Swollen Jaw (ER)

“Can
you open your mouth widely?” Dr. David Goo asks 12-year-old
Christopher Davis. He can, but when Dr. Goo asks Christopher if
it hurts, Christopher shakes his head yes. The examination continues. “Close
your mouth down, bite down,” says Dr. Goo. “Okay right
where it’s swollen? So when I mash on that, it’s tender?” Christopher
says yes.

Experts at the Centers for Disease Control and Prevention (CDC) have
discovered that tooth decay is common among children and often goes untreated.
A recent CDC study found that 52 percent of 410 third-graders examined had
tooth decay or dental caries (cavities). Twenty-two percent had untreated cavities.

Despite improvements in U.S. dental care, Dr. Alicia Williams of
the CDC says by late adolescence, approximately 80 percent of children
have a history of cavities. And even though proven, cost-effective
prevention strategies are available that could reduce oral diseases,
almost $50 billion is spent each year on dental services. The CDC
offers these additional statistics about tooth decay:

• More than 100 million Americans do not have access to fluoridated
  water.
• Almost 20 percent of children in preschool have tooth decay;
  by third grade, 50 percent; by age 17, 86 percent.
• Only one-in-five Medicaid-eligible children receives preventive
  dental services annually.
• Only one-in-four adolescents age 14 has dental sealants that
  protect the molars; among African Americans, only one-in-20 has
  sealants.
• In the United States, 30,000 new cases of oral and pharyngeal
  cancer will be diagnosed this year, and more than 8,000 people
  will die of these largely preventable cancers.
• About one-in-three adults has untreated tooth decay.
• Twenty-five percent of adults older than 65 years have lost
  all of their teeth.

In addition, the Journal of the American Medical Association (JAMA)
recently identified dental care as the most prevalent unmet health
need in U.S. children, particularly in underserved, lower economic
neighborhoods. JAMA further states that tooth decay is the most common
chronic disease of childhood, affecting five to eight times as many
children as asthma. The good news, however, is that the tooth decay
process can be halted or avoided through proper medical management
before it results in cavities and/or gum disease. Childhood tooth
decay is preventable by a combination of community, professional
and individual measures including water fluoridation, professionally
applied topical fluorides and dental sealants (the latter protect
chewing surfaces, where most cavities occur), use of fluoride toothpastes
at home, proper infant feeding practices, and diet.

Tooth decay can basically be defined as the destruction
of a tooth’s enamel. It occurs when foods containing carbohydrates (sugars
and starches), like soda, candy, milk and other products, are converted to
a type of acid that breaks down the enamel covering of the teeth.

In order to help prevent tooth decay and other gum disease, the American
Dental Association recommends that parents take their children to the
dentist for an initial evaluation by the time of the child’s
first birthday. During that first evaluation, the dentist can examine
the infant for signs of tooth decay and/or gum disease, teach new parents
how to properly clean their baby’s teeth, talk about any adverse
dental habits, such as thumb sucking, and identify the child’s
fluoride needs.

According to the American Academy of Family Physicians (AAFP), good
dental care habits begin before the infant’s teeth have begun
to show. Parents should get in the habit of wiping the baby’s gums
with a soft damp cloth after the infant feeds. This will help to prevent
baby bottle tooth decay, a dental problem associated with leaving carbohydrates
associated with formula, fruit juices and other common infant feeding
supplements on the child’s teeth.

The AAFP also recommends that when the child’s teeth begin
to appear, parents and/or the child should start using a soft children’s
toothbrush at least twice a day. Although young children may want to
be active participants in the tooth brushing process, they probably
should not brush on their own until they are 6 or 7 years old. Parents
should be on hand to supervise the process and help their kids make
sure to remove all the plaque from their teeth. Other brushing tips
include:

• Make sure the child uses a soft, multi-tufted nylon bristle brush
• Makes sure the child only uses a tiny, pea-sized dab of fluoride
  toothpaste on the toothbrush. Small children tend to swallow most
  of the toothpaste, and swallowing too much fluoride toothpaste can
  cause permanent spots on their teeth.
• Make sure the child brushes all their teeth. Kids have a tendency
  to brush only those teeth that they can see and miss their back teeth.
• Make sure the child spits out the remaining toothpaste and rinses
  their mouth with water after brushing

Parents should also be using floss or an interdental cleaner on the
child’s teeth as soon as any two teeth begin to touch, in order
to remove any plaque the toothbrush won’t reach.

AAFP recommendations for teen dental health include:

• Brushing your teeth twice a day with fluoride toothpaste.
• Flossing your teeth at least once a day.
• Not smoking or chewing tobacco, which can stain teeth and cause
  bad breath and/or cancer.
• Wearing the right protective headgear while playing contact sports.
• Seeing your dentist every year for regular check-ups and cleanings.

Who is most at risk for tooth decay? According to the University of
Maryland Medicine (UMM), the following groups are vulnerable:

• Children, especially those with diets high in sweets, carbohydrates
  and sugars
• People who live in communities with limited or no fluoridated water
  supplies
• Senior citizens

The UMM says that tooth decay and cavities can be prevented by following
these five simple steps:

• Brushing teeth, tongue and gums twice a day with a fluoridated
  toothpaste.
• Flossing teeth daily.
• Eating a well-balanced diet, and limiting or eliminating sugary
  snacks.
• Consulting a physician or dentist regarding the supplemental use
  of fluoride and/or dental sealants to protect teeth against plaque.
• Scheduling
  routine (every six months) dental cleanings and examinations.