In younger children, their coordination and judgement are incompletely developed and majority of falls happen in and around the house as they become more inquisitive and start to explore their surroundings. In older children, most injuries are a result of falls or collisions while playing and running.

Dental injuries may result in small chips of the tooth to completely avulsed (knocked out) teeth. It is important to note that if the child is experiencing any of the following symptoms due to the accident (loss of consciousness, dizziness, disorientation, unable to open the mouth, teeth do not fit together properly or bleeding from the nose or ears), he or she should be sent to the hospital immediately for management.

Common dental injuries in children and what should parents can do:

• Chipped or Broken Tooth

There are different levels of severity for chipped teeth, ranging from a small enamel chip to a fracture involving the nerves of the teeth. Oftentimes, the chipped tooth will have sharp edges that may cut the lips or tongue, and cause the situation to seem much worse than it really is. In such situations, apply gentle pressure to the bleeding areas with a clean gauze or cloth and try to locate any broken fragments of the tooth. Do visit your dentist at the earliest time possible.

Generally, small chips can be repaired, smoothened down or left alone. In cases where the fractured portion involves the nerve of the tooth, nerve treatment may be required. Dental x-rays are recommended to check for other possible injuries and to ensure that no broken tooth fragments are lodged in the oral soft tissues, eg lips, cheeks and tongue.

• Bleeding Gums

Bleeding gums due to dental injury is not uncommon and can have a wide range of causes.

In many cases, the gum bleeding is due to superficial cuts on the gums or impact trauma to the supporting tooth ligaments. These can bleed readily but usually pose no danger to your child. It is important not to panic in these circumstances and try to render the best possible first aid.

Other causes of gum bleeding can be from deeper lacerations of the gums or injury / fracture of the tooth and surrounding bone.

In most of the above cases, the immediate concern will be to manage the bleeding situation. Application of a gentle pressure with clean gauze / cloth for a few minutes will often significantly reduce or stop the bleeding. This not only calms the child but also allows a better assessment of the extent of the injury. When the bleeding has stopped, it is often found that the actual injury is not as bad as initially imagined. Do consult your dentist as soon as possible for the appropriate follow up management.

• Knocked Out Permanent Teeth

In the event of accidental trauma, avulsion (knocking out) of the adult tooth usually causes the most alarm to the child and their loved ones. While it is understandably disturbing, it is important to remain as calm as possible and take the following steps to increase the chances of a successful replantation by your dentist.

• Hold the tooth by the crown and do not touch the root.
• If the tooth is dirty, wash the tooth briefly (approximately 10 seconds) under cold running water. Do not scrub the root.
• Replace the tooth into the socket, or place it in milk. If replaced in the socket, bite gently on a handkerchief or cloth to retain it in place.
• Attend a children’s dental clinic as quickly as possible.

The critical factors for a successful replantation are:

1. The time interval between the accident and when the tooth is replaced in the socket / placed in milk to protect it.
2. The transport medium the tooth is placed in. The best medium is the tooth’s own socket. However, other mediums of similar osmolarity as our body cells, such as milk and normal saline, are acceptable alternatives. In the same vein, wrapping the tooth in tissue dries up the cells and should not be done.
3. The amount of time lapsed between the accident and when the avulsed tooth is replanted by a dentist. The sooner a dentist gets to manage the tooth, the better the chances for a successful long term outcome.

By Dr Lim Min Min, Dental Surgeon from T32 Junior

Practice Address:
One Orchard Boulevard
17th Floor
Camden Medical Centre
Singapore 248649
Tel: (65) 6733 1388
Email: t32@t32dental.com
Emergency Dental Services: (65) 6398 5578

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