Tooth Injuries in Children

Tooth Injuries in Children

Summary

Tooth injuries in children may include damage to teeth as a result of falls, accidents and other mishaps. These injuries can cause teeth to become chipped, cracked, partially displaced or completely dislodged from the socket in the mouth.

The consequences of a child’s tooth injury depend on the nature and severity of the injury, and whether or not the injury has occurred to a primary tooth or permanent tooth. When a permanent tooth is injured, rapid action is required to save it. When a primary tooth is injured, saving the tooth or restoring it cosmetically is much less important, as the tooth eventually will be naturally lost and replaced.

This patient guide focuses on injuries that occur in the primary teeth of children.

Injuries to primary teeth usually require the care of a dentist or other medical professional. Children who suffer a primary tooth injury may have symptoms such as bleeding in the injury area, pain or increased sensitivity in the tooth. In addition, children who injure a primary tooth may lacerate tissues in the mouth, including the cheeks, lips and gums. If the tooth has been chipped or otherwise partially damaged, it may have sharp edges that can cause further damage unless properly treated.

A dentist can stabilize teeth that are loose but still intact. Teeth that are chipped or cracked can be smoothed during dental procedures. Unlike permanent teeth, primary teeth that have been completely knocked free (avulsed) cannot be replaced. In most cases, this is not a major problem because the gap left by the avulsed primary tooth eventually will be replaced by a permanent tooth. However, in some cases a device called a space maintainer may need to be inserted into the gap formerly occupied by the primary tooth. This prevents other teeth from moving into the gap before the permanent tooth finally emerges.

Parents can help reduce the risk of tooth injuries to their child by child-proofing their home. A child’s behavior can be a major factor in increasing or decreasing the risk of tooth injuries. Children should not walk or run while holding an object in the mouth, and should wear a mouth guard when participating in sports where mouth injuries could occur (e.g., contact sports). Children should always take safety precautions such as wearing a helmet during sports and bicycle riding and wearing a seatbelt when traveling in a car.

About child tooth injuries

Tooth injuries in children can result in teeth that are chipped, cracked, partially displaced or completely dislodged from the socket in the mouth. These injuries often occur as the result of falls, mishaps during play or accidents during athletics.

The consequences of a child’s tooth injury depend on the nature and severity of the injury. All people have two sets of teeth during their lifetimes – a set of 20 primary teeth that begin to emerge between 6 months and 1 year of age and a set of 32 permanent teeth that gradually replace the primary teeth beginning around age 6. Most children have lost all their primary teeth by the age of 13.

Treatment of injured teeth may differ depending upon whether the tooth is primary or permanent. For example, when a permanent tooth is knocked loose (avulsed), rapid action is required to save it. When a primary tooth is knocked loose, saving the tooth is much less important, as the tooth eventually will be lost and replaced naturally.

This patient guide focuses on injuries that occur in the primary teeth of children.

An injury to a child’s primary tooth usually requires a visit to a healthcare professional. It usually is best to consult a dentist when a child’s tooth has been injured. However, a visit to a hospital emergency room may be necessary if the child has suffered a blow to the head – which can be life-threatening – or an injury to another body part.

Parents are urged to seek emergency help in cases of dental emergencies, such as when jaw swelling indicates a potential fracture or bleeding of the gums does not stop despite firm pressure. Appointments with a dentist can be scheduled for less serious injuries, such as a minor chip in a tooth (e.g., cracked teeth).

Types and differences of child tooth injuries

Tooth injuries may be described as uncomplicated and complicated. Uncomplicated injuries do not expose the pulp (tissue at the center of the teeth with nerves and blood vessels). This reduces the chance of infection and loss of the tooth. On the other hand, complicated injuries do expose the pulp to potential infection, which can lead to the death of the pulp. If the pulp dies, pus may begin to build up near the root tip in the jawbone. This is called an abscess, and it can damage the bone around the teeth.

Injuries to a child’s teeth often are classified by the damage caused by trauma. They include:

  • Concussion. Minor injury to the periodontal ligament, which is a bundle of connective tissue fibers that anchors the teeth to the jaws. Typically, such injuries do not cause the tooth to be knocked out of alignment.
  • Subluxation. Injury that causes a tooth to become loose in the socket without knocking it out of position.
  • Intrusive luxation. Injury that causes the tooth to be pushed deep into the socket, sometimes to the point that the tooth is no longer visible. The tooth may appear knocked out.
  • Extrusive luxation. Injury that displaces the tooth from its position.
  • Avulsion. An injury that completely knocks a tooth out of place.

Signs and symptoms of child tooth injuries

Although in most cases the signs of tooth injury are obvious, other signs and symptoms may occur that can indicate the severity of the injury. For example, children who experience concussions may feel dental pain when the tooth is tapped with a dental instrument. Some teeth – such as primary incisors – may change color after a concussion.

Symptoms of subluxation (when a tooth is loosened but not knocked out of place) may include bleeding around the neck of the tooth. In many cases, a splint needs to be placed around the subluxated tooth to help repair the periodontal ligament.

Teeth that are fractured cause various symptoms depending on the extent of the fracture. For example, fractures of the enamel and dentin may lead to increased sensitivity of tooth to cold foods or drinks, or to air. Fractures that go beyond the enamel and dentin and reach the pulp may cause bleeding around the tooth or formation of a small red spot.

In addition, children who injure a primary tooth may lacerate tissues in the mouth, including the cheeks, lips and gums. If the tooth has been chipped or otherwise partially damaged, it may have sharp edges that can cause further damage.

Diagnosis and treatment of child tooth injuries

If an infant or young child suffers an injury to the gums or teeth that causes bleeding, parents are often advised to run cold water over a piece of gauze and apply pressure gently to the injury site. Sucking on an ice pop may help reduce swelling until the child can see a dentist.

Children who visit a dentist after a tooth injury will have their lips, tongue and gums examined for all tooth fragments that may have broken loose during the injury. A dentist often can determine the severity of the injury based on whether or not the tooth is loose and whether or not the tooth is tender to the touch.

In some – but not all – cases, x-rays may be helpful in determining the extent of the injury. If a primary tooth has been knocked completely loose, a space maintainer may be used to prevent other teeth from moving into any gap created by the loss of the injured tooth. If the injured tooth is still in the mouth, the dentist will determine whether the tooth needs to be realigned or removed.

Injuries to baby teeth do not require replacement of the tooth, because permanent teeth will soon grow in its place. In addition, primary teeth that are displaced should not be replanted. Replanting can damage developing permanent tooth germs and often results in death of the pulp. In some cases a device called a space maintainer is placed where the baby tooth was knocked out. This helps to prevent other teeth from crowding into the area before the permanent tooth has a chance to emerge.

For the next several days following injury and treatment, parents are urged to watch for signs of an abscess, such as fever and swollen or tender gums at the site of the injury.

Pain reliever medications can help reduce a child’s discomfort after a tooth injury. However, these should only be used if approved by a physician. Aspirin should not be used to treat a child’s pain, as this medication has been linked to a potentially fatal condition called Reye syndrome.

Prevention of child tooth injuries

Parents can help reduce the risk of tooth injuries to their child by child-proofing their home. This includes removing items that can be tripped over (e.g., extension cords), pulled or tipped over (e.g., certain types of lamps, table cloths) or inserted into the child’s mouth (e.g., loose change, small parts of toys and other objects).

A child’s behavior can be a major factor in increasing or decreasing the risk of tooth injuries. Teach children not to walk or run while holding an object in the mouth (e.g., lollipop) and to avoid chewing on hard or pointed objects. Instruct children not to push or shove in any situation, particularly when near a water fountain or while playing on a playground. Children should wear protective head gear with mouth protection during contact sports such as baseball, soccer, football and hockey. A mouth guard is highly recommended when playing any sport that could result in mouth injuries. This includes any sport where contact among other players or objects (e.g., bat, ball) may occur, or in sports where falls are likely. Children should also wear helmets when bicycling, rollerblading and skateboarding.

Children should always wear a seatbelt when traveling in a car. Buckle up younger children in age-appropriate car safety seats. Parents are also urged to use the restraints provided in strollers and shopping carts.

Sometimes, newly erupting permanent teeth are at risk because of malocclusion (a bad bite). If the top front teeth stick out, there is often a greater risk for injury to the teeth and to the lips. A dentist can recommend if orthodontic intervention is appropriate.

Finally, regular dental examinations allow a dentist to track potential weaknesses and other problems during the child’s development that could result in a tooth injury down the line. Dentists also can provide preventative care and recommend preventive methods to keep teeth strong, healthy and less susceptible to injury.

Questions for your doctor on child tooth injuries

Preparing questions in advance can help patients and parents to have more meaningful discussions with their physicians and dentists regarding their or their child’s treatment options. The following questions related to tooth injuries and children may be helpful:

  1. How can I lower the risk of tooth injury for my child?
  2. If my child injures a tooth, should I call a dentist or the pediatrician?
  3. If my child’s primary tooth is damaged, is it better to have it removed or to try to save it?
  4. If my child loses a primary tooth, will he/she need a space maintainer?
  5. How long will the space maintainer remain in place?
  6. If my child loses a primary tooth, are there signs I should look for that might indicate a problem with how a permanent tooth is emerging in that location?
  7. Can I give my child pain reliever medications to reduce soreness following treatment?
  8. What potential signs of trouble should I look for following treatment?
  9. What are some ways I can encourage my child not to engage in behaviors that could lead to tooth injuries?
  10. Which sports require the use of a mouth guard, or a helmet with mouth protection?
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