Dental trauma in young children is very common. Pediatric dentists often hear stories about a child hitting the edge of a tub or coffee table or hard floor surface. It is estimated that 30 to 50 percent of children have some type of injury to a baby or primary tooth or to the mouth during their childhood. A child learning to crawl and walk combined with excitement, spirit of adventure, and curiosity can result in an unexpected quick fall or collision.
Since a child’s facial bones are developing and growing, they are considered somewhat pliable. It is likely that the force from a fall or bump will cause a baby tooth to move out of position more often than fracture. A child’s mouth is similar to an immature green tree limb. If a force is encountered, it is more likely to bend out of position rather than break.
There are many categories of dental injuries and the type of injury determines which treatment is necessary. A tooth that completely comes out of its socket or the mouth is called an avulsion. A baby tooth is typically not re-implanted, because there is a high likelihood that it will abscess from an infection in the area. The opposite is true for permanent teeth, which usually are re-implanted. An avulsed permanent tooth needs to be preserved in milk or saliva and then re-implanted and splinted into position within one hour for the best prognosis.
If a tooth is displaced out of its regular position, it is called a luxation or extrusion. Depending on the extent of the displacement, a dentist can determine if repositioning is necessary.
Although not as common, baby teeth that sustain a fracture need evaluation to determine the amount of tooth structure that is involved and if nerve exposure has occurred. Bonding these teeth with dental restorations will improve esthetics, decrease sensitivity, and protect the enamel and dentin. In certain instances, treatment of the nerve chamber of the tooth is necessary.
Occasionally a primary tooth will be partially or completed pushed up into the gums, this is known as an intrusion. Sometimes a caregiver may think the child has knocked out the tooth when the tooth has been pushed vertically into the bone completely out of sight. In these cases, the dentist will take radiographs of the area to note the location of the injured primary tooth in relationship to the developing permanent teeth. Fortunately, many significantly intruded teeth re-erupt within months.
A dental concussion refers to a tooth that has had a significant bump but does not move out of position and may show bleeding around the gingiva. These teeth need to be monitored long term for color change and possible nerve changes.
In rare cases, the visible portions of the tooth may appear not to be affected by a trauma, while beneath the surface there is a horizontal or vertical root fracture or alveolar bone facture. This would be diagnosed through dental radiographs. The extent of the fracture determines if the tooth can be preserved or requires removal.
To see images of the different types of injuries see the Dental Trauma Guide
A pediatric dentist is trained to handle young children and treat the types of injuries mentioned above. Parents should call their dentist if a child has a tooth causing pain or sensitivity. If a tooth is broken, loose, or missing after trauma, it is best to be seen for an evaluation.
If bleeding does not stop after 10 minutes of pressure, sutures may be needed. If there is jaw pain upon opening or closing, it is necessary to seek care. If there is difficulty swallowing or breathing, a caregiver should seek emergency medical attention.
Dental accidents can happen quickly. There often is not enough time to prevent a fall or tumble. Finding a dentist early for your child ensures that you will have a doctor to call if you have a question or concern.
By Dr. Angie Baechtold – Dr. Angie Baechtold is a Board Certified Pediatric Dentist with Great Beginnings Pediatric and Adolescent Dental Specialists. www.greatbeginningspedo.com