Toddler Health Archives - Life with Gremlins

Toddler and Kid’s Tooth Extraction: Healing Process, Food List, and Recovery

I didn’t do anything wrong caring for my daughter’s teeth. I brushed and flossed her teeth regularly. She didn’t sleep with a bottle. She was transitioned to a sippy cup before she was even 2. Yet, unlike her three brothers who had and have healthy teeth, she had severe decay and cavities in her baby front teeth by the time she was 3. It resembled baby bottle tooth decay.

Working with her dentist, we tried to reverse the damage—mineral-fluoride paste (MI Paste), diet changes, even xylitol, but they kept getting worse anyway. When the first tooth chipped, I felt horrible knowing they would probably have to be pulled.

Unfortunately, I was right. She had to have all four of her top front teeth extracted. After her procedure, I was surprised to find how little information was floating about online on the healing process and tooth extraction recovery in kids. I decided to build this page as a result.

Toddler tooth extraction healing process:

Thankfully, a fair amount of extractions in kids are baby teeth. The tooth extraction healing process after the removal of a baby tooth is faster than it is for adult teeth, because the wound is smaller.

The first 24 hours:

Immediately after removal, a clot will begin to form in the empty socket.

Your dentist may have also packed the wound with gelfoam. This is often used because children aren’t the greatest about biting down on gauze the way an adult would, but it serves the same purpose—to absorb and slow initial bleeding.

Gelfoam is white in color, so if you look in your child’s mouth and it almost looks like you can see bone or the remainder of a tooth in the socket, this is what you’re actually seeing. The image below is an example of this. It frequently falls out within a day. In fact, your child may even spit it out shortly after the procedure.

Once the gelfoam is gone, the extraction wound will just look like a hole in your child’s gum. It may continue to weep blood lightly in the first 24 hours. For instance, you may see a little blood on your child’s pillow when they wake up. However, for the most part, the bleeding will stop within a few hours of the procedure.

Common complaints the first 24 hours after tooth extraction in kids:

Beyond bleeding the most common complaints that kids or parents have during tooth extraction recovery in the first 24 hours are:
(expressed as a percent of kids that experienced each in the first 24 hours)
-Inability to eat: 12 percent
-Less active: 72 percent
-Sleepiness: 71 percent
-Pain: 48 percent
-Sore throat: 35 percent
-Vomiting or nausea: 26 percent
-Behavior changes: 24 percent
-Fever: 21 percent
-Cough: 12 percent

Some of these issues are likely a result of the procedure itself rather than the tooth removal, such as sore throat and cough. All of the above are considered normal and not cause for concern with the exception of bleeding that is heavy and fevers that are over 101 F. In either of those cases, you should contact your provider.

Things to avoid in the first 24 hours:

While a clot is establishing in your child’s wound, you should do your best to help them avoid:

-Straw or non-spill sippy cup use (the cups with a valve that require suction)
-Touching the wound with fingers or tongue (this one can be difficult)
-Brushing close to the extraction site
-Vigorous activity

Within a three days after a kid’s tooth extraction:

Mouth wounds heal very quickly. As early as 12 hours after the extraction you may notice the gum tissue is beginning to heal. By day three most parents can see a clear difference in the size of the wound site (the “hole” is smaller). Typical complaints (mentioned above) also begin to decrease.

Once again, expressed by percent of children experiencing each (on day 3 in this case):

-Inability to eat: 12 percent
-Less active: 20 percent
-Sleepiness: This side effect should be gone.
-Pain: 17 percent
-Sore throat: 8 percent
-Vomiting or nausea: 1 percent
-Behavior changes: 3 percent
-Fever: 2 percent
-Cough: 4 percent

Within two weeks after a kid’s tooth extraction:

In most cases by day 14 or so, the gum holes have sealed over completely, though occasionally this can take up to a month. A longer time frame is more common in molars and older children (with larger teeth).

You’ll still see an indention of sorts in the gum where the tooth was as bone hasn’t yet mineralized in the socket. This indentation will become less noticeable as time passes with significant bone formation being complete within 6 to 8 weeks.

What to feed kids after a tooth extraction?

Having covered the tooth extraction recovery time and process, your next question might be what your child can eat after tooth extraction.

You want to stick to soft, non-acidic foods that are unlikely to get stuck in the extraction wound. If the extraction was a front tooth, you also want to cut foods small so that your child can easily chew (or more like mush in this case) them with their back teeth only. You’ll find a list of ideas below.

Side note, if you can, try to get your child to swish some water after meals as well. In the case of toddlers, offering water to drink may be the best you can do there.

Some great foods for after tooth extraction include:

-Ice cream, milkshakes, or popsicles
-Fruit smoothies
-Yogurt or cottage cheese
-Jello or pudding
-Apple sauce
-Mashed potatoes
-Steam vegetables with or without cheese sauce (not al dente, arguably overdone and mushy)
-Boiled vegetables or canned soft options such as peas
-Oatmeal or porridge
-Chicken or beef vegetable soup (do not use a tomato base, mince ingredients small)
-White-sauced pasta with small noodles and meat cut into small pieces
-Macaroni and cheese
-Scrambled eggs
-Bananas
-Berries (strawberries may need cut small)
-Baked beans
-Meatloaf (cut in small pieces)

Once the extraction holes have mostly closed, rice and softer baked goods are also OK, such as bread (without a crispy crust) and soft-top cookies. With front-teeth extractions, again you may still have to cut these into small enough pieces your child doesn’t have to bite chunks off so to speak. This can make things like peanut butter and jelly or tuna sandwich squares, waffles, or pancakes an option (things most kids are a fan of).

When will my child’s tooth or teeth grow back after an extraction?

Finally, at least in my case, I was really wondering when my daughter’s front teeth would grow back in. Obviously, this question only relates to baby teeth, as permanent teeth don’t grow back.

Many of the online eruption charts for permanent teeth such as the one shown below are giving an average range. You may find that your child falls outside of this. For instance, my first son got his first front permanent tooth at 5 years old, while most charts state this happens at age 6 to 7. Teeth eruption patterns are largely genetic and vary from child to child.

However, a study published in the Journal of Dental Research in 2015 did find that permanent tooth eruption was tied to baby teeth eruption. So, if your child was an early teether, they may likewise get their permanent teeth faster. The same holds true for late teethers. Girls also tend to erupt teeth earlier than boys.

Xylitol for Toddler Teeth: Best Dental Routine Additions

The effects of Xylitol, a natural sweetener often made from birch bark, on oral health are well documented. A mere 6 to 10 grams daily is enough to reduce bacteria levels, hinder plaque formation, help prevent cavities, and even aid in remineralization of existing damage. Even better, it poses no health risk beyond the chance of digestive upset with heavy use. It’s pretty awesome stuff. For older kids and adults, adding Xylitol to a dental routine is pretty easy too. It’s widely available in chewing gum and mints. What about toddlers, though? Nearly 30 percent of all children under 5 have dental caries (another term for cavities), yet for some reason there are no over-the-counter Xylitol products beyond toothpaste aimed at toddler use. Unfortunately, the issue with Xylitol toothpaste is it would be very difficult to get the recommended dosage in kids (a minimum of 6 g) using this method at .3 g or so per brushing.

Ideal Characteristics of Xylitol for Toddlers:

The first step I took in trying to find the best way to give a toddler Xylitol was to make a list of what would classify a source as “good.”

-Easy and fast to consume
For Xylitol to be effective for dental health it has to actually stay in your child’s mouth for more than 2 seconds. Xylitol is also highly toxic to dogs, so if you have fur-babies as well, you don’t want Xylitol options laying around the house. You want something that comes in flavors your toddler will like that is consumed quickly, but likewise isn’t a huge chore for you.

-Has a relatively high Xylitol dosage per serving

On that easy-for-you note, most of us parents have enough to worry about without trying to remember to give 16 some-odd doses of Xylitol a day. This would mean you’d want a Xylitol product with at least around 2 to 4 g per serving making for just 2 to 3 times a day.

-Won’t break the bank.

In my book, if something is going to become a daily, long term part of our family’s routine, it needs to be budget friendly.

Xylitol options for toddlers and their content levels:

While they may not be aimed at use in toddlers in particular, there are a wealth of options as far as Xyltiol products. This is because in addition to being great for dental health, it also causes very little glycemic response and has about one third the calories of table sugar making it a popular choice for diabetics and dieters.

Granular:

Often found either by the table sugar or in the health/organics section, granulated Xylitol looks just like regular sugar and has a similar taste. Given that, it can be used anywhere regular sugar would be. Keep in mind though that it is sweeter than regular sugar, so adjust down. Additionally, more than 45 g in children or 100 g in adults per day can cause intestinal upset (diarrhea is common). 1 tablespoon equates to about 4 grams, so it can add up quickly. Xylitol in this form is fairly affordable (about 3x the price of regular sugar in your area).

At first thought granular Xylitol seems a great choice for toddlers as far as dosage size, but there’s the issue that in most formats (such as used in baking or mixed into juice) it wouldn’t sit in the mouth long and dosage could vary (unfinished drinks anyone?)

Gum:

The reason Xylitol gum is such a popular method of adding Xylitol to a dental routine is that it stays in the mouth longer than most other choices, despite a relatively low dosage (you’d need 6-10 sticks a day to get there). Gum is a poor choice for most toddlers not just because of that high frequency requirement, but because most toddlers quickly swallow or spit gum and may even choke.

Mints:

Also popular with adults and also requiring many uses (6 to 20!), the flavor of Xylitol mints is often not well received by toddlers. They do make fruit-mint combos, but the mint flavor remains, because, well, it’s a mint.

Suckers:

Clearly aimed at kids, Xylitol suckers are another choice that sound good in theory, but fall short with more consideration. First, at .5 to 1 g per sucker depending on brand, you’d need at least 6 a day to hit the recommended dosage. Second, the sticks. As a parent, if you’ve done suckers with any regularity you know you find those stupid sticks all over, often with unfinished sucker attached. They may also pose a choking hazard depending on the kid, and at, on average, about .25 each, can get expensive.

Hard candy:

Ditches the stick but poses the same issues as a sucker minus that.

Soft candy:

Most of these are sort of like saltwater taffy or caramel, and would be fine for toddlers, though you would need about 6 per day. It’s also important to pay attention to other ingredients. Try to avoid candies with other added sugars or where Xylitol is not high on the ingredient list (as grams per serving may vary by brand). Price wise on average you’re looking at around .25 to .50 per candy ($1.50 to $3.00 per day), less the more in bulk you purchase. Depending on age, they may also pose a choking hazard.

Pebble candy:

I deem them pebble candy, because that seemed a fair description. These are about half the size of a tic-tac and have a similar texture. About 10 of these pebbles is 2.3 g of Xylitol with a serving cost of about .15 each (.45 a day). Being small and easily chewed, they work fine for toddlers, and even come in a range of flavors.

Ice chips:

These aren’t literal ice, they’re chips of flavored solidified xylitol chunks. They start off hard and sort of crunchy, but dissolve pretty quickly too. They make a great choice for toddlers, though the varying sizes of candy can make it hard to get a precise dosage. The average piece is 1 g, with the packaging suggesting 2 chips per serving making for a minimum of 3 servings a day. Price wise, these run .10 to .15 per serving or .30 to .45 per day.

Gummy bears:

These are arguably something made for toddlers and have a decent dosage at 1.5 g per bear. The problem is that you will be hard pressed to find Xylitol gummy bears that don’t also contain other sweeteners. The most common is Maltitol, which for many folks causes watery bowel movements. Some people also tolerate them just fine in moderation, and at about $10 per 1 lb bag (.10 per serving or .30 a day) they certainly are an affordable option, so may be worth a test run.

Jam/honey/syrup:

While obviously mixed with natural sugars, these are options most toddlers will consume. The only downside beyond that would be that none of the above are something that’s chewed or sits in the mouth long. Purchased from the store, all three are also relatively expensive. Xylitol jam is .40 or so per serving, Xylitol honey .43, and Xylitol syrup .55. Each would require two servings daily. At least in the case of jam, you may be able to make your own and cut costs a bit with granular Xylitol and fresh fruit.

Toothpaste/gels/wipes

While wipes are an easy way to cleanse baby gums, toothpastes, gels, and wipes are all an inefficient way to add Xylitol to a toddler’s diet. This is because, as mentioned, even high-percentage options would contain about .3 g per use. You would have to brush your toddler’s teeth 20 times a day to make the minimum recommendation. Often priced at around $1 to $2 an ounce, Xylitol toothpaste is also double to triple the price of your typical toddler paste.

Oral rinse:

At 1 g per tsp (a standard rinse cap holds roughly 2 tablespoons which is ~6 tsp or 6g Xylitol) oral rinses are a great option for older kids, but most toddlers likely won’t get the concept of swish and rinse, and oral rinses are not designed to be swallowed consistently. Xylitol rinses are also, again, fairly spendy at .50 to .80 per ounce (2 tablespoons) as compared to your standard mouth wash which runs closer to .25 per ounce.

So, TLDR, what’s the best way to add Xylitol to a toddler’s dental routine?

Based on price and ease of use, your top options would be Xylitol gummy bears (watch for adverse effects), ice chips, or pebble candies.

Bottle Weaning: A Guide for Weaning from the Bottle

My kids weaned from the bottle with ease–during the day that is. As toddlers, all four still clung to that nippled-relic of babyhood at bedtime, and stories of baby bottle rot fueled my feeling that big kids didn’t need bottles. However, if you’ve made it to the toddler stage, you likely know that discovering your child shouldn’t have something is a lot easier than taking it away. Breast or bottle fed right from birth, babies are taught to associate milk with sleep.

Why should I wean my toddler from night and nap-time bottles?

That was a big question for me. A bottle at bedtime really comforted my toddlers. It also helped when they awoke from nightmares. Often they didn’t drink much of the milk, just held the bottle like a security blanket. I thought to myself, eventually they’ll give it up on their own so what does it hurt? Sadly, it does hurt.

Prolonged pacifier or bottle use can cause dental deformities including over, under, and cross bites. On top of that, the bacteria that like to cause cavities like to feed on the sugars present in milk, which just so happens to pool around the teeth while sleeping. As a result, children who sleep with bottles often develop what dentists call baby bottle tooth decay or rot. Between the two, a toddler who is allowed to bottle feed at night may be smiling at bedtime, but it likely won’t be a very pretty smile after a few years. Ideally, according to dentists, babies should cease nighttime feedings and be weaned from the bottle onto a sippy cup if bottle-fed by 6-12 months of age.

How do I wean my toddler from nap and nighttime bottles?

While there may be subtle variances in each, there are basically two ways to go about bottle weaning a toddler at nighttime or nap.

Crying Turkey:

This is pretty cut and dried. You take the bedtime bottle feeding away, suffer the drama, and eventually your toddler will get over it. Some parents are shocked to find their toddler isn’t that upset by it. Others have a long tantrum-blocked road ahead of them. It may help to exchange your child’s bottles for something, for instance, like a nighttime stuffed friend. You can even make up a bottle fairy, much like the tooth fairy, that will come and switch the bottles for the bedtime snuggly.

Like-a-Turtle:

Your other option is to take it slow and gradually remove the bottle from your toddler’s night or naptime routine. This is where the slight variances come into play. You could slowly decrease the amount of milk in your toddler’s bottle until it is no more than an empty plastic snuggly and then take it away, which makes it less heart-breaking.

You could also simply replace the milk in your toddler’s bottle with water, which eliminates the worry of baby bottle tooth decay, and then slowly decrease the water in the bottle, adding it to a sippy cup. Water is fine all night long and a sippy cup does not cause dental alignment issues as your child won’t be sleeping with it in his or her mouth. Some parents also add a stage on this one where they water down their child’s milk before switching to water. Personally, I find the idea of watered-down milk fairly unappetizing, so this may help deter desire for bottled comfort.

Fence-Sitting Turkey Turtle:

If you just can’t decide which way you want to go, you can take away the bottle cold turkey and introduce a milk-filled sippy cup which you then use one of the gradual techniques with. Alternately, you could offer an empty bottle and a full sippy cup, and let your toddler choose to ditch the bottle, because it’s empty. Also remember that if something just isn’t working and you’ve given it plenty of time (it will take time), there’s no shame in switching your game until you find something that works.