Pink Tooth – by Dr. Richard Simpson, DMD

pink-tooth

image captured with TelScope Telehealth System

image captured with TelScope Telehealth System

PROBLEM

The mother of a 10 year old girl was concerned about a “pink tooth”. There was no report of pain or other concerns.

DIAGNOSIS

The first image, captured with TelScope Telehealth System, reveals an emerging upper left permanent tooth (first premolar), with the primary (“baby”) tooth still present. The primary molar has a pink color to it because it has resorbed internally as the permanent tooth moved into position, and the underlying gum tissue is showing through. This situation is not uncommon, but can be evaluated by a dentist through a teledentistry examination and appropriate questioning to determine if any treatment is indicated. In this case, the baby tooth was loose and can be allowed to be lost naturally if no other problems develop. The parent was informed that an extraction of the primary tooth may be required if it is still present in several weeks.

GINGIVITIS DUE TO POOR BRUSHING HABITS AROUND LOOSE TEETH

The second image, marked using the TelScope app, highlights the red gum margins of other teeth in this area. This inflammation is called gingivitis, and is commonly seen in children with a loose tooth because they are often hesitant to brush the area near that tooth. The child should be supervised when brushing and encouraged to gently but thoroughly brush at the gumline twice per day as normal. The gingivitis will heal with improved hygiene.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related
conditions. 

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Facial Swelling Caused by Dental Infection – by Dr. Richard Simpson, DMD

Dental Infection and Facial Cellulitis TelScope Teledentistry

image captured with TelScope Telehealth System

PROBLEM

A 5-year-old male was seen in a medical emergi-care center with a chief complaint from the parent of pain and “his face is swollen”. He was also febrile (showing symptoms of a fever). The patient was diagnosed with a rapidly developing facial cellulitis (infection spreading into the soft tissues of the face), of probable dental origin. The child was given a shot of Rocephin, and was prescribed an oral antibiotic and an over-the-counter pain medication. The patient was then given a dental referral for further evaluation and treatment.
Note: Untreated facial cellulitis from a dental infection can lead to multiple systemic health complications, blindness, difficulty breathing, and in rare cases, death.

DIAGNOSIS

Upon dental exam, the facial swelling had resolved in response to the antibiotics. This intraoral image reveals the swelling was now localized and associated with an upper left second primary (“baby”) molar that had a large cavity (dental caries) present. This presentation and diagnosis is considered urgent, and treatment should be rendered as soon as possible. The tooth will require extraction (removal). A discussion of the recommendation for a space maintainer should take place.

INTER-PROFESSIONAL COLLABORATION FOR IDEAL PATIENT CARE

This case is an excellent example of how healthcare providers, equipped with a TelScope in their facility, are able to triage a patient and obtain a teledentistry consult for an initial diagnosis and treatment plan, followed by a referral for appropriate treatment. This inter-professional collaboration through telehealth capabilities leads to effective and efficient health care, and can reduce appointment numbers, time, and exposure to others during these times of COVID-19.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related
conditions. 

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Chipped Tooth as a Sign of a Cavity – by Dr. Richard Simpson, DMD

image captured with TelScope Telehealth System

image captured with TelScope Telehealth System

PROBLEM

A 6-year-old male reported to the dental office with his mother, who stated she noticed “a chipped tooth”. There was no current pain reported. However, after questioning, it was confirmed that the patient had experienced oral pain for “a few days” several weeks earlier, but it went away.

DIAGNOSIS

Clinical exam and an x-ray confirmed the patient had a large cavity (dental caries) in the lower right first primary molar. The second photograph, marked using the TelScope App, shows a fistula that developed as a result of a previous tooth abscess. This allowed the infection to eventually drain, which resolved the patient’s original pain. The nerve of the tooth is no longer vital (alive). This is a non-urgent diagnosis, but treatment is indicated. The treatment consists of extraction of the primary tooth, as well as a recommendation for a space maintainer to be placed on the second molar to hold eruption space for the replacement tooth, which usually emerges at age ten to eleven. Failure to remove the tooth could lead to multiple complications to include further fracturing of the tooth, space loss, shifting of teeth, recurrence of the infection, or damage to the underlying permanent tooth.

INTERESTING FACT

Tooth decay can be categorized by the type of tooth surface and the location on the tooth in which it develops. This cavity developed between the teeth and was originally much smaller. An x-ray taken at a routine dental exam can identify this type of cavity before it is visible in the mouth. Early diagnosis is important, because dental decay in primary teeth (“baby teeth”) typically increases in size four to six times faster than in permanent teeth.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related
conditions. 

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Identifying an Oral Lesion – by Dr. Richard Simpson, DMD

image captured with TelScope Telehealth System

image captured with TelScope Telehealth System

PROBLEM

A 6-year-old female patient was seen for a routine Well Child exam by her pediatrician. The doctor noted a “swelling” on her lower lip, and the mother reported that it had been present for 4 weeks. The physician recommended a teledentistry evaluation with a dentist and referred her.

DIAGNOSIS

The “swelling” in question appeared as a raised, 4mm x 3mm soft tissue lesion with a broad base and normal color. It is located in the midline of the lower lip inside of the wet-dry line. The lesion did not change in size since it first appeared, and was not painful.
The diagnosis is a mucocele. A mucocele is a harmless fluid-filled retention “cyst” that most commonly results from the rupture of a minor salivary gland. Hundreds of salivary glands are located under the surface of the lip and other areas of the oral mucosa to maintain moisture. If a mucocele does not disappear after 4-6 weeks, it should be removed by a dentist or an oral surgeon, as it can interfere with normal function and often lead to the development of chronic biting or sucking habits and scar tissue, especially in children.
This is an excellent example of how an oral lesion or area of concern could be pre-screened by a healthcare provider, photographed using the TelScope Telehealth System, and transmitted to a dentist for a teledentistry consult prior to scheduling an appointment.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related
conditions. 

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Eruption of a Permanent Tooth – by Dr. Richard Simpson, DMD

image captured with TelScope Telehealth System

image captured with TelScope Telehealth System

PROBLEM

10-year-old female patient says, “I feel something in the top of my mouth”. No pain reported.

DIAGNOSIS

A clinical exam, documented here with a TelScope image, confirms an over retained primary (baby) tooth with a stainless steel crown present.

It’s replacement permanent tooth is emerging (erupting) in the palate. The primary tooth was not mobile because a portion of the roots failed to resorb. Although this is not an urgent situation, the removal of the primary tooth by a dentist is indicated to allow the permanent tooth to fully erupt. The permanent tooth will likely drift back toward a more ideal position if the baby tooth is removed soon.

INTERESTING FACT

This is not an uncommon problem, and is an excellent example of a situation that can be pre-screened by a dentist through a teledentistry consultation with a clear photograph such as this that can easily be taken with a TelScope Telehealth System.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or guarantee of outcome for patients. No patients should use the information, resources, or tools contained within to self-diagnose or self-treat any health-related conditions. 

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Dental Growing Pains – by Dr. Richard Simpson, DMD

PROBLEM

An 11-year-old female patient is complaining of occasional pain in the lower right quadrant of her mouth in the evenings and at night for two weeks now.  The patient’s mother is concerned about possible “swelling”. This teledentistry photo taken with TelScope Telehealth System shows there is a permanent second molar emerging (“erupting”) in a normal position.

DIAGNOSIS

The tissue over the back of the tooth will recede with time as the tooth erupts into the mouth further. There is no inflammation or infection, and no treatment is indicated. The patient’s mother was instructed that the patient should brush the emerging tooth as normal. She could give her child an over the counter pain medication like acetaminophen or ibuprofen if needed.

INTERESTING FACT

Children grow, and teeth move, in the evenings and nighttime, as their growth hormone increases during this time. It is not uncommon to occasionally have discomfort from tooth movement that may come and go with no other symptoms – dental “growing pains”.

However, other more significant oral health issues can also cause night time pain. A photograph and a teledentistry consult with a dentist can help determine if an in-office examination is indicated.

About the Author: Dr. Richard Simpson, DMD

Dr. Richard is a board certified pediatric dentist in private practice.
His achievements include:
• Diplomate in the American Board of Pediatric Dentistry
• Fellow in the American College of Dentists
• Fellow in the International College of Dentists
• Fellow in the American Academy of Pediatric Dentistry
• Advisory Board Member of The TeleDentists
• Advisory Board Member of Holland Healthcare
Dr. Richard’s experience and active interests include telehealth, child advocacy, health disparities, policy, and advancing improved medical-dental access to care. Dr. Richard is also a veteran with 15 years of military service.
————
INFORMATION & CONTENT DISCLAIMER

This content is for information only. This content is not for advice, diagnosis, or
guarantee of outcome for patients. No patients should use the information,
resources, or tools contained within to self-diagnose or self-treat any health-related
conditions. 

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