21219asDid you know? Nearly a third of children have encountered some type of dental trauma in their lives, and many more have experienced a dental emergency. Despite being extremely common, dental injuries and dental emergencies can be most distressing for both children and parents alike.

Primarily, there’s two times which are most at risk for dental-related traumas – the early toddler years (usually between 18 months to 3 1/2 years) when youngsters venture out to explore their environment, and later, the adolescent period, when sports-related injuries become frequent.

We’ve listed just a few of the most common childhood dental emergencies, along with some useful guidance on how best to deal with them.

Toothache

A common ailment in children of any age, this rarely occurs without a real reason. Sometimes, the culprit is impacted food, and can usually be dislodged with some floss, a toothbrush or even a clean finger. Persistent pain should be referred to the care of a pediatric dentist. A short list of common causes of toothache could be: tooth trauma, fractures, dental decay, or in pre-teens, wisdom teeth eruption.

Steps to remedy the problem:

1. Use warm (not hot) water to clean the affected area. Avoid using medications or warm the affected tooth & gum area directly.
2. Check and clear away all impacted food particles.
3. Reduce swelling by application of a cold compress to the affected area.
4. Seek the assistance of a pediatric dentist.

Avulsion (knocked-out tooth)

It is essential that if a tooth has been forcibly knocked-out of the child’s mouth completely, that a pediatric dentist is contacted immediately! Generally, avulsed primary (baby) teeth are not reimplanted, as this can cause complications with the emerging permanent tooth. On the other hand, unless there is significant and lasting trauma to the tooth, they will usually reimplant avulsed permanent teeth. The reimplantation procedure is has a greater degree of success when performed within one hour of the avulsion, so every moment is critical!

Steps to remedy the problem:

1. Carefully retrieve the tooth, handling it only by the crown. Be very careful not to allow anyone to touch the tooth roots, (due to infectious contamination).
2. Gently rinse off all surface debris and dirt using only water, and without scrubbing.
3. With younger children, immerse the tooth in a glass of saliva or milk (do not attempt to reinsert the tooth, as it poses a choking hazard). In the case of older children, re-insert the tooth into using mild pressure, or encourage the child to couch the tooth in their cheek pouch.
4. Keep the tooth moist – this is absolutely critical for a successful reimplantation procedure.
5. Rush the child to your nearest pediatric dentist (where possible) or the emergency room at a medical facility – time is critical in saving the tooth.

Dental intrusion (tooth pushed into jawbone)

Occassionally, dental trauma forces a tooth (or several teeth) inwards toward the jawbone. There’s a somewhat better prognosis in situations where teeth have been pushed up to a lesser extent (< 3mm). The force of the trauma can be sufficient in many cases to injure the tooth’s ligament and permanently fracture its socket.

It is very important to contact the pediatric dentist immediately if dental intrusion of either the primary or permanent teeth is suspected. Depending on the severity and depth of the intrusion, the pediatric dentist will opt to wait for the tooth to descend naturally, or perform root canal therapy in order to save the underlying tooth structure.

Steps to remedy the problem:

1. Thoroughly rinse the child’s mouth with cold water.
2. Apply cold ice packs where necessary to reduce swelling.
3. Give the child Tylenol or Ibuprofen (Motrin) for swelling reduction and to relieve pain.
4. Notify your pediatric dentist if possible, or proceed to the Emergency Room promptly.

Tooth luxation/extrusion/lateral displacement (tooth displacement)

The forcible displacement of teeth is generally classified as “lateral displacement, “luxation”, or “extrusion”, depending on how the tooth’s orientation changes after suffering from trauma. An extruded tooth is one which has been partially popped out of its jaw socket. A luxated tooth remains in the socket – with the tooth pulp usually intact in 50% of cases. However, the underlying jawbone is often fractured, and the tooth protrudes at an unnatural angle.

In young children, primary tooth extrusions tend to self-heal without intervention. However, when it comes to permanent teeth which have suffered any kind of displacement, dental treatment should be sought to prevent infection and ultimately save the tooth. As always, it is essential that you notify the pediatric dentist if any displacement is suspected.

Steps to remedy the problem:

1. Apply cool, moist compresses where necessary to reduce swelling.
2. Give the child Tylenol or Ibuprofen (Motrin) for swelling reduction and to relieve pain.
3. Notify your pediatric dentist as soon as possible.

Crown fracture

In most cases, the crown is the part of the tooth that suffers the bulk of trauma, as it is the largest & most visible portion of the tooth. Crown fracture can be classified in several ways, ranging from minor enamel cracks (non-urgent) to pulp exposure (critical emergency). Your pediatric dentist can assess the severity of the damage through dental X-rays. However, if you note any change in tooth color (such as yellowish or pinkish hues forming inside the tooth) then this is a sign of an emergency. Minor crown fractures oftentimes necessitate application of dental sealant, while more extensive crown fractures may lead to pulp treatments/root canals. Either way, the pediatric dentist should be contacted in the case of crown fractures. Cracked, serrated enamel can cause serious inflammation of soft oral tissues, potentially leading to an infection.

Steps to remedy the problem:

1. Use warm (not hot) water to clean the affected area.
2. Apply cool, moist compresses where necessary to reduce swelling.
3. Give the child Tylenol or Ibuprofen (Motrin) for swelling reduction and to relieve pain.
4. Carefully cushion the tooth with a soft, semi-edible material (something that the child won’t mind carrying in the mouth)
5. Notify your pediatric dentist if possible, or proceed to the Emergency Room – depending on severity of the injury and availability of medical help.

Root fracture

This type of injury is often unnoticeable to the naked eye, and is caused by direct trauma. If the injury is presumed to be a root fracture, then dental x-rays will be necessary. Depending on the exact positioning of the fracture as well as the child’s level of discomfort, the affected tooth can be either treated, or monitored for further results. The worst-case possiblity would be tooth extraction.

Steps to remedy the problem:

1. Place a cold, moist compress on the affected area.
2. Give the child Tylenol or Ibuprofen (Motrin) for swelling reduction and to relieve pain..
3. Notify your pediatric dentist if possible.

Dental concussion

This is a tooth which has recieved physical trauma, but it has not been dislodged from its socket or fractured, and as such, it is described as “concussed.” Although this frequently appears in toddlers, unless the tooth discolors to a darkened or black color (indicative of tooth death), it does not usually require dental treatment. However, a dental concussion can cause the tooth to discolor temporarily or permanently.

Injured lip, cheek, or tongue

If you observe that the child’s lip, cheek, or tongue is bleeding as a result of a bite or cut, simply apply firm, direct pressure to the area using gauze or a clean cloth material. Administer ice to help reduce swelling. In more serious cases, if there’s uncontrollable bleeding, proceed to the Emergency Room or call a medical professional immediately.

Fractured jaw

A suspected fractured or broken jaw requires that you proceed immediately to the nearest Emergency Room. Try your best to calm and encourage the child to avoid moving or readjusting the jaw. Very young children will likely require carefully tying a soft scarf (or other similar material) lenghthwise over and around the head and jaw to immobilize it.

Head injury/head trauma

Head trauma is a very critical injury, and should only be assessed by trained personnel – proceed immediately to the Emergency Room. Whether the child has lost consciousness or not, it is important for pediatric doctors to eliminate the possibility of delayed concussion and complex internal bleeding.

Please be sure to contact your pediatric dentist if you have additional questions.