Shaky Tooth

WF has a very shaky left front upper incisor. It was accidentally knocked by his classmate yesterday and the part of his gum where the tooth is, bled (again).

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WF's teeth had developed very early. I remember that I first spotted both of the lower incisors emerging when I was giving him baby cereal one morning just 1+ weeks after he turned 4 months old. I was still on no-pay leave then and so hadn't returned to office yet.

He was sitting in his colourful bouncer after his morning bath. (We all love that bouncer - it can actually vibrate! It was a gift from CP's colleagues, and it was one of the most useful baby gifts we have ever received and which we really treasured. We took very good care of it and it is now being used by S all the way in Switzerland!)

I was giving him his brown rice cereal, spoonful by spoonful. Then as we were about to finish, I suddenly saw 2 white 'slits' in his lower gums. I pondered momentarily. Very incredible because it would be at least another 2 weeks before he turned 5 months old! And the books always say the baby's 1st tooth is expected from about 5 months, right?! (WY's first tooth had emerged when he was about 5+ months old.)

So I quickly called the maid (we had one then) to come to see. She stopped her chores and squatted down to try to peer into WF's mouth. After about 2 seconds, she also exclaimed excitedly, "Ya! Ma'am! Got teeth already, can see!"

I remember that we were both so excited that little WF just looked at us intently, as if asking us, "What's the fuss?"!!!! :)

From that morning onwards, I did a quick informal visual check of the teeth's progress at almost every possible opportunity. Even the maid asked me every now and then whether other teeth had emerged.

These 2 teeth grew, of course, and others also started to emerge. Some singly, others in pairs. By the time WF turned 2 years, he had most of his baby teeth. An early developer, definitely, dentally speaking.

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WY's 7th birthday was a very quiet event - Mother and CP were away in Switzerland then - but we didn't want WY to feel 'left out' or 'neglected' because WF had a birthday celebration in LV school (plus a dinner with the rest of the family at Fatty Weng Restaurant) just 2 week before WY's birthday, so we decided to have a private birthday cake-cutting at home for WY.

So it was about 8pm on WY's 7th birthday when R started to get the candles and decorations ready. I was about to finish hanging the wet laundry and the boys were playing with some balloons in the living room. WF was especially fond of kicking and chasing the balloons which had been inflated by the manual balloon pump earlier. I remember he was chuckling away and WY was also playing to his heart's content.

All of a sudden, we heard a really loud THUD followed by 2 seconds of silence then followed by big loud WAILS!!!!!!!!!!!!!!!!!!!!!

R and I dropped everything and dashed into the living room to find a wailing WF and a dazed WY standing close to him. I don't recall whether much conversation followed after the initial questions of "What happened?", but I remember we held WF closely to comfort him while fumbling to try to 'assess' where he has been injured.

His gums were bleeding profusely and it wasn't immediately clear whether he had hurt his teeth or only scratched his lips etc. We grabbed tissue paper by bunches and tried to dab the blood off. My heart started to race and my head began to swirl. I yelled at WY for not taking care of his little brother. I also started to yell at R for not watching out for WF since he was supposed to be near(er) the boys at that time.

Ya, I know the yelling wasn't going to help but that was just how (badly) I had responded to the accident. I knew it was bad reaction, and I started to cry while trying to pacify and calm the wailing WF. Almost impossible because I wasn't calm myself. In fact, I think I was hysterical.

After a while, when WF's wails 'subsided' a little, R got WF to open his mouth and it was then that we realised that poor WF had chipped his left front upper incisor! Quite a substantial chip, considering that his teeth are all not very 'big'.
So we started to frantically search the floor for the fallen chip but to no avail. R and WY even went on their knees to try to see if the chip could have 'bounced' to somewhere under the safa. Alas, nothing could be found. I held on to WF who continued to cry so pitifully.

After a while, WF stopped crying. We checked his teeth again and realised that not one but both of his front upper incisors were shaky (the chipped one was more shaky, of course, but it was scary to see that both teeth were shaky)! We decided that we would bring WF to the dentist for a proper assessment and advice 1st thing next morning.

Meanwhile, I think WY also realised the severity of the accident and was generally quite stunned by everything. R recovered his composure fairly quickly - thank goodness he did, because we also knew that we had to take care of this big-little boy's feelings too, so we tried to calm ourselves down.

About half an hour later, when WF was ok enough to resume joking with WY (much to our relief), we proceeded to cut the cake as planned. I remember WF also ate the cake anyway albeit very 'tenderly'.

It was the cake with 3 off-road monster truck toys. We gave a substantial portion of the 2-kg cake to the opposite neighbour (who had 2 daughters whose ages are between WY's and WF's). 2kg was the minimum order for that design.

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Early next morning, we left WY with AhYee after she came by, and brought WF to NUH. We had no prior appointment, but the staff at the dental clinic were very understanding and made arrangements for us to see the paediatric specialist anyway.

The dentist was very professional and during the whole checkup, kept reassuring WF and spoke to him in a comforting voice, asking him for 'permission' to check his teeth and very bruised gums etc. I guess it helped that WF had accompanied WY to the clinic during WY's regular dental checkups although WF himself had not actually been seated on the dental chair until that morning.

Conclusion of the dentist was that the left front upper incisor was chipped (obvious, lah, right?!) but don't need to extract or anything like that. The impact must have been quite great, and that was why the teeth became shaky (logical, lah, hor?!). Gums around these 2 teeth were very bruised but otherwise everything looked ok. No treatment was needed for the time being, but we had to watch out for any further swelling or signs of infection etc.

My heart ached so much when the dentist warned that given the shakiness of the 2 teeth, there was a high chance that these teeth may have been detached from the jaw bone and may gradually die off before maturity. I think she could sense my anxiety (of course lah, with the non-stop questions that I kept posing to her!) and gently suggested that we just observed the progress till a review the following week or so.

So, I took childcare leave that day to keep WF company. The diagnosis recorded on the MC was 'trauma to upper front incisors due to fall'. Trauma, yes, definitely, but not only to incisors ah......

The few days following the accident, AhYee helped to keep dinner simple and 'soft' like porridge etc. When Mother called one of the evenings, we told her briefly about the accident.

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As days and weeks went by, the right tooth became more steady and eventually stopped shaking. What a relief.

The left tooth, however, remained shaky although with the recovery of the swollen gums, the shakiness was substantially reduced.

Thankfully, there had been no signs of infection and all the dental checkups and reviews have so far been ok. ...... Ok, that is, until one night some time in June 2006 (I cannot recall the exact date), WF played a fool on my bed and fell off it and knocked his front teeth again.

This time, the gums bled less profusely; but it was no less worrying because we saw that the right tooth had become shaky again and the already-shaky left tooth had become even shakier!!

Now that we had previous experience of such 'trauma on teeth', R and I were more 'steady' and didn't plunge into a panic mode like before. We pacified and soothed WF (who, of course, cried in pain after the fall) but decided that we should observe for a while instead of rushing to the dentist again. In any case, the boys were scheduled to visit the dentist in about 3 days' time, so we waited.

In the meantime, I explained to WF in a very serious and stern tone that he had once again injured his teeth, and warned that if he still didn't take good care of them, he could possibly lose all his teeth. And if that ever happened, he wouldn't be able to speak properly, read properly, sing properly, drink properly, eat properly (including his favourite bak-hu and fishballs) etc etc. As expected, he burst into loud sobs at each mention of these activities and food items. In between sobs, he kept telling me that the dentist could and would help him to put things right.

Actually, he understood all that I said, because he actually repeated to me that night before he finally went to bed, "Mama, I will take care of my teeth. Cannot knock, right? The dentist will help to repair it, correct?" I could only tell him that the dentist would try.

By the time we went to the dentist as scheduled, the bruise had already gone. We updated the dentist nevertheless of this 2nd fall. The dentist ordered a dental x-ray on the 2 front incisors, just to find out better how things were below the gum-line.

When the x-rays came back, we found that there was a hairline crack at the roots of the right upper incisor. According to the dentist, this should heal so long as there is no further impact on it. The x-rays also showed that roots of the left upper incisor had already dissolved, ie this left tooth was already detached from the jawbone and was no longer growing... (Argh! *sob* *sob* *sob*...)

The dentist explained that this was probably due to the impact during the 1st accident. There was nothing to be unduly worried about unless infection sets in, in which case, the ongoing development of the replacement adult tooth may be adversely affected. So, like before, her advice was to observe good oral hygiene and to watch out for signs of infection eg swelling at the gum near this tooth and seek immediate treatment if infection sets in.

I asked if it would be better to extract the tooth. She explained her view that extraction was not necessary. She also explained that to extract the tooth, she would have to give that dreadful anaesthesia shot which would almost certainly make WF's dental experience an awful and horrendous one. So, very straighforward decision, right?

So, from that day on, I took super extra care to brush this very shaky tooth very clean each night. To prevent WF from accidentally 'dislodging' the rootless tooth, we arranged for him to only gargle his mouth rather than brush his teeth before his naps in CH school. We also reminded WF to always use his other teeth to chew his food and to avoid biting hard on his front teeth. We also gave umpteen reminders to the teachers to keep reminding WF to be careful while eating and playing in school.

Meanwhile, I also started to ask for divine help to watch over WF and to protect his teeth from further trauma. I was particularly worried that WF might be putting up with the discomfort of a shaky tooth but not knowing how to voice out his discomfort. I asked that if it were better for the shaky tooth to fall off, let it fall off soon and smoothly; if it were better for WF to retain the shaky tooth till a later date, let the shaky tooth become more steady once again.

One night soon after that, I overheard WF 'grinding' his teeth in his sleep and the 'grinding' sounds actually ended abruptly with a relatively loud creak! I switched on the lamp to check on him but found him fast asleep like usual, so I thought all was well and went back to sleep.

In the morning that followed, when WF woke up, R and I were shocked to see WF's upper gums and part of his lips bloodstained! There were several drops of dried blood on the pillowcase but apart from that, there was nothing unusual.

After coaxing the little boy to open his mouth to let us take a look, we found that whatever bleeding there had been earlier had already stopped. The shaky tooth, however, was now somehow 'pushed' further into the gums at an awkward angle! When we tested the tooth gently, it was significantly less shaky.

And so, that was how the shaky tooth came to be positioned at that special angle.

Through the subsequent months, the tooth remained like this. It does not seem to bother WF, so I take it that it is meant to stay till the new tooth is ready. And to repeated suggestions to extract the tooth, I now only say this: "No need for extraction. Extraction would have made things worse. Just let it be until it is ready to be replaced."

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Yesterday, his teacher called me in the afternoon to inform me that WF's classmate had during play-time accidentally knocked into WF's teeth and the gums had bled. Sigh. The bleeding had stopped after she got WF to gargle his mouth etc.

At night, I took special extra care to brush the shaky tooth and to check on it. I think it has become even shakier now, but it may not be ready to fall off yet.

It bled briefly again this morning when I cleaned him up. He told me there was no pain, so after some gargling, we went to school. Before we left him, I told the principal to get the teachers to watch out for any further bleeding and if it bled again, to call me. And of course, the usual reminders about non-biting or chewing with the front teeth etc.

Up to now, I have not heard from the school. I hope they won't call.