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Active Living
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A Healthy Balance
Ankle Sprains
Active Kids, Healthy Kids
Active Kids in Winter
Athletic Skin Infections
Children, Nutrition & Exercise
Beat the Heat!
Cold Weather Workouts
Concussions
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Exercise and Disabilities
Exercise and Menstrual Irregularities
Exercise in the Cold
Exercise in the Heat
Exercise is Medicine
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Exercising in Pregnancy
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FITT Prescription
Footwear for Running
From Surviving to Thriving
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Get Moving!
Get Motivated
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Jump Start Weight Loss
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Live Actively
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Osteoarthritis of the Knee
Plantar Fasciitis
Prehistoric Workout
Prevention of Sports Injury
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7 Wonders of Walking
Adolescent Health
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
Birthing Etiquette
Birth Plans
Birthing Procedure Trends
Bleeding in Pregnancy
Breastfeeding Benefits
Caesarean Section by Request
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Cord Blood Banking
Delaying Motherhood
Blue after Baby or Postpartum Depression
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Folic Acid in Pregnancy
High Blood Pressure in Pregnancy
Getting a latch on breastfeeding
Group B Streptococcus
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Low Birth Weight Babies
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Nausea & Vomiting in Pregnancy
Pain Relief in Labour
Prenatal Classes
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Planning a Pregnancy
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Prenatal Care Providers
Postpartum Repetitive Strain Injuries
RH Disease
Rupture of Membranes Before Labour
Sex During Pregnancy
Skin Changes in Pregnancy
Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
Vaccinations During Pregnancy
Vacuum & Forceps for Delivery
Vaginal Birth After Caesarean
When Baby Comes Home
Childhood
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Asthma in Children
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Not Just Baby Fat
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Red Rashes
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Safe Summer Fun
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Vaccinations
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When to go to the Doctor
Whooping Cough
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Yeast Infections in Children
Chronic Pain
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Introduction
Managing Your Pain
Movement Matters
Moving Forward
Nutrition
Opioids
Pacing
Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
Cosmetic Dentistry
Mouth Guards
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First Dental Visit
Headaches
A Healthy Mouth
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Jaw Joint and Muscle Problems
Keeping it Clean
Laser Use in Dentistry
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Oral Health Care Products
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Painless Dentistry
Periodontal Disease
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Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
Insulin Handling
Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Traveling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
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Antibiotic Use
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Aspirin Every Day?
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Back Pain Myths
Back Pain - Lower
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Doctor Visit
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5 Ways to Stay Healthy
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Get Active!
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Stroke
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Urinary Tract Infections
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First Aid
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Bites and Stings
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Eye Injuries
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First Aid Travel Kit
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Growing Older
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Have Health, Will Travel
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Canada's New Blood System
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5 Tips to Manage Weight
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Healthy Diet, Healthy Smile
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Feeding Your Kids
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Food Chemistry 101
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Healthy Eating for Teens
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Iron
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Family Health Magazine - CHILDHOOD

Tooth Injuries in Childhood
Your dentist can help

As babies start to crawl and explore the world, they meet many obstacles where they might be hurt. Through the active years of childhood and adolescence, these obstacles become even more common. Injuries causing damage to the teeth, bone, gums, cheeks and lips are common. Childhood dental injuries can have a long lasting and serious effect. They may lead to discomfort, discolouration, altered tooth development, infection (if left untreated) or tooth loss.

The most likely causes of dental injuries in children are falls and tripping over objects. For young children, playing near sharp-edged coffee tables or fireplaces, running at the swimming pool, and wearing socks on slippery linoleum floors are common activities that often cause falls and dental injuries.

Anyone of any age who plays sports without the protection of a mouthguard also risks severe dental injury. A tooth may be knocked out, moved, broken or suffer from a severe blow (concussion) when left unprotected. Other dental injuries seen by dentists result from fights, car accidents, rough play, electrical burns and, unfortunately, child abuse.

Dental injuries can be divided into those involving the baby or primary teeth and those involving the adult or permanent teeth. Baby teeth begin to appear at about six months of age. By two-and-a-half to three years, all baby teeth should be present. The exchange of baby teeth for adult teeth begins at about age six and continues until about age 13. Although baby teeth are not permanent, their presence is valuable in the growth and development of the mouth and its structures. They guide the adult teeth into their appropriate spots, and aid in speech, eating and appearance.

If the early teeth are lost or altered, these important functions can be affected. Even though the permanent teeth cannot be seen when you look into your child’s mouth, injuries to the baby teeth can have a dramatic influence on later tooth development. For this reason, all dental injuries should be evaluated by a dentist. Some injuries, if left untreated, can lead to nerve death with that tooth. In the case of baby teeth this can also damage the developing adult tooth associated with it.

Injuries to Baby Teeth

Bumped front tooth

These injuries may occur as early as the days when a child is learning to crawl. As a result of the concussion, the tooth may be loosened and bleeding may occur around the gums. This type of injury causes concern for dentists because the tooth may be so loose the child could inhale it. The dentist will also want to check the position of the tooth to ensure that it has not been moved in a way that would interfere with the child’s normal bite. Most teeth that have been bumped tighten up on their own within one to two weeks after the injury.

Injured teeth may discolour by turning grey or brown. Because the baby teeth are so white, the colour change is easy to see when compared to the surrounding teeth. The colour change may be the result of normal healing or a sign of an underlying infection developing. Examination by a dentist is important. Your dentist will decide how often the injured tooth should be checked. It may be a schedule such as one week, three weeks, six weeks, three months and six months after the injury occurred, or longer.

Teeth knocked out

For baby teeth only, a knocked out tooth is not replaced into its original spot. Doing so may damage the permanent tooth that is developing. The success rate is also poor for re-implanted baby teeth.

The lost tooth should be located. If it cannot be found, an x-ray should be done to see if the tooth has been pushed into the gums and bone. If it is still not found, an x-ray of the chest and abdomen may be needed to see if the tooth has been swallowed or inhaled. A follow-up with a doctor may be indicated if the tooth is located by an x-ray of the chest or abdomen.

Your dentist will want to make recommendations about the space that results after a baby tooth is lost due to injury. Sometimes no further treatment is necessary. Other times the space will need to be maintained so there will be enough room for the permanent tooth when it comes through. This is done after the injured area heals.

Broken Teeth

For children ages three to six, this is the most common injury. Your dentist will want to take an x-ray to assess the extent of the injury. Dental fractures may involve:

If you suspect any type of dental fracture, your child should be seen by a dentist to have the damage assessed and monitored.

Teeth pushed out of position

Sometimes a tooth will be injured and its position altered. You may find that the tooth is in the way of your child closing the teeth together or the tooth may be pushed into the gums and bone. You will want your child to see a dentist in any case. X-rays will be needed to assess the extent of the injury.

If the crown (the part of the tooth you brush) is angled backwards towards your child’s tongue, it may be a favourable displacement or favourable injured position. This is because the root (the part that holds the tooth in the bone) will have likely moved forward towards the lip. Since most top adult teeth are forming behind the roots of the baby teeth, this root movement will be away from the developing adult tooth. Although the baby tooth may need to be removed, it may not have affected the forming adult tooth.

For teeth that are pushed into the gums and bone, often the tooth will be allowed to return to its original position (re-erupt). It is possible that the adult tooth may have been damaged as the baby tooth was pushed into it. Your dentist will want to monitor this injury to ensure the tooth is re-erupting and to check that infection is not developing.

Fractures of the jaw

Fractured jaws in children account for two to eight per cent of injuries. Children will need emergency care immediately whenever there is significant injury involving the mouth.

Injuries to the Adult Teeth

Several different types of injuries can occur to permanent teeth.

Crown cracks

These are cracks in enamel that may be horizontal, oblique or vertical. There is no treatment recommended other than monitoring by your dentist.

Crown fractures

This fracture involves the crown of the tooth only. It may encompass:

Immediate care is necessary by your dentist. Partial or complete nerve removal may be required depending on the length of time the nerve has been exposed. Depending on the tooth’s maturity at the time of injury, your dentist may want to encourage the tooth to develop more quickly than it would normally do, then do a root canal.

Root fractures

Root fracturesThis type of injury may involve the crown as well. It may be a horizontal, vertical or oblique fracture. Immediate care by your dentist is necessary. The location of the fracture will dictate if the tooth can be saved and determine the treatment needed. It may involve splinting the tooth for a week to 10 days, or even longer. A follow up root canal may also be required. Because these fractures can be complicated, other treatments may be recommended by your dentist.

Displaced permanent teeth

Displaced permanent teethThis type of injury may push the tooth forward, backwards, into the gum and bone or almost completely out of the bone. You will need to see your dentist immediately. Usually the tooth is replaced into its original position and splinted for a select period of time. A root canal may be needed. If the tooth is pushed into the gum, it may be allowed to re-erupt once again. Braces (orthodontics) may also be needed to reposition the tooth.

Knocked out teeth

Here the tooth is completely lost from the socket. From one to six per cent of dental injuries are of this type. Immediate treatment is urgent as the longer the tooth is outside the socket, the poorer the chance it can be saved.

The tooth should be rinsed with water (being held only by the crown, not the root) and replaced into the socket and gently held in position until seen by a dentist. If the tooth cannot be replaced in the socket, it should be placed in milk or under the tongue. The dentist will splint the tooth in place. A root canal is highly likely. Any cuts to surrounding tissues will need to be assessed and treated accordingly.

The Protective Mouthguard and Your Child

Studies show that 22 to 46 per cent of children aged nine to 10 have suffered some form of dental injury. Boys have more injuries than girls and the front teeth are more often injured than the back teeth. Accidents to the mouth may damage the gums, bone, jaw, the temporomandibular joint as well as the teeth.

People of all ages who are active in sports are advised to wear protective mouthguards.

These guards help cushion the force of an injury and minimize the trauma during an impact. Because a proper, comfortably fitting mouthguard is essential in protecting the teeth and surrounding oral structures, your dentist can discuss making one specifically designed for you or your child. Remember, unless it is worn, the mouthguard cannot reduce or prevent an injury!

Immediate Care

Any injury to the mouth (teeth, gums, bone) should be examined by a dentist as soon as possible after the injury. This increases the chance the dentist’s treatment will be successful. It is better to have an injury checked than to wait and have the situation become worse.

Dental injuries to children may be common but they should not be taken for granted and ignored. Have your dentist check your child’s teeth whenever such an injury occurs. It could make a lifelong difference. No matter what the fracture is, your child should be seen by a dentist to have the damage assessed and monitored.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [CH_FHa99]
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