When Teeth Are Casualties
Absolutely Parents: Kids Health 2008/9

Management of Dental Trauma in Children

Dental emergencies and injuries in children can occur anytime. Studies in the UK show that such injuries occur most frequently between the ages of 1 and 3 years when toddlers learn to walk and the ages 8 to 11 years, when the children's activities become more boisterous and less cautious, and when they participate in contact sports. Parents, caregivers and even teachers, have a big role to play when the children under their charge encounter a dental emergency.

Dental Injuries

Injuries to children's teeth can be very distressing for children as well as their parents. Dental trauma may occur as a result of a sports mishap, an altercation, a fall inside of the home, a road traffic accident or other causes. Promot 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.

Causes and Frequency of Dental Injuries

Approximately 30% of children experience dental injuries. The peak period for trauma to the primary teeth is 18 months to 40 months of age, becasue this is a time of increased mobility for the relatively uncoordinated toddler. Injuries to primary teeth usually result from falls and collisions as the child learns to walk and run.

For permanent teeth, school-aged boys suffer trauma almost twice as fequently as girls. Sports accidents and fights are the most common cause of dental trauma in teenagers. The upper central incisors are the most commonly injured teeth. Upper teeth protruding more than 4mm appear two to three times more likely to suffer dental trauma than normally aligned teeth.

Management of Dental Injuries

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 concentrate on the child's well-being. Wounds should be washed carefully with gauze or cotton for 5 minutes. Injuries to the primary teeth may have long term consequences on the development and eruption of the permanent teeth. Always seek emergency treatment at the earliest possible opportunity.

The most serious injury to the permanent tooth occurs when it is completely displacedor knocked out of the dental socket, this is known as dental avulsion. Dental avulsion injuries occur most frequently in children between the ages 7 and 9, an age when the alveolar bone surrounding the tooth is relatively resilient. The best way to preserve a tooth that has been knocked out is to put it back into its socket as quickly as possible. If possible, this can be performed at the scene of the accident even before taking dental consultation. The single most important factor to ensure a favourable outcome is the speed with which the tooth is replanted. If immediate replantation is not possible, then the tooth must be placed in a protective solution while being transported to the dental office or emergency room. However, the primary avulsed tooth is generally not replanted to avoid injury to the developing permanent tooth.

Prevention of Dental Trauma

Most dental trauma is preventable. Car seat belts should always be worn, and young children should be secured in appropriate car seats. Homes should be monitored for potential tripping and slipping hazards. Child-proofing measures should be taken, especially for toddlers. In addition to placing gates across stairs and padding sharp table edges, electrical cords should be tucked away.

Orthodontic treatment, or "braces" can be considered to align upper front teeth which are protruding to reduce the likelihood of dental injury to the front teeth. Everyone who participates in contact sports should wear a mouthguard to avoid dental trauma. Mouthguards should also be worn along with helmets in non-contact sports such as skateboarding, in-line skating and bicycling. Any activity involving speed, an increased chance of falling, and potential contact with a hard piece of equipment has the likelihood of dental trauma that may be prevented or substantially reduced in severity with the use of mouthguards which help to distribute the force of the impact of any accident. A mouthguard for your child can be easily fabricated by your family dentist.

First aid if your child avulses a tooth Important: If a tooth is avulsed, check if it is a permanent tooth before replantation. Keep your chin calm. Find the tooth and pick it by the crown (the white part). Avoid touching the root. If the tooth is dirty, wash it briefly (10 seconds) under cold running water before replanting it. Ask your child to bite on a handkerchief and hold it in position. If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or in saline. The tooth can also be transported in the mouth, keeping it between the molars and inside of the cheek. Avoid storage in water. The tooth should not be wrapped in tissue or cloth. The tooth shoud never be allowed to dry. Seek emergency dental treatment immediately.

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