Dental Trauma

Dental Trauma: What to Do When Your Child Suffers an Injury to the Teeth

Spring is almost here, and children’s sports are going to be in full swing!  This means an increased risk for injuries to your child’s teeth.

As children grow and learn new things, the risk of injury is relatively high.  Toddlers fall down when they are learning to walk.  Children have accidents when learning to ride a bicycle.  Adolescents suffer trauma when learning to play sports.

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Accidents and injuries happen.  In children, often these accidents involve injuries to the mouth and teeth.  This blog highlights what you need to know about trauma to the teeth.

Different Types of Trauma to the Teeth

Baby Teeth vs. Permanent Teeth

All of these types of trauma can happen to both baby teeth and permanent teeth.  The consequences of trauma to baby teeth are usually less severe than those for permanent teeth, simply because baby teeth fall out. 

The only serious consequence of trauma to a baby tooth occurs when the trauma affects the underlying permanent tooth as it is developing.  The crown (or visible part) of the permanent tooth forms underneath the roots of the baby tooth.  If an injury occurs which forces the baby tooth or its roots into the developing permanent tooth during this formation stage, the permanent tooth can be deformed.

The majority of injuries to teeth occur on the front of the face and affect front teeth.  It is possible for a back tooth to be injured if a child is hit from the side, for instance with a baseball.  The recommendations below apply to both front teeth and back teeth.

Injuries that Move a Tooth

When force from an injury moves a tooth, it needs to be addressed quickly. 

What You Will See:

The tooth looks whole, but it is in a different position.  It could be pushed up into the gums, hanging down out of the gums, or protruding at an unusual angle.  It is very common to have bleeding in the gums around a tooth that has been moved.

Baby Teeth vs. Permanent Teeth

In general, the treatment for this type of injury is the same for baby teeth and permanent teeth.  In severe cases, the baby tooth may be extracted.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Attempt to move the tooth back to its normal position using light finger pressure only.  Whether you are able to reposition it or not, go to the dentist for an x-ray of the tooth to evaluate the health of the root, and the bone around the tooth.

Follow-Up Care:

Your child will need a soft diet for a period of a few days up to two weeks.  The goal is no additional pressure on the injured tooth as it is healing.  You may need to give your child over-the-counter pain reliever such as Children’s Advil or Children’s Motrin as needed for pain.

Follow-up with your dentist in 3 months.  He will x-ray the tooth to confirm healing and the health of the tooth and its surrounding structures.

Possible Long-Term Consequences:

When a tooth moves, it is possible that the nerve supply to the tooth has been broken where it enters at the tip of the root.  In many cases, the nerve supply can reattach, and the tooth heals.  In other cases, the nerve does not reattach, and the tissue inside the tooth dies.  A dead nerve must be removed, and the tooth needs a root canal.

The injury to the surrounding structures may also damage the connection between the tooth and the jaw bone.  A condition called ankylosis often develops, in which the tooth becomes fused to the bone and is unable to move.  This is a major concern in orthodontic treatment, when you desire to move that tooth.

Injuries that Chip or Break a Tooth

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If an injury to a tooth causes a portion of the tooth to chip or break off, the consequences are usually a little milder than a tooth that is moved or knocked out.  In minor cases, the small chip can be filled in to return the tooth to its natural shape.  In severe cases, the chip extends into the nerve of the tooth, and a root canal is needed.

What You Will See:

The tooth looks broken or jagged on the edge.  Look specifically for any pink or red spots in the center of the tooth.  This is the nerve inside the tooth, and large breaks may extend this far. 

Baby Teeth vs. Permanent Teeth

In general, the treatment for this type of injury is the same for baby teeth and permanent teeth.  Minor cases will be restored with filling material. In severe cases, a permanent tooth will need a root canal, and the baby tooth may be extracted.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Try to locate any fragments of the tooth, and bring them with you.  Whether you are able to find it or not, go to the dentist for an x-ray of the tooth to evaluate the health of the root, and the bone around the tooth.  The dentist will evaluate the depth of the chip and determine whether or not the nerve is affected. 

Follow-Up Care:

If you have the tooth fragment, your dentist can reattach it to the tooth.  If not, he can rebuild the tooth back to its normal shape and size. 

Your child will need a soft diet for a period of a few days.  You may need to give your child over-the-counter pain reliever such as Children’s Advil or Children’s Motrin as needed for pain.

Follow-up with your dentist in 3 months.  He will x-ray the tooth to confirm healing and the health of the tooth and its surrounding structures.

Possible Long-Term Consequences:

The force to the tooth, which chipped it, could also have disrupted the nerve supply, as noted above.  Your dentist will monitor the tooth closely for any signs of a dead nerve.  If a root canal become necessary, your dentist will guide you in the steps involved in treatment.  It is important to know that the nerve inside a tooth could die at any point in the future, even decades later.

The tooth could also become ankylosed

The dental treatment, which restores the broken tooth, may need replacement at any point in the future.  Be careful not to use that tooth for anything besides chewing and speaking (i.e. holding hair pins or cutting fishing line).

Injuries that Knock Out a Tooth

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A tooth that is completely knocked out needs immediate action!  The longer you wait, the less chance the tooth has of surviving.

What You Will See:

The tooth is completely gone from the mouth.  Evaluation of the tooth should show the crown (visible part) of the tooth, as well as the root.

Baby Teeth vs. Permanent Teeth

There is no treatment for knocked out baby teeth.  The child will have a space in that tooth’s site until the permanent tooth comes in.

For a permanent tooth, we make every attempt to save and reattach the natural tooth.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Hold the tooth by the crown ONLY.  Do not touch the root.  If you can, put the tooth back into the socket after very gently rinsing off any dirt or debris.  If you are unable to put the tooth back into the child’s mouth, place it in a cup with milk or saliva.  That’s right: fill up a cup with enough spit to cover the tooth.  Saliva is the best thing to keep the cells and fibers on the knocked-out tooth alive until it can be reimplanted into the mouth.

Whether you are able to reinsert it or not, go immediately to the dentist.  The dentist will clean and reinsert the tooth, using anesthetic if the child is in pain.  The sooner the tooth is reimplanted, the better the chances of its full healing.

Follow-Up Care:

Follow the recommendations for a soft diet and OTC pain relievers noted above.  The dentist will follow-up with you more frequently to confirm healing and reattachment of the tooth.

Possible Long-Term Consequences:

The consequences noted above, a dead nerve and ankylosis, are both highly likely when a tooth is completely knocked out.  Another possible consequence is failure of the tooth to reattach.  In this case, it is necessary to extract the tooth and replace it with a dental implant. 

Adhering to your dentist’s prescribed follow-up schedule will keep you informed of any of these consequences as they occur.

Be Prepared for Injuries to Your Child’s Teeth

As you can see from the instructions listed above, getting in to see your dentist as soon as possible is very important!  Save our number in your phone, and call us at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) as soon as an injury happens.  Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell will treat your child’s emergency and give you all the information you need for the right follow-up care.