SOMETIMES, a child may suffer a blow to a tooth without it being displaced from its normal position. The structures supporting it would be injured. This condition is called a concussion. The tooth is usually tender to biting pressure and may shake, with bleeding occurring around the crown. No treatment is indicated other than slight filing of the chewing surface if the child complains of biting sensitivity. Mobile teeth generally tighten up on their own after a few weeks. The parent should be instructed to give the child a soft diet and eventually return to normal foods according to the child’s tolerance. The future for concussed teeth is good.

The dental health of a person is primarily decided during the preschool period of that person’s life, and the role played by the parent or guardian is an essential factor. While tooth decay is the principal agent which decimates an individual’s oral health, traumatic injuries form an important part of this, especially in children. A recent study of injuries to primary teeth showed children aged two to four had the highest incidence. Falling has been described as the most common cause of dental injury, and the most common type of injury to the primary dentition is displacement. Other studies have shown soft tissue injuries and enamel-dentine fractures to be the most prevalent.

Clinical evaluation of the injured pre-school child can be difficult because the dentist often deals with distraught parents and a frightened and uncooperative child. Crown fractures of primary teeth involving enamel only are usually not restored or filled. All that is needed is a slight recontouring of the biting edge to improve aesthetics. However, the involvement of dentine in the crown fracture necessitates restoration to seal the exposed dentinal tubules that contain nerve endings. Because of short roots, root fractures in primary teeth are unusual. The location of a root fracture in a primary tooth usually determines the outcome. Only when the X-rays show that the tip is broken should they be treated. When the fracture is closer to the crown, the tooth is usually dark and shaky and must be extracted.

Displacement occurs more frequently than a crown or root fracture because of the resiliency of the alveolar bone and short tooth roots. These injuries may be extrusive (the tooth being knocked straight outward), lateral, or intrusive (driven deeper into the jaw bone). In most cases, these displaced teeth must be removed. The dentist analyses the clinical picture before deciding to extract the displaced tooth. Trauma to temporary teeth can cause psychological affliction to the child, unlike in adults. If these teeth require more than six months to be replaced by the underlying new ones, special effort must be made to preserve them in the dental arch. Failure to do so could result in crowding (“riders”) and malocclusion (abnormal bite) unless a space retainer (a type of denture) is fabricated for the child. Parents should not insist on extraction but should allow the dentist to advise them on the proper recourse so that any hasty action will not be regretted.