Did you know the mouth is one of the most common sites for injury in children? If a child is injured in the face or mouth, a quick general assessment is needed to rule out more serious medical problems. Was there any loss of consciousness, vomiting, trouble breathing, or bleeding that does not stop? These are all signs the child should first be taken to medical emergency department. If the trauma involves the mouth and bleeding is occurring, use direct pressure with paper towel or washcloth. Keep in mind that when saliva mixes with blood, it seems to be a lot. Keep calm and apply pressure for 15 minutes. If this is a strictly dental trauma involving the lips, tongue, gum tissue or teeth, a dentist should assess and discuss treatment options. Some dental traumas do not need any treatment except observation.
Important questions when your child has a mouth injury:
- What was traumatized?
- Were any teeth fractured?
- Was the pulp (nerve) exposed?
- Were any teeth pushed out of their normal position?
- Were any teeth completely knocked out?
One of the most common dental injuries is a tooth fracture. There are couple of classifications but one of the most important is whether it involves that pulp/nerve tissue or not. If the fracture does NOT involve the pulp/nerve tissue, some sensitivity can occur from the exposed dentin (the layer underneath enamel). If the fracture does involve pulp/nerve of the tooth, increased amounts of sensitivity can occur and some type of treatment is likely. As portrayed in the picture, the pulp/nerve is exposed in the permanent tooth (the exposure is a small bright red or pink spot on the tooth).
Permanent and baby teeth can be injured without being fractured or pushed out of position. They may or may not bleed around the gum line. Frequently, permanent and baby teeth will need to be monitored with radiographs, but typically no treatment is needed. In primary teeth it is likely the teeth can change from orange, gray, or brown in color. As long as there is no sign of infection, there is no treatment needed at the time. In permanent teeth, if there is a color change and infection occurs, the tooth will likely need a root canal. If there is no sign of infection, intermittent monitoring is recommended.
For avulsed teeth or teeth knocked out of the socket, treatment will vary from baby teeth to permanent teeth. For a PERMANENT tooth, try to pick up the tooth by the crown (the white part), if the tooth is dirty, BRIEFLY (less than 10 sec) wash under cold water and try to place the permanent tooth back into its proper place. Once the permanent tooth is in the proper place have the child bite onto paper towel or washcloth. If it is not possible to place the tooth back into its original position, place tooth in cold milk or in Hanks balanced salt solution “save-a-tooth.” Doing this will help keep the cells alive on the tooth to aid in the reattachment of tooth into the socket and bone. DO NOT place the tooth in water, sports drinks or contact solution. These will kill the cells on the tooth. Call the dentist after placing in proper solution or tooth back in the socket. If the knocked out tooth is a BABY tooth, it is NOT recommended to place the tooth back into the socket.
Keep in mind, this is not an all-inclusive list of dental emergencies, but some of the more common traumas. If you ever have any questions about dental trauma or dental emergencies give your dental office a call to discuss.
About Dr. Garol
Dr. Whitney Garol attended Galena High School, then the University of Nevada, Reno where she graduated with distinction, receiving her Bachelor of Science degree in biology and a minor in psychology. Dr. Garol graduated magna cum laude with a doctor of dental medicine degree from the University of Nevada, Las Vegas School of Dental Medicine. Always having a passion for treating children, she decided to further her training with a pediatric dental residency at Cincinnati Children’s Hospital. At one of the premier children’s hospitals in the nation, she received extensive training to provide excellent dental care to infants, children, and adolescents. She is a board candidate of the American Board of Pediatric Dentistry and active member of the American Academy of Pediatric Dentistry.