Dental trauma - First Aid


First aid

First aid

Emergency intervention in children

Sunburn in children Diaper rash Febrile seizures The child who does not sleep Acute asthma access Dental trauma Head injury
  • Sunburn in the child
  • Diaper rash
  • Febrile seizures
  • The child who does not sleep
  • Acute asthma access
  • Dental trauma
    • What is meant by dental trauma
    • Causes
    • What to do
    • Prevention
  • Head trauma

Dental trauma

Dental trauma can occur during the child's usual play activities and often affects not only the teeth but also other structures of the mouth such as the lips, tongue and cheeks. In the event of major trauma, even multiple teeth and even the bone structures that support them can be involved. Children from a year and a half to about 3 years old often face this type of trauma because they fall frequently. About half of children experience dental trauma (crown fractures are the most frequent trauma). The treatment of a traumatized tooth varies significantly in relation to the severity of the trauma.

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What is meant by dental trauma

Damage to a tooth and / or its supporting structures. More frequently, a fragment of the crown of the incisors occurs in the child. In some cases the tooth can undergo a rupture (fracture), a mobilization on the gum (dislocation), a partial re-entry into the gum (intrusion), a partial "slipping" (extrusion) or a complete spill (avulsion). These injuries are of different severity and involve different interventions.

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Any fall, an impact against a piece of furniture or a hard and resistant object or an accidental hit by a peer can cause dental trauma. Young children are frequently subject to the impetuosity with which they move both at home and during outdoor play. In the case of older children and young people, the opportunities are represented by sports activities, accidents by bicycle, scooter etc.

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What to do

The speed of intervention has a considerable importance in safeguarding the fate of the tooth affected by the trauma even if, as we will see, the possibilities of intervention by the dentist change a lot depending on whether it is a deciduous tooth (commonly called "tooth from milk ") or a definitive one (they generally appear after 5-6 years of age to replace deciduous ones). However, the immediate intervention that the person who is taking care of the child does not change.

The wound should be rinsed with cold water and an ice pack can be placed on the lips and other nearby tissues to reduce swelling and pain. Bleeding can also be stopped by compressing the wound with a sterile gauze tablet. If it does not stop spontaneously within 5-10 minutes, stitches are likely to be needed.

A tooth that has undergone a trauma can cause intense pain, often aggravated by the presence of wounds in the oral mucosa and trauma to other parts of the face (cheeks, jaw). In this case it may be useful to give the child an analgesic (paracetamol or ibuprofen at the dosages recommended by the pediatrician).

Not all traumas are of equal severity. In many cases there is an urgent need for the intervention of the dentist. Let's examine some of the most typical dento-alveolar traumas to describe their characteristics and behaviors.

  • Detachment of a small fragment of the crown, generally affecting the anterior teeth. It is a frequent trauma in the first years of life, fortunately often with deciduous teeth. In this case, gentle cleaning of the wound and tamponade with ice may be sufficient to limit swelling and bleeding. After some time the tooth can lose its brilliance and take on a grayish color because the pulp has degenerated as a result of the trauma.
  • Crown and / or root fracture. In this case the situation is more serious because there may be exposure or in any case significant damage to the pulp of the tooth. Especially for permanent teeth, after the first cleaning operations and with the ice pack applied, it is necessary to immediately seek the care of a dentist if you want to save the pulp avoiding its "death" (necrosis).
  • Tooth intrusion. As a consequence of the trauma, the tooth is pushed into the alveolar bone. As a result, you may get the impression that the tooth has shortened or completely disappeared. If the tooth involved is a deciduous tooth, an intrusion up to 3 mm in general does not involve particular risks for the germ of the permanent tooth above; over 6 mm of intrusion, however, the prognosis for the germ of the permanent tooth is often unfavorable. In such a situation, however, an ice pack must be applied and the treatment of a dentist as soon as possible.
  • Tooth extrusion. There is talk of extrusion when the tooth is partially outside the alveolus. The tooth is mobile and appears taller than before. It must be repositioned as soon as possible and it is therefore essential to seek the treatment of a dentist as soon as possible.
  • Tooth dislocation. Dislocation involves moving the tooth towards the lips, tongue or laterally. If the deviation is less than 5 mm, the pulp of the tooth can remain viable in 50% of cases. In 1-2 year old children, dislocation often occurs because the bone surrounding the deciduous teeth is quite elastic, it is accompanied by a slight gingival hemorrhage. In this case it is necessary to return the dislocated tooth to its original position by gently pressing with the fingers. However, it is good to have recourse to a dentist as soon as possible.
  • Avulsion. This is a particularly serious event. The tooth that has undergone trauma is completely detached from the alveolar bone and the periodontal ligament is broken. It is the same as when a dentist extracts a tooth! What happens when the tooth is detached? The protective layer around the root (the periodontal ligament) dries up early and dies, unless the tooth is quickly replanted. Every minute outside the mouth results in the death of many cells of the periodontal ligament. After 15 minutes from the avulsion, if the tooth remains dry, the damage to the periodontal cells is irreversible. In the case of a permanent tooth, this must be repositioned as soon as possible in the alveolar bone and stabilized to allow the periodontal ligament and the other structures that support, nourish the tooth and guarantee its sensitivity to be better restored. The earlier this is done, the higher the chance that the tooth will survive. Unfortunately, after one hour from the trauma, the success rate will be reduced by 75%.

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Many dental traumas are preventable. As far as children are concerned in the first years of life, houses must be checked to avoid conditions that favor falls or major traumas. Gates must be placed to block access to the stairs, the edges of the furniture are padded, the possibility of climbing is eliminated. The child must never be left unattended if he is on the high chair or changing table.

The seat (infant seat) must always be placed on the ground, never on the tables or chairs, because the movements of the child can make it overturn causing a ruinous fall forward.

When the child is of age, to be taken to the playground, vigilance must always be exercised to at least partially limit the physiological impetuosity in the movements. Also pay attention to the proper use of the available equipment.

They are not unusual traumas due to the fact that children get off the slide lying down with their heads forward, launch themselves from the top of the platform of the ladder, and anything else the imagination and the lack of awareness of the risk can suggest.

The child in the car must always travel insured or on the appropriate seat or tied with belts when he has reached the age and size that allow it.

All children / teenagers who practice contact sports must wear a mouthguard to avoid dental trauma (American football, ice hockey or wheel hockey, rugby etc.).

Another useful safety measure is a protective helmet with chin guard for children who practice cycling, skatebording, inline skating. A boy who practices sports and does not use a mouth and tooth protection runs the risk of dental trauma 60 times greater than expected.

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