Pediatric Oral Surgery
Supernumary Teeth / Mesiodens
A mesiodens, also known as a supernumary tooth, is an extra tooth located in the middle of the upper jaw behind the incisors. It is most often found on routine x-rays and is usually asymptomatic. Sometimes the extra tooth will erupt like a normal tooth, but it should be monitored closely. If the tooth does not erupt and is left untreated, this extra tooth can lead to crowding of the teeth or even prevent the eruption of the permanent teeth. Typically, the tooth is removed between the ages of 6 and 8 if asymptomatic. Removal of the tooth is usually done while the patient is asleep through a small incision on the top of the mouth. Stitches are typically used to hold the gums in place during the healing process. Once the tooth is removed, the permanent teeth will erupt in their normal pattern.
Ankylosed Primary Teeth
Impacted teeth are usually found in the permanent dentition. Very rarely is a primary tooth impacted. The most common primary tooth to be impacted is the primary second molar. Primary teeth become impacted for various reasons which include: trauma to the tooth bud or by a mechanical obstruction. In either case, it is very important to closely follow the eruption of the primary tooth. If the primary tooth remains impacted, it may cause a delay in the eruption of the permanent tooth. Typically, if the primary tooth is impacted, the tooth is removed while the patient is asleep, and a space maintainer is used to prevent movement of the adjacent teeth and allow room for the permanent tooth to erupt.
Frenectomy / Tongue Tied
A frenum is a band of tissue or muscle that attaches the tongue or lip to the upper or lower jaw. In the upper jaw, sometimes the labial frenum can attach too high on the gums causing the upper teeth to become spaced. In the lower jaw, a lingual frenum that connects the tongue to lower jaw may be too short causing the term tongue-tied. If this happens, problems with feeding may occur in infants and speech problems in older kids. To prevent these problems, usually the child is put to sleep and the band is removed through a small incision. Stitches are usually placed, but dissolve on their own.
Mucocele Blocked Salivary Gland
The mucocele is one of the most common soft tissue lesions found amongst children. A mucocele occurs usually when there is trauma to the lower lip such as lip biting. The salivary duct and gland becomes blocked and saliva gets trapped in the tissue. More often than not, there be weeks or months of swelling that increases and decreases but usually never completely disappears. The treatment includes put the child to sleep and removing the small salivary gland through a small incision. Stitches are placed to hold the lip together and fall out on their own.
Injuries to the teeth, gums, and lips can be quite dramatic to the pediatric patients. The site of blood and pain can cause the young patients to panic and cry. Patients who lose teeth in the primary dentition usually do not have the teeth placed back in the mouth. It is important for the parent to locate the tooth if possible to make sure that the tooth has not been swallowed or if all of the tooth has fallen out. Patients who lose their permanent teeth typically have the tooth placed back in the socket if there is not too much damage or there has not been a long time since the tooth had fallen out. Remember, it is also important for the parent to locate the tooth if possible. If a tooth falls out, place the tooth in milk, inside the gums (be sure not to swallow the tooth) or in a special solution provided by your dentist or emergency room physician. The tooth is splinted to the adjacent teeth while the patient is asleep and root canal therapy is usually performed by a general dentist at a later date.