Children often suffer from dental traumatisms or knocks, both at younger and older ages.
Small children aged between 6 months and 1 year are learning to walk and fall often, but rarely do themselves any harm. However, sometimes they bang their mouth and teeth, which can have a number of consequences on their temporary or milk teeth, which stay with them until around the age of 7 years.
In some children, their permanent teeth grow in at 6 or 8 years. The problem usually affects the front teeth, and both the parents and the children will know whether the affected tooth or teeth are their milk or permanent teeth, with the latter being much bigger.
The damage suffered by milk and permanent teeth is similar. However, a traumatism to the milk teeth is less serious given that they will eventually be replaced by new, permanent teeth.
Every traumatism to the teeth is important. If your child bangs his mouth, you should visit your dentist to check that his teeth are healthy and unaffected by the knock, even if they don’t hurt.
Here we will always take an X-ray in case there is a fracture that we can’t see simply by looking or touching. A knock will almost always cause discomfort or pain, and we have to check whether the root is broken or the nerve is affected, and whether or not the tooth is vital.
Teeth are composed of a root and a crown, the visible part of the tooth once it has completely erupted. A knock may affect the crown, the root, or both.
Types of injury
1)The tooth moves and is painful when eating or touching it, but it is still in place
The gums around the tooth may bleed. While this is not an immediate emergency, you should ask us for an appointment as soon as possible. We will take an X-ray and may prescribe a gentle anti-inflammatory medicine to reduce swelling in the area and prevent it from hurting.
We will apply a vitality test, which consists of lightly pressing a cotton bud impregnated in liquid nitrogen against the tooth, causing a strong sensation of cold which should irritate the nerve and make it hurt a little.
If it doesn’t hurt, it means that the nerve has been affected and that a root canal is required, i.e.removal of the nerve. If we don’t, it will necrotise and rot, eventually causing an infection. We will do this in the event of a permanent tooth.
If a milk tooth has no sensitivity, we will simply remove it, because if not,it can be infected. As a milk tooth cannot be devitalised, it may affect the permanent tooth lying beneath it if we leave it in place.
If the root is broken, meaning that we can’t proceed with a root canal, we will have to extract it, whether it is a milk or a permanent tooth. If the extracted tooth is a milk tooth, we will do nothing else, and simply wait for the permanent tooth to grow in.
The worst situation is when the broken root corresponds to a permanent tooth, since it will require replacing after extraction. Remember that we can’t fit implants until the child is 18 years of age, i.e. until they have completed their adolescent growth.
If the lost tooth is a top front tooth and the space is very visible, we will fit a provisional denture, removable or glued to the teeth on either side, until an implant can be fitted.
2)The tooth has been knocked out of its normal position
Here the tooth must be returned to its place as soon as possible. With clean hands, the adult with the child can do the following: if the tooth has been pushed inwards, pull it forward until it is in line with the others. If, due to a knock from the bottom up, it is leaning outwards, it can be pressed back into its position. You must take the child to the dentist as soon as possible, on the same day if you can. Meanwhile, the child or adolescent should be given anti-inflammatory medicine like Ibuprofen.
In the surgery, the tooth will be returned to its place if you haven’t done so beforehand. To keep it in place and stop it from moving when eating or speaking, the traumatised tooth will be fixed to those on either side, by means of either a white filling or composite, which we will remove at a later date.
We can also use a guard or join the moving tooth to the others from behind with a wire.
We will proceed with vitality tests, and will check to see that the tooth isn’t broken
3)The crown of the tooth is broken and the fracture line is clean
Here we will take an X-ray to ensure that the root isn’t broken and that the nerve is functioning properly. If the tooth is broken but alive, the patient will feel cold air when blown on to it. We can then rebuild the dental crown with composite in the same colour of the other teeth, or with the piece of natural tooth that you should previously have saved in a saline solution or sterilised milk and, if possible, kept cold.
We almost always fill or reconstruct the tooth with composite, in the case of both milk and permanent teeth.
4)The crown of the tooth is broken and there is a drop of blood in the fracture line
This means that the nerve is exposed. If the tooth is a permanent tooth, we will have to remove the nerve and prescribe antibiotics and anti-inflammatory medication to prevent infection. We will then reconstruct the tooth with composite in the same colour. If you have kept the broken part of the tooth as described, we can sometimes use it for the reconstruction.
In the case of a milk tooth, if the nerve is exposed, we normally remove it, as it will otherwise cause problems. In some cases, particularly in the case of the second milk molar, we can proceed with a pulpotomy, i.e. removing only the exposed part of the nerve and covering it with calcium hydroxide for protection. We then fill the tooth. This procedure is not always a success.
5)The tooth has completely fallen out
This is known as avulsion. It normally only happens in children and adolescents, given that the ligament connecting the bone and the tooth hasn’t mineralised and isn’t as strong as it is in adults.
Sometimes, in children, only the ligament connecting the root to the bone breaks, so the tooth falls out in a single piece, leaving the bone around it intact. In adults, given that the root is strongly joined to the bone, a knock of this kind would cause the crown or root of the tooth to break.
If we are dealing with a milk or temporary tooth, we do nothing. Sometimes, if the milk tooth has fallen out, the permanent tooth will grow in a little before time
Aesthetically, there is no problem in seeing a child under the age of 8 years without a milk tooth. If the child is very small, only 3 or 4 years, some parents prefer to have a false tooth fitted, fixed to the teeth on either side. This is perfectly feasible, and different kinds of temporary dentures are available in this case.
If we are dealing with a permanent tooth, it must be re-implanted, i.e. returned to its place, inserting the root in the corresponding space
To do this, the tooth should be kept in saliva, i.e. between the gum and the cheek, to prevent it from dehydrating and enabling us to re-implant it. Another way to keep it in conditions for re-implantation is to put it in a saline solution, which you can purchase from the nearest chemist’s shop, or in sterilised milk, and even better if the glass or container is kept surrounded by ice.
You must urgently make your way to the dentist nearest you to re-implant the tooth as soon as possible. If you are in the countryside or the mountains, far from the dentist, you can re-implant it yourself. The child must rinse their mouth well with water, and the tooth, without brushing it, so as not to lose the attached periodontal ligament cells.
Reimplantation often works, but sometimes the tooth will eventually fall out at some stage.
The dentist will take an X-ray, and will more than likely prescribe an antibiotic for the child.
While doing some sports, it is advisable for children to wear tooth guards to minimise the consequences of traumatisms to the mouth.