FROM personal experience, I know how it feels to be a parent when your child injures a tooth. The consequences and prognosis for the injured tooth vary depending on the type of injury. These range from survival (of the injured tooth) to tooth ankylosis (fusion to the bone), pulp decay and calcification, and ultimately to tooth extraction.
Most traumatic injuries to the teeth and supporting tissues of children 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. But the good news is that children can self-repair remarkably well, unlike adults.
An acute impact can easily transmit energy to the developing tooth germ because of anatomical relationships. Periapical (root tip) complications can also occur after a primary tooth injury and may adversely affect the developing permanent tooth.
The objective in the management of 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 injury, the type and severity of the injury, and the time elapsed since the injury. The interval between injury and treatment affects the likelihood of a successful outcome and the risk of side effects and pulp exposure.
Dentists who treat children for mouth injuries generally observe a consistent pattern. Most of the victims are boys between the ages of four and six years. 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 are highly likely to be damaged. There are usually almost 10 times as many injuries to the upper teeth as to the lower teeth.
For the upper incisors (anterior), the most common injury is intrusion, in which the blow forces the teeth partially back into the bone, like a nail 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 have developed complications, of which dental abscesses are generally predominant. Other complications include non-vitality, discolouration, gum infection and excessive mobility.
It is interesting to note that approximately 25 per cent of the children with trauma to the teeth who were seen at the GPHC last year had sustained their injuries more than four weeks before initial attendance at the hospital.
Because young teeth (three-year-olds) have immature roots and root resorption, they are less firmly held in their sockets, and a significant blow can easily dislodge them in any direction. The soft, resilient bone surrounding the teeth also contributes to this relative weakness.
The most crucial aspect of injury to children’s teeth is to recognise it and seek and obtain adequate intervention within 12 hours after the trauma. In the initial stage, apply ice packs to prevent or delay the acute inflammatory 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 along with physical trauma. Reassure the child and tell them that everything will be all right. Also, have the child checked for any other injuries besides the mouth.