Injuries to Children's Teeth

Written by Dr. Rory Vinsky; Photo: Fotolia.com

As babies start to crawl and explore, they meet many obstacles. Through the active years of childhood and adolescence, these obstacles may become more prevalent, and injuries causing damage to the teeth, bone, gums, cheeks, and lips are common. The most likely cause of dental injuries in kids are falls and tripping over objects. For young kids, playing near coffee tables or fireplaces, running at the swimming pool, and wearing socks on a slippery floor are activities that often cause falls and dental injuries. And anyone who plays contact sports without the protection of a mouthguard also risks severe dental injury; a tooth may be knocked out, moved, broken.

Baby teeth begin to appear at about six months of age. By two-and-a-half to three years of age, all baby teeth should be present. The exchange of baby teeth for adult teeth begins at about six years and continues until about age 13. Baby teeth are valuable in the growth and development of the mouth and its structures. They guide the adult teeth into their appropriate spots and aid in speech, eating, and appearance. If the baby teeth are lost or altered, these important functions can be affected. Injuries to baby teeth can have a dramatic influence on later tooth development. For this reason, all dental injuries should be evaluated by a dentist. If left untreated, some injuries can lead to nerve death with that tooth. In baby teeth, this can also damage the developing adult tooth associated with it.

Injuries to baby teeth

Bumped front tooth. This injury may occur when a child is learning to crawl. Fortunately, not all bumps loosen teeth. In the case of a concussion, the tooth may be loosened (subluxated), and bleeding may occur around the gums. This type of injury causes concern for your dentist because the tooth may be so loose that the child could inhale the tooth. Your dentist will also want to check the position of the tooth to ensure it has not been moved in a way that interferes with the child’s normal bite.

Injured teeth may discolor by turning grey or brown. The color change may be the result of normal healing or a sign of an underlying infection developing. Just because a tooth changes color does not mean something needs to be done, but there is a chance something needs to be done so examination by your dentist is important. 

Teeth knocked out. For baby teeth, a knocked-out tooth is not replaced into its original spot; doing so may damage the permanent developing tooth beneath it. The success rate is also poor for reimplanted baby teeth.

The lost tooth should be located. If not, an x-ray should be taken to see if the tooth has been pushed into the gums and bone. If the tooth still can’t be located, an x-ray to the chest and abdomen may be needed to see if the tooth has been swallowed or inhaled. A follow-up with a doctor may be indicated if the tooth is located in the chest or abdomen by the x-ray.

Your dentist will want to make recommendations about the space that results after a baby tooth is lost due to injury. Sometimes, no further treatment is necessary. Other times, the space will need to be maintained so there will be enough room for the permanent tooth when it comes through.

Broken teeth. For kids aged three to six, this is the most common injury. Your dentist will want to take an x-ray to assess the extent of the injury.

Dental fractures may involve:

• the enamel or outer layer of the tooth only (often minimal or no treatment needed).
  
  
• the enamel and dentin. These need to be seen by your dentist as a sedative dressing is often required to soothe the tooth. The dressing also helps protect the pulp. A tooth-colored filling is placed over the sedative dressing and bonded
  to the tooth to restore the shape and your  child’s smile.
  
  
• the whole tooth where the nerve is exposed. You will notice bleeding coming from within the tooth. After the injury, you will want this checked by your dentist as soon as possible. The time elapsed since the injury will guide your dentist on the best course of treatment. Treatment may involve placing a sedative dressing over the exposed nerve or a partial or complete nerve removal. A tooth-colored filling will be used to restore the tooth’s appearance. If left untreated, the tooth may become infected and develop an abscess. Sometimes, these injuries require the tooth to be removed rather than managing the injured nerve and keeping the tooth in place.
  
  
• fractures of the root. The tooth portion above the fracture may need to be removed. Your dentist will discuss the option of removing the root below the fracture. If done, the developing tooth associated with it may be affected. If the root is left in place, your dentist will monitor it closely in case an infection develops. In the latter case, the remaining root will need to be removed.
  
  
• If you suspect any type of dental fracture, your child should be seen by a dentist to have the damage assessed and managed properly.

Teeth pushed out of position (displacement). Sometimes when a tooth gets injured, it changes its position. You may find the tooth is in the way of your child’s closing the teeth together or the tooth may be pushed into the gums and bone; you will want to see a dentist. X-rays will be needed to assess the extent of the injury.

If the crown is angled backward toward the tongue, it may represent a ‘favorable displacement’ or ‘favored injured position.’ This is because the root will have likely moved forward toward the lip. Since most top adult teeth are forming behind the roots of the baby teeth, this root movement will be away from the developing adult tooth. Although the baby tooth may need to be removed, it may not have affected the forming adult tooth.

For teeth that are pushed into the gums and bone, often the tooth will be allowed to return to its original position. It is possible the adult tooth may have been damaged as the baby tooth was pushed into it. Your dentist will want to monitor this injury to ensure the tooth is re-erupting and to check that infection is not developing.

Fractures of the jaw. Children will need emergency care immediately whenever there is significant injury involving the mouth.

Given the variability in how a baby tooth can be injured, a follow-up with your dentist is very important. Although it may appear isolated, often more than one tooth is affected by the injury. Because of the close proximity of the developing permanent tooth to the baby tooth, your dentist will need to assess both in their examination. Injured baby teeth can cause damage to developing permanent teeth and/or change their position.

Childhood dental injuries can have a long-lasting and serious effect, and may lead to discomfort, discoloration, altered tooth development, infection (if left untreated), or tooth loss so it is important to visit your dentist when an injury occurs to ensure your child has a beautiful smile now and for years to come.

Rory Vinsky, DMD, is a pediatric dental specialist at North Calgary Pediatric Dentistry. For more information, visit northcalgarypediatricdentistry.com or call his office at 403-295-8010.