides or the

“pimple-like swelling” disappears, it is important to follow up with your dentist.

Bitten Lip or Tongue. Wipe area clean with a cloth, and apply pressure with a cold compress to help decrease the bleeding and swelling.

Apply pressure for at least 5 minutes. If the bitten area continues to bleed, go immediately to the hospital emergency room.

Sharon Nelson, RN BSN Stephanie Elam RN, BSN

Richland Elementary Math Science Technology Magnet

Dental Sealants

Dental sealants are thin plastic coatings that are applied to the

chewing surface of the molars. Brushing and flossing help to

remove food particles from the teeth, but there are deep

grooves in the molars that may be difficult to reach. The dental

sealant fills in those deep grooves and acts as a barrier, pre-

venting cavities from

forming. Sealants are

typical ly appl ied

shortly after the mo-

lars erupt, before they

have a chance to de-

velop decay. Seal-

ants are not visible

and can last about 5

years. Having seal-

ants does not mean

that you no longer have to brush and floss regularly. It is still

important to maintain good oral hygiene.

Richardson ISD Nurses, through a partnership with the Baylor

College of Dentistry, coordinate a dental sealant program that

is offered to all third grade students at participating schools.

This voluntary program is offered at no cost to the student,

whether or not they have insurance. This year almost 1,100

sealants were applied on RISD students!

Visits take place during the school day, with each visit lasting

approximately 20 minutes per student. Dental students, super-

vised by Dr. Stephen Crane DDS, faculty at Baylor College of

Dentistry, work in a temporary clinic set up in an available room

at the school. There they perform a brief screening, place the

sealants, and apply fluoride. Students with dental concerns,

such as cavities, are referred for additional treatment.

Sources:

“Dental Sealants” from the Centers for Disease Contol and Prevention

“Dental Sealants” from the American Dental Association

Joan Cary RN, BSN Special Procedures

Davina Harms RN, BSN Forestridge Elementary

Kim Clark RN, BSN O’Henry Elementary

Shara Strickland RN, MSN Springridge Elementary

“Handling Dental Emergencies” from WebMD

Sources:

“Dental Emergencies” from the American Dental Association

“Dental Emergencies” from the Colgate Oral and Dental Health Resource Center

Page 3

Halitosis (better known as bad breath) can be an uncomfortable and embarrassing problem. For those living with

halitosis, it can be difficult at times to find the cause and treat it. Many cases of halitosis can be treated with bet-

ter oral hygiene (brushing & flossing), but what you put in your mouth also can affect your breath. Food particles

remaining in the mouth collect bacteria which cause odor and damage gums

and teeth. Tobacco products and certain foods with strong odors, such as gar-

lic and onions, can linger on your breath long after you have brushed your teeth or rinsed your

mouth. If you suffer from dry mouth (caused by chronic mouth-breathing or some medications),

you may not have the saliva needed to clean your mouth throughout the day. Treatment for hali-

tosis can be as simple as drinking more water or sugar-free beverages to keep the mouth moist

and clean. Caffeinated beverages can further dry out the mouth if dry mouth is the problem.

Chewing sugarless gum stimulates the production of saliva to wash away bacteria in the mouth.

A dentist may also recommend an antimicrobial mouthwash. Since 80-90% of bad breath origi-

nates from the bacteria produced on the tongue, it is important to thoroughly brush the tongue as

well as your teeth or use a tongue scraper.

If halitosis persists after a clean bill of health by your dentist, it may be your body’s signal of an-

other problem such as a respiratory or sinus infection, diabetes, or gastrointestinal ailments, so

consult your primary healthcare provider.

Rhea Jarrett RN, BSN Lynne Houghton RN, BSN

Big Springs Elementary Yale Elementary

Is Teeth Whitening For You?

If you have ever wished for more than just the sparkle and whit-

ening obtained from brushing twice a day, you may have con-

sidered using a tooth whitening product. If so, you are not

alone. It is the number one requested cosmetic service today,

with $1.4 billion being spent on these products.

When deciding whether to pursue a tooth whitening program,

the first step would be to consult with your dentist, and to have

a thorough oral exam. Whiteners may not be for everyone, and

may not correct all types of discoloration. If your teeth appear

yellow, they will probably bleach well. Brownish teeth may

bleach less well. If they appear grayish-hued they may not

bleach well at all as these stains are intrinsic, or deep within the

tooth itself. Crowns and tooth-colored fillings will not whiten, so

if they are on the front teeth, es-

pecially, they may stand out in a

newly whitened smile. For difficult

to whiten teeth, bonding materi-

als or the application of por-

celain veneers might be an

alternative.

Whitening products can be

categorized into two major

groups, bleaching agents

like peroxide-containing

products, and whitening products like toothpastes. Tooth whit-

ening products help to restore the tooth to its natural color,

while bleaching agents whiten beyond the tooth’s natural color.

Whitening toothpastes remove surface stains on the teeth

through gentle polishing and chemical chelation agents. They

can lighten the tooth’s color by about one shade. Other over

the counter products including whitening strips, gels, and rinses

are peroxide based bleaching agents in a lower concentration

than what is offered in the dentist’s office. Strips and gels are

applied as instructed for about 14 days. Initial results can be

seen in a few days, and final results can last for about four

months. Rinses may take up to 12 weeks to show results, and

may be less effective due to the short amount of time they are

in the mouth. Per the American Dental Association, clinical

data continues to support both the safety and effectiveness of

these products.

In-office bleaching provides the quickest way to whiten teeth,

has the most dramatic effect, and is the most expensive. As

with over the counter products, the most commonly observed

side effects are temporary tooth sensitivity and occasional irrita-

tion of oral tissues. On rare occasions, irreversible tooth dam-

age has been reported. Excess bleaching can erode enamel

and make teeth translucent and unnatural looking, so be sure

to follow your dentist’s instructions. Bleaching is not —

Continued on Page 4…

Sources:

“Dental Health and Bad Breath” from WebMD

“Halitosis” from the American Dental Association

“Halitosis” from Wikipedia

Help for Halitosis

Page 4

Teen Teeth Trouble

Many teens have either never been seen by a dentist, or do not go regularly for preventative

care. The most significant cause of dental health problems in adolescents is drinking sodas.

It is reported that the average teenage boy drinks the equivalent of 868 cans of soda per year.

When you consider that each can of soda contains about 10 teaspoons of sugar that amounts

to 540 cups of sugar per year! Not only can this excessive amount of sugar cause dental cavi-

ties, but the acidic additives in the soda can also erode the enamel on the teeth. When soda is

consumed dentists recommend drinking it with a straw (to aide in reducing contact on the teeth)

and rinsing the mouth afterwards. Brushing on a regular basis as always is beneficial, without

question, in reducing the development of cavities and/or gum disease.

Mouth jewelry or oral piercing is another concerning and potentially dangerous aspect of adolescent dental health. Piercing of the

tongue can lead to infection of the tissue, swelling, uncontrolled bleeding, nerve damage, chipping and/or cracking of teeth, etc.

which can also lead to the need for a root canal/crown or the extraction of a tooth. In addition, mouth jewelry can cause choking or

internal problems such as bleeding if the stud, barbell or hoop comes loose inside the mouth and possibly swallowed.

During puberty (13 and older) most of the permanent teeth have erupted in the adolescent mouth. The

wisdom teeth (or the third molars) are the last to come through the gums and very often there is not enough

room in the mouth to accommodate them. The gums may intermittently swell before the molars come

through the skin or they could possibly remain impacted under the gum tissue. This impaction can lead to

damage of the adjacent teeth or the gum tissue. Damage to the gum tissue can lead to further gum disease

often related to difficulty cleaning the teeth around the swollen tissue. Wisdom teeth are not necessarily

required; therefore, if they are causing a problem most dentists recommend that they be removed to allow

adequate room for the remaining teeth.

Braces are sometimes placed on the teeth of adolescents to allow for straightening and/or alignment of

the teeth. This provides for proper bite alignment of the upper and lower teeth which often, when not

corrected, can impede speech, chewing and wear and tear on other tooth surfaces.

Janet Rambo RN & Sandy Wheeler RN, BSN, NCSN

Sources: Berkner High School

“Teens Oral Health” from the Academy of General Dentistry

“Impacted Teeth” from KidsHealth.org

recommended for teeth with decay or in people whose gums are infected. It is not recommended for

use in pregnant or lactating women. It is also not recommended for children under the age of 16, as

the pulp chamber, or nerve of the tooth, is enlarged until this age, and bleaching could cause it to be-

come sensitive.

Pam Crocker RN, BSN Nyla Karim RN, BSN Judy Quicksall RN, BSN

Jess Harben Elementary Mark Twain Elementary Dartmouth Elementary

Each year, Americans spend $1.4 Billion on over-the-counter

teeth whitening products.

Is Teeth Whitening For You? continued...

You are not supposed to keep your toothbrush within 6 feet of a toilet.

The airborne particles from the flush can travel up to a distance of 6 feet.

Sources:

“Teeth Whitening” from WebMD

“Tooth Whitening” from the American Dental Association

“Tooth Bleaching” from Wikipedia

“All About Teeth Whitening” from Livestrong.org

You should replace your toothbrush after you have an episode of flu, cold or other viral infection. Notorious

microbes can implant themselves on the toothbrush bristles leading to re-infection.

Page 5

Eat Your Way to Dental Wellness

Good dental health has a lot to do with what you eat and how often you eat! Eating right can help you fend off plaque, gingivitis,

and periodontal disease.

Sugar plays a big role in your overall dental health; in general it’s a good idea to eat fewer foods containing sugars and starches

between meals. Sugars from foods (natural or added) are converted to acids by bacteria in the mouth. This acid attacks the enamel

on teeth and begins the tooth-decay process. Because sticky snacks stay in your mouth longer than foods that you quickly chew

and swallow, they expose your teeth to sugar for a longer time. The more often you snack, the more frequently you are exposing

your teeth to the cycle of decay.

What about sugar-free food? Sugar-free means that no sugar was added to the food during processing. It does not mean that the

food does not contain natural sweeteners, such as honey, molasses, cane sugar, or fructose, which contain the same number of

calories as sugar and can be just as harmful to teeth.

It is not necessary to completely omit snacking, snacks are important for good physical health—

growing children need the calories and nutrients from snacks for proper growth—just snack

wisely and brush often!

Teeth and bones are fortified from dairy products such as milk, cheese and yogurt

which are rich in calcium. Not a fan of dairy? No problem! Raw almonds, dried

herbs, and sesame seeds are also rich in calcium.

Cheese, milk, yogurt, meats, plain nuts, peanut butter, fresh fruits and vegetables, unsweetened breads or cereals,

and popcorn protect tooth enamel by providing calcium and phosphorus needed to re-mineralize teeth.

Crunchy fruits and vegetables are also excellent for healthy teeth. The high water content in these foods dilutes the

effects of the natural sugars, increases the flow of saliva, and washes away food particles. They can also have addi-

tional benefits for your mouth; raw celery cleans teeth, reduces plaque and massages your gums; onions build tooth

enamel and strengthen gums.

Broccoli, carrots, sweet potato and pumpkin are rich in Vitamin A from which tooth enamel forms.

Chewing sugarless gum is beneficial to the teeth. Chewing helps dislodge food that sticks to teeth and also increases

saliva flow to neutralize acids and wash away leftover food in the mouth.

The best beverage choices are water, milk, and unsweetened tea.

Artificial sweeteners do not contribute to tooth decay. Because they are not digested the same way as sugar, they do

not cause bacteria to produce decay causing acids.

“Diet and Oral Health” from the American Dental

Association

“Diet and Oral Health” from WebMD

Sources:

“What Foods are Good for Your Teeth” from

Dental.net

“Smart Snacks for Healthy Teeth” from the

Colgate Oral and Dental Health Resource Center

Charmaine D’Souza RN, BSN

Apollo Jr. High

Dear Dentist,

When should a child start regular visits to the dentist? The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth,

and no later than the child's first birthday. A dental visit at an early age is a "well baby checkup" for the teeth. Besides checking for

tooth decay and other problems, the dentist can show you how to clean the child's teeth properly and evaluate any adverse habits

such as thumb-sucking. Continued on page 6...

Disclaimer: The Richardson ISD and its offices, and employees make no warranty as to the accuracy, reliability, completeness or timeliness of any informa-

tion included in the contents and are not responsible for any errors or omissions or for results obtained from the use or misuse of this information.

Gloria Canham RN, MSN Director of Health Services

Health Services thanks the Berkner area nurses for this issue’s articles.

“Nurses’ Notes” compiled by Becky Geise RN, BSN Health Services Lead Nurse

Dental Crossword

Page 6

Dear Dentist,

those who use tobacco in any form. Signs include:

A sore that bleeds easily or does not heal

A color change of the oral tissues

A lump, thickening, rough spot, crust or small eroded area

Pain, tenderness, or numbness anywhere in the mouth or

on the lips

Difficulty chewing, swallowing, speaking or moving the jaw

How often do I real ly need to get dental x-rays? Do children real ly need to get x-rays every year? How often X-rays should be taken depends on your oral health,

your age, your risk for disease, and any signs and symptoms of

oral disease you may be experiencing. Children may require x-

rays more often than adults because their teeth and jaws are

still developing and their teeth are more likely to be affected by

tooth decay than those of adults.

Questions answered by Diego Hurtado, Senior Dental Student

Baylor College of Dentistry and Dr. Robert Moore, DDS

Ragan Seefeldt-Boland RN, BSN

Audelia Creek Elementary

I have sensitive teeth, what can I do? Some of the causes of sensitivity include tooth de-

cay, a cracked tooth, worn tooth enamel, worn fill-

ings and roots that are exposed as a result of

aggressive brushing, gum recession and gum

disease. To treat/prevent sensitive teeth:

Soft bristle electric toothbrush. Apply as

much pressure when brushing as you would

to break a piece of lead from a lead pencil.

Make sure to floss.

Try using desensitizing toothpaste.

Seek in-office dental treatment which may be fluoride gels

or desensitizing agents.

If a result of dental decay or gum recession arises, your

dentist may recommend a filling and maybe a surgical

gum graft to cover the root surface.

What signs / symptoms of oral cancer should I look for? Oral cancer often starts as a tiny, unnoticed white or red spot

or sore anywhere in the mouth. It can affect any area of the

oral cavity including the lips, gum tissue, cheek lining, tongue

and the hard or soft palate. Oral cancer most often occurs in

Across:

1. Overlapping of the upper teeth over the lower teeth 3. Part of tooth above the gum; an artificial replacement for the covering on a tooth 5. Condition of having bad breath 8. Thin plastic coating that is applied to the grooves on the chewing surface of a tooth to prevent decay 10. Device used to protect mouth from injury when participating in sports Down:

2. Chemical solution that hardens teeth and prevents decay 4. Inflammation of the gums caused by improper brushing 6. Colorless, odorless, sticky substance containing acids and bacteria that causes tooth decay 7. Dental appliance used to exert pressure to straighten misaligned teeth 9. Hard calculus deposit that forms from not brushing teeth

Joan Cary RN, BSN

Special Procedures