MOST traumatic injuries to children’s teeth and supporting tissues constitute a true dental emergency and require immediate assessment and management. Injuries to the primary dentition can result in physical and emotional complications, which may persist for many years.
Depending on the type of injury, there are various consequences and prognoses for the injured tooth. These range from survival to tooth ankylosis (fusion to the bone), pulp decay, calcification, and tooth extraction.

Energy from an acute impact can easily be transmitted to the developing tooth germ because of anatomic relationships. There is also potential for periapical (root tip) complications after a primary tooth injury, which can adversely affect the developing permanent tooth.
The objective in managing a child with a history of recent trauma to the primary dentition is to ascertain the health of the succedaneous (permanent) tooth and immediately treat the injured tooth as indicated by the extent and severity of the injury. Treatment may range from “nothing” to extraction.

Successful management depends on several factors, notably the child’s age at the time of the injury, the type and seriousness, and the time elapsed since the injury. The interval between injury and treatment relates to successful outcomes, minimal side effects, and pulp exposures.
The dentist who attends to children brought in for treatment for injuries sustained to the mouth generally can observe a consistent pattern. Most of the victims are boys between four and six years old. Nine out of every 10 patients are injured because of a fall. Nearly all the teeth involved in falls are not broken. However, the supporting structures suffer a high incidence of damage. There are usually almost 10 times as many injuries to the upper teeth as the lower teeth.

For the upper incisors (anterior), the most common occurrence is intrusion, in which the blow forces the teeth partially back into the bone the same way a nail is hammered into wood.
Most parents or guardians have the injured child examined and treated about 24 hours after the accident. By the time the traumatised teeth are presented for treatment, most had developed complications of which dental abscess was generally predominant. Other complications include non-vitality, discolouration, gum infection and excess mobility.
Interestingly, approximately 25 percent of the children with trauma to the teeth who were seen at the GPHC last year sustained their injuries more than four weeks before initial attendance at the hospital.

Because young teeth (three-year-olds) have immature roots and root absorption, they are less firm in their sockets, and a significant blow can easily dislodge them in any direction. The soft, resilient bone surrounding the teeth also contributes to the relative weakness.
The most crucial aspect of injury to children’s teeth is to recognise, seek and obtain adequate intervention within 12 hours after the trauma. In the initial stage, apply ice packs which will prevent or delay the acute inflammation stage (pain, swelling, bleeding, etc.) before professional help is received.

Finally, it is important to remember that children are more susceptible to emotional and psychological trauma than physical ones. You must reassure and convince the child that everything will be all right. You should also have the child checked out for any other injury besides the mouth.