How to preserve a beautiful smile after tooth trauma.
Parents spend a lot of time, effort and money taking care of their children’s teeth. The brushing, flossing, fluoride and braces are all intended to give a child a beautiful smile to last a lifetime. Early on kids have primary teeth, which are necessary when learning to eat solid food. At about age 6, the primary teeth begin to give way to the permanent teeth and, by age 12, a full set of teeth heralds the onset of adolescence.
Primary and permanent teeth, though nestled safely in the mouth, can be prone to serious injury. Nearly one-half of all kids sustain dental injury during childhood. About 30 percent of preschool children — boys and girls alike — will suffer primary tooth trauma, while up to 33 percent of school-age kids — boys twice as often as girls — will injure their permanent teeth. The front teeth are more prone to serious injury, which can cause long-lasting cosmetic, functional, economic and psycho-social effects.
It’s important to know what to do in the event your child suffers dental trauma at any age. Falls are the most common cause of tooth injury in preschool and school-age kids, whereas sports-related tooth injuries are more common in adolescents. Once an injury has occurred, it may be difficult to tell which type of tooth has been damaged. Here is how to distinguish the teeth:
* Permanent teeth have a wavy top while they are coming out of the gum. After eruption, permanent teeth will have a nice smooth edge.
* Primary teeth are much smaller than permanent teeth.
* Children five years and younger mostly have primary teeth.
* Between six and seven years of age, primary teeth fall out and permanent teeth replace them.
* From 6 to 12 years of age, a child will have a mouth full of both primary and permanent teeth.
* By 13 years of age, most primary teeth are gone, and a child has a mouth full of permanent teeth.
Whether primary or permanent, teeth can sustain many kinds of injuries. When a tooth is hit with enough force to make it feel loose or have bleeding at its base, there is little concern for long-term issues. These injuries are usually completely healed within three to four days without any problems.
If the tooth becomes shoved forward or backward in the gum, your child should see a dentist in case some re-positioning or stabilizing is necessary. If the tooth is very stable in the gum, the visit to the dentist can wait until the next day.
If the tooth is very loose and there is a risk that it will fall out and your child could choke on it, a dentist should see her immediately. Chipped teeth also require a dental visit. An immediate visit is necessary if the pulp (red dot or tissue in the center of the tooth) is visible. If the pulp is not visible, a child with a chipped tooth can visit the dentist in the next several days. The sharp edges of the tooth may cause cuts inside the mouth, so it’s important to get it fixed.
When a tooth is knocked out completely, it can be either the least or the most worrisome dental injury, depending on the type of tooth. Primary teeth that get knocked out cannot be put back in the socket. It is recommended that a dentist examine the underlying teeth for injury.
When a permanent tooth is knocked out, emergency care becomes necessary. The tooth must be put back into the socket immediately. The faster it’s put back in the socket, the better the outcome. Teeth implanted in the first 15 minutes have a better chance for survival and return to normal. A knocked-out tooth cannot be put back in the socket after two hours.
A parent or other adult should do the following:
* Hold the tooth only by the crown; do not touch the root end of the tooth.
* Gently rinse (don’t scrub) the tooth off with saliva or water (do not soak the tooth in water).
* If your child is old enough to not swallow the tooth, put the tooth back into the socket facing the right way.
* Push on the tooth until the top of the tooth is at the same height as the teeth next to it.
* Take a piece of cloth, fold it, put it on the tooth and have your child bite down on it until you reach your dentist or the emergency room.
* If you cannot put the tooth back in the socket you will need to put the tooth in some cold milk or saliva and take your child to the dentist or emergency room immediately.
* Do not transport the tooth dry or in water (the pulp will be destroyed).
Severe tooth injuries may require tetanus prophylaxis, so check with the child’s pediatric health care provider to make sure his immunizations are up to date. Your provider may prescribe antibiotics following a tooth avulsion (displacement).
Tooth trauma often occurs with other mild or major injuries. Up to 75 percent of children who are abused have tooth injuries. Other conditions associated with tooth injury are:
* head or neck pain
* loss of consciousness
* altered mental status
* jaw pain
* pain opening or closing the mouth.
If any of these symptoms are present, your child should be stabilized and transported by Emergency Medical Services (EMS) to the closest emergency department.
Comfort measures following tooth injury include using ice or an ice pop to help decrease swelling, stop any bleeding and provide some pain relief. Note that in some cases a cold item may cause more pain and not be well tolerated. An appropriate, weight-based dose of acetaminophen or ibuprofen may also provide some pain relief. A diet that consists of soft foods may be necessary if the tooth is loose or painful. Once the pain is reduced or gone, you child can resume a regular diet.
Tooth trauma can be very scary for parents and kids. Rapid assessment of the injury and appropriate interventions are important. Putting a tooth back in a socket seems a nearly impossible task, but it’s necessary in order to save a beautiful smile.
Ann Petersen-Smith, PhD, RN, CPNP- AC, is an Assistant Professor at the University of Colorado Anschutz Medical Campus College of Nursing.