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Dental Trauma

Dental Trauma is injury to the child’s mouth, including teeth, lips, gums, tongue and jawbones. The most common dental trauma is a broken or lost tooth. Dental Trauma may be inflicted in a number of ways: Contact sports, motor vehicle accidents, fights, falls, eating hard foods, drinking hot liquids and other such mishaps. As oral tissues are highly sensitive, injuries to the mouth are very painful. Prompt treatment is essential for the long-term health of an injured tooth. Obtaining dental care within 30 minutes can make a big difference.

  • Causes of dental Trauma
  • Patterns and Risk Factors
  • Types of Dental Trauma
  • Complications of Tooth Injury
  • Prevention
  • Sports Dentistry

Causes of Dental Trauma

Falls are the most frequent cause of dental trauma among pre-school and school-age children; most falls and collisions occur inside the home. The peak period for trauma to the primary teeth is from 18 to 40 months of age, because this is when the uncoordinated toddler learns to walk and run.

Sports-related injuries and altercations are common causes of trauma to permanent teeth. School- going boys suffer trauma almost twice as frequently as girls. Sports accidents and fights are the most common cause of dental trauma in teenagers.

Patterns and Risk Factors

The most common injury site is the maxillary (upper) central incisors, which account for more than 50% of all dental injuries. Oral injuries result from falls (most common), bike and car accidents, sports-related injuries and violence. The mouth is also a common site for non- accidental trauma and child abuse should be considered in a child with oral trauma.

Here are some additional risk factors for oral trauma:

  • Children with compromised reflexes or poor coordination.
  • Hyperactivity.
  • Substance abuse (by the adolescent or within the family)
  • Child abuse or neglect.
  • Malocclusion: An abnormality in the alignment of teeth.
  • Malocclusion with protruding front teeth.
  • Failure to use protective face and mouth gear.

Types of Dental Trauma Concussion

  • Injury to the supporting structures of the tooth, without loosening or displacement of the tooth.
  • Tooth is tender on percussion.
  • Stick to a soft diet for 2 weeks.
  • Monitor for changes in tooth colour.
  • Permanent teeth should be monitored, but the risk of complication is low.

Subluxation

  • Injury to supporting structures of the tooth with loosening but no displacement.
  • Tooth is tender to percussion, with bleeding at the gingival margin.
  • Stick to a soft diet for 2 weeks.
  • Requires follow-up, may splint permanent teeth.
  • Monitor for changes in tooth colour that may indicate pulp necrosis.

Lateral Luxation

  • Injury to the tooth and its supporting structures, resulting in tooth displacement.
  • Injured tooth is at risk for pulpal necrosis and root resorption.
  • Requires prompt referral to a dentist for repositioning of the injured tooth/teeth. A splint may be required to hold the injured tooth/teeth in place.
  • Even primary teeth should be examined by a dentist, because the underlying permanent tooth may be injured.

Intrusion

  • Tooth is pushed into the socket and the alveolar bone. May appear shortened or even barely visible.
  • Poor prognosis and high risk for complications, including root resorption, pulp necrosis and infection. May require root canal treatment.
  • May damage underlying permanent dentition, especially if an infection develops.
  • Teeth may re-erupt. Approximately 90% of primary teeth re-erupt in 2 to 6 months. Permanent teeth may also re-erupt. If a primary tooth does not re-erupt, it will require extraction so that it does not interfere with permanent tooth eruption.
  • Tooth is partially displaced from its socket.
  • Requires re-positioning and stabilization.

Avulsion

  • Tooth is completely out of the socket.

  • Avulsion most often occurs in children from 7-9 years of age, when the permanent incisors are erupting and newly formed tooth attachments provide only minimal resistance against a blunt force. Management depends on tooth type.

    • Avulsion of a Primary Tooth: Do not re-implant as this may damage the underlying permanent tooth.
    • Avulsion of a Permanent Tooth: This is a dental emergency. The most common teeth avulsed are the central maxillary incisors. The best chance for tooth survival occurs if the tooth is re-implanted within 30 minutes. After 1 hour, there is almost no chance for survival.
  • Re-Implanting an Avulsed Tooth:
    • Wash tooth and socket with saline.
    • Hold the tooth by the crown.
    • Rinse with water – don’t srub.Insert the tooth using adjacent teeth as a reference. Have child bite down on the gauze to hold it into position.
    • The best chance of survival for the tooth is to have the tooth in the socket and get the child to a dentist ASAP!
    • If the tooth cannot be placed back in the socket, it can be placed inside the cheek of the patient (if they won’t swallo it).
    • The tooth can be placed in a "tooth saver" solution (Save-A-Tooth), milk or saliva.
  • Fracture

    Fractures are confined to the enamel or they can involve an entire tooth.

    • Small fractures may need to be smoothed or repaired with a small filling.
    • Large fractures may involve the placement of a pin, placing a large restoration or a crown and if the pulp is involved a root canal may be necessary.

    • Fractured teeth should be monitored at every 6 month for check up. If there was trauma to the root, the tooth may discolour over time. An X-ray is taken to check the vitality of the tooth.

    Treatment for a tooth fracture:

    • Have the child rinse the oral cavity with warm water.
    • Save the tooth pieces. The dentist may be able to cement the tooth back together. There is no need to place the broken tooth in milk or water.
    • If an area is bleeding, have child bite on a piece of gauze for about 10 minutes or until the bleeding stops.
    • Apply a cold compress to the lips. This will help reduce swelling and relieve pain.

    Prevention

    Following is a list of suggestions for accident prevention specifically related to oral trauma

    • When your child is learning to walk and the front primary teeth can be easily injured.
    • Counsel about the risks of walkers. It is recommended that the use of all walkers be banned due to safety and developmental concerns.
    • Childproof your home. Concentrate on safety gates, window locks and furniture corner protectors.
    • Review safety measures for outdoor activities and sports.
    • Mandatory bicycle helmets. Helmets should also be used with scooters, skateboards and in- line skates. Use mouth guards and masks or helmets, where recommended.
    • Stress the importance of adequate supervision at all times, especially on furniture, stairs, at the playground and at athletic events or practices.

    Sports Dentistry

    Sports Dentistry is the treatment and prevention of oral/facial athletic injuries and related oral diseases and manifestations.

    Whether you are a professional athlete or a weekend warrior, protecting your mouth, face, head and neck should be a priority when you participate in your favourite sport or activity. Any sport that presents the chance of contact or collision with another person, object or surface can potentially cause injury to the teeth, jaws and oral soft tissues. Taking the appropriate protective measures while on the court, field, rink or ring can save you from serious injury and costly dental repairs.

    Prevention of Sports related Oral/ Dental Trauma

    Mouth guards hold top priority as oral protective sports equipment. They protect not just the teeth, but the lips, cheeks and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Organized sports require mouth guards to prevent injury to their players. Selection of mouth guard for your child

    Any mouth guard works better than no mouth guard. So, choose the mouth guard that your child can wear comfortably. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room.

    You can select from several options in mouth guards. First, preformed or “boil-to-fi” mouth guads are found in sports stores. Different types and brands vary in terms of comfort, protection and cost. Second, customized mouth guards are provided through your dentist. They cost a bit more, but are more comfortable and effective in preventing injuries.

    Professionally made mouth guards

    • When a dentist makes a custom mouth guard they start the process by taking a dental impression of the patient.
    • The impression material is a paste-like substance that sets within a few minutes after having been mixed and it is placed in a tray.
    • Once the impression material has solidified the assistant will remove the tray.
    • The dental impression is then filled with plaster so to form a cast.
    • The net result is that the dentist now has a three-dimensional representation of the patient's hard and soft tissues that the mouth guard needs to cover over.
    • The mouth guard will be made so it fits on the plaster cast accurately
    • Once the mouth guard has been fabricated (the time allowed for the fabrication process may be just a few days or even a few weeks) the dentist will have the dental patient return to their office so they can evaluate the guard's fit and refine it as necessary.

    Boil and bite mouth guard

    • A "boil and bite" mouth guard refers to a type of guard that is made out of thermoplastic materials.
    • The idea is that the athlete customizes the fit of the mouth guard by immersing it in hot water (until it becomes soft and pliable) and then placing it in their mouth and subsequently using their fingers, lips, tongue, cheeks and biting pressure to seat and form the contours of the guard.
    • These can also be used at night for grinding.
    • Boil and bite mouthpieces are the most used type of mouth guard.

    Facts about sports guards

    • They help to protect the teeth and soft tissues of the mouth from injury.
    • The better the fit, the more is the protection offered.
    • Generally, a mouth guard covers only the upper teeth. However, adolescents undergoing orthodontic treatment are at increased risk for oral injury, especially to the soft tissues and trauma may damage expensive brackets or fixtures. A dentist may recommend a custom-fit mouth guard to cover and protect both the upper and the lower teeth.
    • Mouth guard use may reduce the risk or severity of a concussion.
    • Helmets are very important when participating in sports that involve speed and impact. Properly fitted helmets can prevent major head injuries, as well as facial and neck injuries. Helmets should always fit well and be fastened correctly.
    • For certain sports, other protective gear, such as facemasks and body pads, also should be worn.