What to do with dental trauma?

It was 5:30pm, at childcare pick up time for all the working mums & dads. My phone rang when I was stuck at traffic, panicking if I would make it to pick my kids up on time. It was a call from my friend whose son just had a fall at his childcare. Apparently, the little friend’s face was swollen with blood coming out from the mouth! My friend was very apologetic for ringing me at this hour, knowing that I must be racing to pick my kids up from school too. You could tell from her voice that she must be very worried and so could not resist herself from calling me straight away. I reassured her everything would be fine & asked her if her son was feeling any dizziness etc. She told me her son was still very alert & just crying badly. There was some blood coming out from his mouth though & she knew he must have hurt himself somewhere in his mouth. I asked my friend if she could see where the blood was coming from? Was if from an ulcerated lip or from the gum? She told me she could see the blood was from the gum & that a tooth got pushed into the gum a little bit. I calmed her down over the phone, telling her that if her son was still conscious, no dizziness & no need to go to the hospital, his condition should be stable & can wait a little bit for a proper appointment. Since she is a really good friend of mine, I offered to go over to her place that night to have a look at her son. But I reassured her, that normally, if the tooth is pushed in, we can still wait for a next day proper emergency dental appointment.

This was not the only time I was approached by some worried parents when their children had an accident in the playground. I remembered there was another time that one of my daughter’s childcare friends had an accident in the playground & I happened to be there too. I still remembered on the day, I saw the dad holding the little friend panicking, running around, not knowing what to do. And the little friend was crying badly in his arms. I asked the dad what happened & dad told me that the little girl lost her baby front tooth in the playground while falling from the top of the slide. He was trying hard to find the lost tooth but couldn’t! He was thinking that he had to find that baby tooth so that his dentist can implant the tooth back in for his daughter!

Too often, when our little ones have accidents, being a loving parent, we panic & not knowing what to do. Sometimes, we do not know what to do, simply is because we do not know what we are supposed to do! I hope this article can help all the mums & dads or careers out there have a better understanding on what we should do to our little ones if they have an accident and hurt their little mouths or teeth.

Trauma Position Matters

Basically, when our little ones have some trauma in their heads & face, the first priority is to check if our little ones are still conscious & orientated. If they appear to be unconscious, or a bit disorientated or vomiting, please take them to the hospital ASAP. Most hospitals have an emergency department. Then we should look at what part of their head or face is hurt. Being a dentist myself & for any other dentists out there, we can only give advises if the trauma happens in the mouth. If the trauma is in anywhere else, please take them to see a medical doctor!

Soft Tissues or Hard Tissues

Then we need to check if the trauma is from the soft tissues (the gum, palate, cheek & lips) or the hard tissues (the teeth). If the trauma is on the soft tissues & the cut is not too deep, usually the bleeding can be controlled very soon after the trauma has happened & it will start healing in a few days time.

If the trauma is on the hard tissues, then we need to consider, if the teeth are adult teeth or baby teeth. Most children will start having their first adult teeth around the age of 6. These teeth are the ones that we would like to preserve & save as much as possible because we simply do not have a 3rd set of teeth to come through! If one of these teeth falls out, please look for them!!! On the contrary, if the trauma is on the baby teeth, we can relax a little bit. We do not normally implant a fall out baby tooth back into the gum. It is because the adult tooth bud is usually sitting right underneath the gum & if we try to push the baby tooth back in there, there is a high chance that we can damage the adult tooth!!! So in cases like this, we rather prefer the child has a missing baby tooth for a few years but he/she will have a beautiful adult tooth in the same spot in a few years time. It will be much better than having a damaged adult tooth there for the rest of his/her life, especially if it is a front tooth!

You Need A Dentist for Further Diagnosis

Trauma in teeth comes in different scenarios: Concussion, subluxation, lateral luxation, intrusion, extrusion, avulsion & fracture. Treatment for the different cases will be different too. Having a proper diagnosis with your dentist is the key for the success on saving or preserving the tooth. As I mentioned above, the child should see a dentist ASAP after a trauma but it is usually okay to wait till the next morning if it happens late at night. So pain relief would usually be the only thing that parents or careers need to do while waiting for the proper emergency appointment. There is only one exception & that is if an adult tooth falls out from the trauma. We should try our best to find the lost tooth & try to handle the tooth with no bare hands (eg try to handle the tooth in a tissue). Then keep the tooth in some milk before you see the dentist at the emergency appointment. By keeping the tooth in milk, rather than letting it try out or keeping it in water, can help to preserve the living cells on the tooth & it can increase the success rate for the implantation of the tooth.

I truly hope that this article can give all the mums & dads or careers a better understanding on the management on our little ones when they have an accident in their little mouths.

Step-by-step guide:

1. Make sure the child is safe and check if any medical emergency or first aids attention is required (eg consciousness, breathing, bleeding, pain by the use of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach).
2. If a tooth gets knocked out, it is important to find it and pick it up by the crown (head) of the tooth. Never handle it by the root and never scrub it.
3. If the tooth is not soiled or is loose or broken in the mouth, don’t remove it and make an emergency appointment to see your dentist immediately.
4. If the tooth is soiled or fell out of the mouth completely, soak it in milk in a container and make an emergency appointment to see your dentist immediately.
5. Our dentist will help you with the most appropriate treatment approaches in your best interest. Clinical photographs, x-rays, antibiotics and review appointments are important to determine the tooth condition to return to full function if treated timely at Chats Dental.