Dental Trauma in Children
More than 50% of children have some type of injury to a tooth during childhood. Its part of growing up. Most cases of mouth injuries are not life threatening and rarely a child may develop serious complications. However, injuries to the teeth and mouth can have long lasting effects on the childs appearance and self-confidence.
The teeth injured most frequently are the four upper front teeth. Children aged between one and three are at high risk of injuring their upper front baby teeth. They are starting to walk and run and still have poor muscle coordination. The second-high risk group is children between the ages of eight and twelve years. Boys are twice as likely as girls to fracture their front permanent teeth. The main causes of mouth injuries are falls, fights, sports and motor vehicle accidents.
1. What to do when accidents happen
Firstly, dont panic! Even small cuts in the mouth can bleed profusely. Hold a clean cloth with pressure to slow the bleeding. Bleeding normally stops after 10 to 15 minutes. Then rinse the mouth and surrounding areas gently with warm water to remove the dirt and debris.
If you suspect concussion or the bleeding doesnt stop with big lacerations, seek medical attention.
2. Injuries to baby teeth
Parents often wonder whether it is baby teeth or permanent teeth that got injured. The permanent teeth are not usually present before six to seven years of age. Baby teeth also look different from permanent teeth. If the child is younger than 6 years, it is most probably his/her baby teeth that got injured. The treatment goal for an injury to baby teeth is to avoid damage to the permanent teeth.
If the baby tooth is knocked out, never try to re-implant it. It is not worth risking the developing permanent tooth. The baby tooth is often displaced up into the socket or to the side. It usually re-erupts on its own and doesnt need further treatment.
If the tooth is broken (fractured), the child should see the dentist promptly. The dentist will determine whether the nerve and blood vessels had been damaged or not. Treatment may include smoothing of the rough edges, repair of the tooth with a tooth colour filling material called composite resin, leaving the tooth in place or removing it.
3. Injuries to permanent teeth
The key is to act fast; time really is of the essence with permanent teeth. Children aged between nine and ten are the most susceptible to this damage, with boys about twice as likely as girls.
If a permanent tooth is knocked out, it must be re-implanted immediately and it is a dental emergency. This is not as difficult as it sounds and can be done by a parent or another adult or even the child himself.
The following steps can be followed:
Handle the tooth carefully by the top part (crown) and dont touch the root. Remove any debris by only rinsing the tooth with saline or tap water. Dont scrub or sterilize the tooth.
Place the tooth in the socket by hand.
Keep the tooth in place by having the child bite on a clean cloth.
Then get to the dentist as quickly as possible. The dentist will place a splint to keep the tooth in place during the healing time.
If you dont want to attempt to put the tooth back, you can keep it in milk or the childs saliva and get to the dentist as soon as possible. The tooth should ideally be replaced with in 15 minutes. If it is replaced after more than an hour, the survival chance drops drastically. Time is of essence.
If a permanent tooth is broken (fractured), it can be repaired with a material called composite resin, which can match the colour of the tooth. If the tooth is hot or cold sensitive, immediate attention is needed. The tooths nerve can be damaged and it will need a root canal treatment. If the tooths structure is compromised, a protective coverage is needed by placing a porcelain crown.
4. Potential complications
The tooth might discolour. This means that the nerve got damaged and the tooth needs a root canal treatment.
The tooth can be lost
The tooth can be hot or cold sensitive and then it might also need a root canal treatment.
The permanent tooth can get damaged.
5. What to do to prevent injuries
Use a mouth guard during contact sports. A custom-made one can be fabricated by a dentist.
Use approved car seats and seat belts while travelling.
Beware of bunk beds as children commonly fall from these (often while sleeping).
Teething infants will try to chew on everything. Make sure that objects made of materials which can splinter or crack their teeth are kept away from them.
Learning to walk is a treacherous time for toddlers! Its not possible to avoid falls on tiles, stairs or onto tables. However, its necessary to check their upper front teeth regularly to look for signs of damage (colour change of the tooth or an abscess in the gum above the tooth). Regular (4 monthly) dental visits are also necessary for the dentist to check for these signs.