Trauma Tooth trauma is especially tricky in kids, especially when dealing with primary versus permanent teeth. “With baby teeth, if it’s avulsed, do not reimplant it,” Dr. Sharma stresses. “The risks to the developing permanent tooth are too high.” Instead, the focus is on comfort and monitoring. Fractures on the other hand may need smoothing or a pulp cap. For permanent teeth, re-implantation is the goal, but time is of the essence. “If a parent calls, I tell them to put the tooth in milk or saline and try to get here fast. We seat them immediately. Every minute counts for reimplantation success.” Watch Dr. Sharma’s conversation on pediatric dental emergencies on CDA Oasis at: bit.ly/41WUHY7 Follow-Up and Prevention For Dr. Sharma, nearly all emergencies require followup. “I rarely say, ‘See you in six months.’ Most cases need a 1- or 2-week check-in, especially those caused by trauma. And for anything unresolved, I book further treatment or make a referral accordingly,” he says. His concluding advice? Establish a dental home early on with the family. “Prevention starts before there’s a problem. Indeed, prevention beats treatment,” he says. “Whether it’s a pediatric dentist or a family one, have an established dental home. That’s where kids learn, get protected, and have someone ready when emergencies arise.” Mysterious Unknowns Some cases aren’t tooth-related at all. “Apthous ulcers are a common relief moment for me,” he says. “At least it’s not an infection or trauma.” Apthous ulcers are self-resolving and can be managed with diet and analgesics. Primary herpetic gingivostomatitis, caused by HSV-1, is another common non-tooth emergency. “Lots of ulcers, fever and fatigue in toddlers. If they’re dehydrated or very sick, I’ll refer them to the ER for IV fluids and antivirals, but mostly it resolves on its own with time,” he says. Care for primary herpetic gingivostomatitis includes analgesics, lots of liquids, bland foods and monitoring. Parents as Partners A unique element of pediatric dentistry is the triangular dynamic between child, parent, and provider. “Parents can escalate anxiety or defuse it,” says Dr. Sharma. “So, I always aim to earn the parent’s trust first. If they’re calm, the child will follow.” He considers the parents as essential historians too. “Kids don’t give reliable pain narratives. I need parents to fill in the blanks,” he says. During procedures, parents help maintain calm or, if unmanaged, can accidentally stir more fear. “That’s why I take time to prep them. We’re a team.” Parents can escalate anxiety or defuse it. So, I always aim to earn the parent’s trust first. If they’re calm, the child will follow. 30 | 2025 | Issue 5 Supporting Your Practice
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