Dental Trauma In Children

Dental Trauma in Children

Dental emergencies and injuries in children can occur anytime, although studies show that such injuries occur most frequently between ages 1 to 3 when toddlers learn to walk, and ages 8 to 11 when children participate actively in contact sports.

Approximately 30% of children experience dental injuries. Parents, caregivers and teachers have a big role to play when the children under their charge encounter a dental emergency.

Prompt treatment is essential for the long-term health of an injured tooth. Obtaining dental care within 30 minutes can sometimes make the difference between saving or losing a tooth.

Preventing Dental Trauma

Most dental trauma is preventable. Young children should always be secured in appropriate car seats and seat belts should be worn. Child-proofing measures should be taken at home, especially for toddlers, to minimise tripping and slipping hazards. These may include placing gates across stairs, padding sharp table edges and tucking away electrical cords.

Older children who participate in contact sports or other activities such as skateboarding, in-line skating and cycling may consider wearing a mouth guard. Mouth guards help to distribute the force of impact from an accident, thereby reducing the risk and severity of dental trauma.

In addition, orthodontic treatment or "braces" can be considered to align upper front teeth which are protruding, to reduce the likelihood of dental injury to these teeth.

Causes and Risk Factors

Injuries to primary teeth usually results from falls and collisions as a young child (18 to 40 months of age) learns to walk and run.

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Injuries to permanent teeth usually result from sport accidents and fights. School-aged boys suffer trauma almost twice as frequently as girls. The upper central incisors are the most commonly injured teeth; upper front teeth protruding more than 4mm appear 2 - 3 times more likely to suffer dental trauma than normally aligned teeth.

Types of Dental Injuries and Treatment

Injuries to the mouth include teeth that are knocked out, fractured, forced out of position, pushed up, or loosened. Root fracture and dental bone fractures can also occur, as well as injuries to the adjacent soft tissues.

With any injury, always keep calm and consider the child's well-being. If the child has experienced loss of consciousness, nausea, vomitting, headache or dizziness, it is best to see a medical doctor first to rule out neurological injuries.

Here are some dental injuries which are commonly encountered:

• Soft tissue injuries

Injuries to the face or lips often present together with tooth injuries, and may range from bruises to cuts / lacerations. Depending on how severe the injury is, sutures (stitches) may be required to help stop the bleeding and optimise healing.

• Tooth fracture

Part of the tooth appears broken or "chipped", and the fractured edges may feel rough or sharp. With the exception of minor fractures, the inner layers of the tooth are often exposed and this is a potential pathway for bacteria to reach the nerve of the tooth (dental pulp). Fractured teeth will require a filling or crown, depending on how much tooth structure has been lost. If the fracture extends into the dental pulp, pulp treatment will also be required.

For primary teeth with superficial fractures, your dentist may only recommend smoothening the sharp edges, since these teeth will eventually be replaced.

• Luxation (partial displacement of tooth)

The tooth is partially displaced out of its socket. Primary teeth which are very mildly displaced and not interfering with the child's bite (occlusion) may be left to spontaneously align. However, those which are severely displaced or displaced toward the developing permanent tooth may require extraction. For permanent teeth which are displaced, it is considered best practice to reposition them into the correct position, to provide patient comfort and restore function. We recommend seeing a dentist as soon as possible to determine the most appropriate management for your child.

Partial intrusion of upper left primary central incisor

Complete intrusion of upper right primary central incisor, and avulsion of upper left primary central incisor. An x-ray is required for diagnosis. 

• Avulsion (complete displacement of tooth out of socket)

The tooth is completely displaced out of the socket. Avulsion injuries can occur both in primary and permanent teeth. Most frequently, they occur in children aged 7 to 9, an age when the alveolar bone surrounding the tooth is relatively resilient.

The best way to preserve a permanent tooth that has been knocked out is to put it back into its socket as quickly as possible. This can be performed at the scene of the accident, before dental consultation. Even if the tooth has been out of the oral cavity for an extended time, it should still be replanted as an interim measure until the patient can receive a more definitive tooth replacement in the future, especially in young patients.

In contrast, primary teeth are NOT replanted as this may cause further injury to the developing permanent tooth. Nonetheless, you should seek emergency treatment at the earliest possible opportunity to rule out other injuries. Injuries to the primary teeth (incuding avulsion) may have long term consequences on the development and eruption of the permanent successors.

Post-Trauma Care

• Pain management: local anaesthesia may have been given during the dental visit. However, your child may complain of pain after the anaesthesia effect wears off. Pain medication should be given as prescribed.
• Home-care: you should continue to brush your child's teeth with a soft toothbrush twice daily. Avoid the areas of injury for the first few days; instead, gently wipe these areas with a damp gauze soaked in an antibacterial mouthrinse, such as chlorhexidine.
• A soft diet is advised for the next 2 - 3 days.
• Attent the follow-up appointments scheduled for your child.