Accidents involving the teeth and face are common among children. A child’s tendency to be active before she can fully develop her motor skills and coordination make accidents unavoidable at times. Thus, the most common age for injuries to occur to baby teeth usually falls between 2-3 years. When your child is older, sporting accidents and car accidents are common causes for damage to her permanent teeth. While dental trauma is common, it is also both highly preventable and highly treatable. Different outcomes from a blow to the face can result in teeth becoming displaced, broken or even knocked out completely. If accidents do happen, take comfort in knowing that most dental injuries are treatable and even a tooth that has been knocked out can be saved if the proper treatment is initiated very soon after the injury occurs. There are certain steps that you should take to improve the long-term survival of a tooth after it has been traumatized.

DO

Do seek advanced medical care for severe injuries

The first thing you should do if your child has had a blow to the head or face is to do a quick assessment of your child’s vital signs. You want to make sure that she has not suffered a concussion. If your child loses consciousness or has any signs of nausea or vomiting following an accident, bring her to the doctor or emergency room as these are signs that she may have a concussion. You should also seek care from a doctor for any other more severe injuries to the face or head. Your child’s medical health is paramount and takes priority over any dental injury. After addressing her health status, your medical doctor can also evaluate her dental injuries and make the appropriate referral to a dental professional.

Do seek guidance from your dentist

If your child has had a dental accident, immediately call a dentist. Because the best outcome for teeth that have been injured involve timely management and treatment, all dentists have an ethical obligation to make sure that reasonable arrangements for emergency dental care are made available to their patients. This may involve assessing your child in person following an injury or triaging and giving an appropriate referral to a doctor or facility that is available for assessment and care. Either way, your dentist will be able to guide you down the right path.

While all dentists have been trained in the management of dental emergencies, pediatric dentists have had advanced training in traumatic injuries specifically in children. When coming in for an assessment, be prepared that even though your child is uncomfortable due to the accident, a thorough clinical exam will be necessary and may include intraoral or extraoral radiographs and tests of the teeth in order to appropriately diagnose what type of injury has occurred and what steps need to be followed.

Do be familiar with the initial first-aid management of teeth following trauma

No matter what the injury, timely actions will be important in order to help save the tooth. Different steps are indicated, depending on the scenario. The International Association of Dental Traumatology (IADT) has a great website designed to guide patients and doctors in the management of acute dental trauma. Here are some general steps you can do to help your child before you see the dentist.

If the tooth is loosened or displaced

• If your child displaces a baby tooth, the concern will most likely be its effect on the adult tooth developing nearby. It is advised not to manipulate the baby tooth and see your dentist for treatment. The dentist may decide to leave the tooth in place or choose to extract it. For an adult tooth, use clean hands and try to reposition the tooth using finger pressure. The earlier you do this after the accident, the easier it will be to reposition because after some time a blot clot will form and make it difficult. In some cases, a tooth may be displaced to the point that it gets locked into a different position in the bone. If you are afraid to hurt your child by snapping the tooth back into place, the dentist can do it. Either way, a trip to the dentist or emergency room will ensure that the tooth will be treated properly. Your child may need to have her teeth temporarily splinted depending on the severity of the injury. The splint is generally a flexible splint that looks similar to braces and will help secure the tooth in place until the bone and gums heal around the affected tooth.

If the tooth is broken

• A blow to the tooth can commonly cause it to chip or fracture. The important thing is to try to locate any broken fragments of the teeth if possible and then go to the dentist or emergency room. Depending on how much the tooth is broken, your dentist will be able to determine what needs to be done. In general, a small chip can be either repaired or smoothed down and left alone. In cases where the fractured piece is large enough to expose the nerve, the dentist will need to do immediate nerve treatment to protect the nerve and avoid infection. The tooth will likely need a full root canal, or endodontic treatment in the future.

If the tooth is knocked out

• Sometimes your child may knock out a tooth. This is called an avulsion and it happens when a tooth is knocked completely out of the mouth. The treatment for an avulsed baby tooth will be different from that of an avulsed adult tooth. For a baby tooth you will still want to bring your child to the dentist to have it checked out, but putting the baby tooth back into her mouth is not indicated. An adult tooth avulsion will be more serious. The good news is that an avulsed permanent tooth can likely be saved if certain steps are taken within the first hour (and preferably immediately) following the accident:

1. Try to avoid touching the root of the tooth. Pick it up by the crown part and do not rinse or wash the tooth.
2. If possible, place the tooth back into her mouth, into the socket in which it came from and have her bite down on a washcloth to keep it in place. Putting it back into the socket will be most ideal if done immediately or within the first 30 minutes. If you are unable to place the tooth back into your child’s mouth, the key is to keep it moist by keeping it in certain liquids such as Hanks Balanced Salt Solution (HBSS), saline or milk. HBSS is a physiologic liquid that has a similar pH and salt concentration to the cells that attach the tooth to the jawbone and thus will keep them alive until the tooth can be replanted. Another way to keep it moist is if you place the tooth between your own cheek and gum. The key is to keep the tooth from drying out and to protect the cells of the root of the tooth from dying, thus providing a better outcome once the tooth is replanted in your child’s mouth. It is best to avoid plain water as a storage medium.
3. Go to the dentist or the emergency room for treatment.

Do be aware of all the possible outcomes after trauma

Your dentist should give you all the information regarding all the possible outcomes that may happen following an injury. One of the most common complications is a gradual discoloration or darkening of your child’s tooth following the accident. This generally indicates changes going on in the tooth’s nerve and blood supply after hitting it. It is similar to a bruise. However, because a tooth itself doesn’t have as much blood supply as skin it may not rebound as quickly as a skin bruise. The tooth may lighten up over time or stay dark. The important thing to remember is that discoloration alone does not mean the tooth has to be treated. If discoloration is coupled with pain or infection (which sometimes appears as a swelling or small pimple near the gum line of the tooth), then a visit to the dentist and treatment will be indicated. Another important thing to remember is that if a primary or baby tooth has been hit it is always possible that the permanent tooth that replaces it can become affected depending on the nature of the injury and the developmental stage of the adult tooth at the time of the accident. Your dentist will be able to detail the most likely outcomes of your child’s particular situation and injury.

Do try your best to prevent injuries

Dental injuries in teenagers are commonly the result of accidents during sporting events or practices. All sporting activities have an associated risk of orofacial injuries, especially contact sports. The American Academy of Pediatric Dentistry (AAPD) recommends that your child uses appropriate protective gear while participating in sports. This includes the use of mouthguards during games and practice, as it has been proven to reduce the risk of injury by distributing the forces of impact. For younger children, anticipatory guidance from your dentist is important to impact. For younger children, anticipatory guidance from your dentist is important to avoid age-related accidents.

DON’T

Do not wait to seek dental treatment

Remember that the greatest chance of having a favorable treatment outcome following dental trauma will be when appropriate first-aid and treatment measures are initiated immediately. For an avulsed tooth, the IADT recommends putting the tooth back into the socket or an appropriate storage medium within the first 60 minutes after it is knocked out. After 60 minutes, the treatment prognosis will decrease dramatically. This is why an avulsed permanent tooth is the definition of a true, time-sensitive, dental emergency.

Do not let a knocked-out permanent tooth get dry

There have been cases when a parent comes to the dentist or the emergency room with his child’s avulsed tooth wrapped in a tissue. This is probably the worst thing you can do for your child’s tooth. Healthy teeth are attached to the jawbone by important and delicate Periodontal Ligament (PDL) cells and fibers. When a tooth is knocked out of the mouth these fibers are severed. Thus, keeping an avulsed adult tooth moist will ensure that these cells remain viable so that when the tooth is replanted into her mouth, the tooth has a chance to heal and reattach properly. The tooth will have the best chance of being saved and survive long-term if you can place the tooth back in her mouth or in a proper storage medium such as HBSS, saline or milk immediately or within the first hour. Many hospitals, dental offices, and even schools have a Save-a-Tooth as part of their first-aid kit which contains HBSS in a sterile container. You can purchase a Save-a-Tooth kit online and it may even be a good idea to keep one around the house in case of emergency. The time sensitivity issue in an avulsion emergency refers to the time that it takes to put the tooth back in the mouth or appropriate liquid.

Do not leave the tooth or any tooth fragments behind if possible

When a tooth is avulsed or broken, try to locate and hold onto the tooth and tooth pieces. When your child seeks treatment, your dentist will try to make sure that all pieces are accounted for even if they are not of use for the treatment. If your child cuts her gums or lips and breaks her tooth the dentist will want to make sure that no tooth fragments became imbedded into the wounds, which can cause a dangerous infection if left untreated. The dentist may want to take a radiograph of the soft tissue to confirm this if any tooth fragments are unaccounted for.

Do not miss recommended follow-up appointments

Many of the complications that can occur after an injury may occur days, weeks, months or years after the accident. Depending on the injury, the IADT and AAPD recommends follow up-clinical exams and x-rays of the tooth at different time intervals to monitor it over time. During these visits your dentist will be able to make proper diagnoses of the tooth and ensure that any necessary treatment will be performed in a timely matter. Follow up is just as important as the initial management visit following a dental accident, so be prepared for the traumatized tooth to be examined and followed up for a long time.

Do not panic

It’s important to stay calm and remember the tips you learned in this article. Most parents panic initially because of the amount of blood that is associated with a dental or orofacial injury. While bleeding can be serious, it is also important to note that a lot of bleeding associated with tooth and mouth accidents is very common. The blood supply to the gums, tongue and mouth is very generous which will explain why your child may bleed a lot when her mouth or gums sustain even the most mild form of trauma. This is also the reason that these types of injuries heal very well and quite fast. The bottom line is that you should treat a tooth accident like an emergency, but still keep a clear head so you can take the steps outlined above to help your child have the most positive outcome.

Posted by Megan Chin, DDS in Dentistry Tags: avulsion, dental emergency, dental trauma, pediatric dentistry, save a tooth