Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common. Approximately one-third of children have experienced some type of dental trauma, and more have experienced a dental emergency.
There are two peak risk periods for dental trauma - the first being toddlerhood (18-40 months) when environmental exploration begins, and the second being the preadolescent/adolescent period, when sporting injuries become commonplace.
Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.
Toothache is common in children of all ages and rarely occurs without cause. Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss. If pain persists, contact the pediatric dentist. Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).
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If a tooth has been knocked-out of the child’s mouth completely, it is important to contact the pediatric dentist immediately. In general, pediatric dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the tooth bud, and thereby damage the emerging permanent tooth.
Pediatric dentists always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage. The reimplantation procedure is almost always more successful if it is performed within one hour of the avulsion, so time is of the essence!
Sometimes, dental trauma forces a tooth (or several teeth) upwards into the jawbone. The prognosis is better for teeth that have been pushed up to a lesser extent (less than 3mm), but every situation is unique. Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.
If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact the pediatric dentist immediately. Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or perform root canal therapy to preserve the structure of the tooth.
Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma. A luxated tooth remains in the socket – with the pulp intact about half of the time. However, the tooth protrudes at an unnatural angle and the underlying jawbone is oftentimes fractured.
The term “extrusion” refers to a tooth that has become partly removed from its socket. In young children, primary tooth extrusions tend to heal themselves without medical treatment. However, dental treatment should be sought for permanent teeth that have been displaced in any manner in order to save the tooth and prevent infection. It is important to contact the pediatric dentist if displacement is suspected.
The crown is the largest, most visible part of the tooth. In most cases, the crown is the part of the tooth that sustains trauma. There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).
The pediatric dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign. Minor crown fractures often warrant the application of dental sealant, whereas more severe crown fractures sometimes require pulp treatments. In the case of crown fracture, the pediatric dentist should be contacted. Jagged enamel can irritate and inflame soft oral tissues, causing infection.
A root fracture is caused by direct trauma, and isn’t noticeable to the naked eye. If a root fracture is suspected, dental x-rays need to be taken. Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worse case scenario.
A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.” Typically occurring in toddlers, dental concussion can cause the tooth to discolor permanently or temporarily. Unless the tooth turns black or dark (indicating that the tooth is dying and may require root canal therapy), dental concussion does not require emergency treatment.
Injured cheek, lip or tongue
If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze. To reduce swelling, apply ice to the affected areas. If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.
If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room. In the meantime, encourage the child not to move the jaw. In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.
Head injury/head trauma
If the child has received trauma to the head, proceed immediately to the Emergency Room. Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.
If you have questions about dental emergencies, please ask your pediatric dentist.
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