Dental trauma is injury to the teeth, gums, and jawbones. The most common dental trauma is a broken or displaced tooth.
Description
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. Dental trauma includes teeth that are knocked out (dental avulsion), cracked (fractured), forced out of position (dental luxation, lateral displacement, or extrusion), pushed up into the jawbone (dental intrusion), or loosened by impact (subluxation or dental concussion). Oral tissues are sensitive, and injuries to the mouth are typically very painful. Dental trauma should receive prompt treatment from a dentist and in some cases is considered a dental emergency.
Demographics
Children between the ages of 1.5 and 3.5 years are most likely to experience dental trauma to their primary (baby) teeth, because this is the age at which they are learning to run. According to the International Association of Dental Traumatology, half of children experience dental injury, with injury occurring most often in children ages eight to 12. Fracture of the tooth crown (the part that is above the gum line) is the most common injury. School-age boys are twice as likely to experience dental trauma as girls.
Causes and symptoms
The cause of dental trauma varies depending on the age of the child. Toddlers are more likely to injure a tooth by falling, while older children are more likely to suffer dental trauma from a sports injury. Teenagers often present with dental trauma as the result of fights. The incisors in the upper jaw are the most commonly injured teeth.
Pain characterizes all dental trauma. The tooth may be knocked out and the socket bleeding, or it may be loose. There may be additional damage to the bones of the jaw and to the soft tissues of the mouth.
When to call the dentist
A permanent tooth that has been knocked out is a dental emergency. The dentist should also be called whenever dental trauma results in pain, dislocation of the tooth, or tooth sensitivity to hot or cold.
Diagnosis
Dental trauma is readily apparent upon examination. Dental x rays may be taken to determine the extent of the damage to fractured teeth. More comprehensive x rays are needed to diagnose a broken jaw.
Treatment
There is a possibility that a permanent tooth that has been knocked out can be re-implanted if handled promptly and correctly. If possible, the tooth should be reinserted in the socket and held there until the child sees a dentist or visits the emergency room. If it is not possible to replace the tooth in the socket, the tooth should immediately be placed in milk, saliva, or cool water with a pinch of saline solution (not contact lens solution or plain water). The tooth should be handled only by the crown and never be allowed to dry out. If a dentist can see the child within half an hour and the tooth has been preserved correctly, there is a possibility that it may be successfully re-implanted. Primary teeth are usually not re-implanted.
For lesser dental trauma, soft tissue injuries may require only cold compresses or ice to reduce swelling. Bleeding may be controlled with direct pressure applied with clean gauze. Deep lacerations and punctures may require stitches. Pain may be managed with aspirin or acetaminophen (Tylenol, Aspirin FreeExcedrin), or ibuprofen (Motrin, Advil).
Treatment of a broken tooth will vary depending on the severity of the fracture. For immediate first aid, the injured tooth and surrounding area should be rinsed gently with warm water to remove dirt, then covered with a cold compress to reduce swelling and ease pain. A dentist should examine the injury as soon as possible. Any pieces from the broken tooth should be saved and taken to the dentist with the child.
If a piece of the outer tooth has chipped off, but the inner core (pulp) is undisturbed, the dentist may simply smooth the rough edges or replace the missing section with a small composite filling. In some cases, a fragment of broken tooth may be bonded back into place. If enough tooth is missing to compromise the entire tooth structure, but the pulp is not permanently damaged, the tooth will require a protective coverage with a gold or porcelain crown. If the pulp has been seriously damaged, the tooth will require root canal treatment before it receives a crown. A tooth that is vertically fractured or fractured below the gum line will require root canal treatment and protective restoration. A tooth that no longer has enough remaining structure to retain a crown may have to be extracted (surgically removed).
A broken jaw must be set back into its proper position and stabilized with wires while it heals. This is usually done by an oral surgeon. Healing may take six weeks or longer, depending on the patient's age and the severity of the fracture.
Alternative treatment
There is no substitute for treatment by a dentist or other medical professional. There are, however, homeopathic remedies and herbs that can be used simultaneously with dental care and throughout the healing process. Homeopathic arnica (Arnica montana) should be taken as soon as possible after the injury to help the body deal with the trauma. Repeating a dose several times daily for the duration of healing is also useful. Homeopathic hypericum (Hypericum perforatum) can be taken if nerve pain is involved, especially with a tooth extraction or root canal. Homeopathic comfrey (Symphytum officinale) may be helpful in treating pain due to broken jaw bones but should only be used after the bones have been reset. Calendula (Calendula officinalis) and plantain (Plantago major) can be used as a
mouth rinse to enhance tissue healing. These herbs should not be used with deep lacerations that need to heal from the inside first.
Prognosis
When dental trauma receives timely attention and proper treatment, the prognosis for healing is good. As with other types of trauma, infection may be a complication, but treatment with antibiotics is generally effective.
Prevention
Most dental trauma is preventable. Car seat belts should always be worn, and young children should be secured in appropriate car seats. Homes should be monitored for potential tripping and slipping hazards. Childproofing measures should be taken, especially for toddlers. Parents can place gates across stairs and pad sharp table edges.
Everyone who participates in contact sports should wear a mouth guard to avoid dental trauma. Athletes in football, ice hockey, wrestling, and boxing commonly wear mouth guards. The mandatory use of mouth guards in football prevents about 200,000 oral injuries annually. Mouth guards should also be worn along with helmets in noncontact sports such as skateboarding, in-line skating, and bicycling. An athlete who does not wear a mouth guard is 60 times more likely to sustain dental trauma than one who does. Any activity involving speed, an increased chance of falling, and potential contact with a hard piece of equipment has the likelihood of dental trauma that may be prevented or substantially reduced in severity with the use of mouth guards.
Parental concerns
Parents are sometimes concerned about the appearance of their child after he or she loses a permanent tooth. Cosmetic dentistry and orthodonture can with time and patience correct almost any problems arising from dental trauma.
KEY TERMS
Avulsion—The forcible separation of a piece from the entire structure.
Crown—The natural part of the tooth covered by enamel. A restorative crown is a protective shell that fits over a tooth.
Extraction—The removal of a tooth from its socket in the bone.
Pulp—The soft, innermost layer of a tooth that contains its blood vessels and nerves.
Root canal treatment—The process of removing diseased or damaged pulp from a tooth, then filling and sealing the pulp chamber and root canals.
ORGANIZATIONS
American Academy of Pediatric Dentistry. 211 East Chicago Ave., Ste. 700, Chicago, IL 60611–2616. Web site: <www.aapd.org>.
American Association of Endodontists. 211 East Chicago Ave., Ste. 1100, Chicago, IL 60611–2691. Web site: <www.aae.org>.
American Association of Oral and Maxillofacial Surgeons. 9700 West Bryn Mawr Ave., Rosemont, IL 60018–5701. Web site: <www.aaoms.org>.
American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. Web site: <www.ada.org>.
WEB SITES
Flores, M. T., et al. "Guidelines for the Evaluation and Management of Traumatic Dental Injuries." International Association of Dental Traumatoloty, 2000. Available online at <www.iadt-dentaltrauma.org/Trauma/guidelines.htm> (accessed November 29, 2004).
Goss, Lisa A. "Tooth Injuries." KidsHealth, May 2004. Available online at <www.kidshealth.org/parent/firstair_safe/emergencies/tooth_injury.html> (accessed November 29, 2004).
Ravel, Daniel. "Management of Dental Trauma in Children." Pediatric Dental Health, August 1, 2003. Available online at <http://dentalresource.org/topic50trauma.html> (accessed November 29, 2004).
