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Children’s Dental Injuries
Quick action can save a tooth
When your child is hurt, it is distressing for both of you. An injury to the teeth of a toddler, young child or teenager is no exception. What’s more, dental trauma can have serious long-term consequences if not dealt with as soon as possible after injury.
Children beginning to crawl and explore the world can damage their teeth and tissue surrounding and supporting them. About 30 per cent of children experience dental trauma.
What should I do?
- When picking up the tooth DO NOT touch the root of the tooth.
- Do not rub the root or scrape off any debris. Rinse off any dirt with water.
- Replace the tooth in its socket as soon as possible, holding it gently in place.
- If you cannot reposition the tooth, place it in a solution of milk, saline, or a special transport medium that can be purchased at pharmacies if one happens to be nearby.
- Never allow the tooth to dry out.
- See the dentist as soon as possible, ideally within an hour of injury.
Most injuries between 12 months to two and a half years of age result from a fall. This may be from a high chair, down stairs, or while walking or running. A collision with the corner of a piece of furniture can also do damage.
Automobile accidents can also hurt the mouth if a child is not secured in an appropriate car seat. Family violence is another possibility. Up to half of abused children suffer injuries to the head and neck, which include damage to the teeth.
Injuries in first and permanent teeth
The top front four teeth are most often involved in a dental injury in children. Most injuries to primary (first or baby) teeth displace or move the tooth rather than actually breaking the crown or the root. In small children, the supporting bone for these teeth is quite forgiving. It allows the tooth to move to the side, tip to the front or back, or drive directly up into the bone.
On occasion, the tooth actually comes out. If this happens to a primary tooth, it is usually recommended that the tooth not be put back into the tooth socket.
Most dental injuries seen in young permanent teeth also involve the top front four incisors. However, these permanent teeth are usually broken rather than moved out of position. If they are displaced or totally lost, the treatment they receive is different than with primary teeth.
If any loss of consciousness is associated with the injury, take your child first to a doctor, then a dentist. Generally, the sooner a dentist sees the child, the more likely the injured tooth or teeth can be saved.
At the dentist’s office
The dentist assessing your child will take a thorough medical history. Expect to answer questions about allergies, health conditions and medications your child routinely takes. The dental team needs this information before giving any treatment. Immunizations will also be discussed. It is particularly important that your child’s tetanus immunization is up to date.
The dentist will ask how, where, and when the injury occurred. This helps in deciding the most effective treatment for that specific injury. A parent or a legal guardian must provide consent for treatment.
The dental examination will include a full exam of the head and neck. This rules out less obvious injuries that can sometimes go unnoticed. The dentist will visually examine your child. Appropriate diagnostic imaging, such as x-rays and CT scans, may also be used. The choice of imaging tool is based on the type of injury, the child’s age and ability to cooperate. Most often, a single x-ray is used.
Next, the dentist will recommend the best treatment for the particular situation. You will discuss this treatment before the dentist begins to repair or restore the tooth or teeth.
Fractured teeth
Fractures to the crown of the tooth vary in severity.
- They can be limited to the enamel (outer layer).
- They may involve the dentin (inner layer).
- They may involve the pulp (nerve and blood vessel).
Treatment for such injuries all aim to keep the pulp alive and healthy, while restoring the function and look of the tooth.
Fractures can also affect the root of the tooth.
• Fractures may be at the end of the root, middle of the root, or just below the crown.
• They may be horizontal or vertical.
• They may involve fully or partially formed roots.
In some cases, both the crown and the root of the tooth may be fractured.
Treatment depends on the age of the child, the stage of development of the root, and the chance that the tooth can be stabilized to allow healing to occur.
Many aspects must be considered when faced with this type of injury. The dentist will discuss these with the parents.
After a tooth has been injured, the less stress that is placed on the pulp tissue the better. Avoid giving your child hot, cold and hard foods. For some injuries, a mouth guard will need to be worn whenever possible to protect the tooth from being injured again.
Displaced or lost teeth
Displacement/Luxation |
Bone Fracture |
Pushed up - Intrusion |
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Teeth can be displaced in different ways.
- Concussion: the tooth is not mobile and not displaced.
- Mobility: the tooth is loose but not displaced from the socket.
- Intrusion: the tooth is driven into its socket.
- Extrusion: the tooth is dislocated from the socket.
- Lateral luxation: the tooth has been moved forward, backward, or sideways.
- Avulsion: the tooth has been completely knocked out of its socket.
Treatment for these types of injuries depends on a number of factors.
- Is the tooth primary or permanent?
- How old is your child?
- Is there damage to the supporting bone?
If a primary tooth has been driven into its socket, treatment usually allows it to re-erupt. A permanent tooth may be allowed to re-erupt on its own or be repositioned and splinted.
If teeth have been moved out of place, both primary and permanent teeth must be repositioned. They may be splinted to allow the supporting tissues time to heal.
If a primary tooth has been knocked out, it is not usually repositioned into the socket. The chance of success is usually low and the risk of complications to developing permanent teeth is too great. Successfully implanting a lost permanent tooth depends on the length of time the tooth is out of the mouth, the condition of the bony socket, and the stage of development of the tooth.
If your child’s teeth and mouth have been injured, see a dentist immediately. Treatment to save the tooth can vary. Your dentist will decide on treatment based on the situation.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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