The most important thing you should do is to try and remain calm. Understand that injuries to the mouth, teeth and face do happen frequently with both adults and children. In order to minimize the traumatic situation and comfort the injured person you must remain calm and take the appropriate prompt action. The next thing you should do is assess whether or not the accident involved hitting the head or causing them to lose consciousness at all. If consciousness was lost, even briefly, then you should contact a physician immediately, and then focus on the teeth once everything is stabilized. If there is any bleeding, use a clean towel or gauze, and then check around you for any broken or missing teeth. It is possible broken fragments may have entered parts of the lip. If any teeth are missing, you should look for them in case they can be utilized.
The first thing you should do is contact your child’s dentist as soon as possible. The baby tooth should not be replanted because it may cause subsequent damage to the developing permanent tooth. Usually this type of injury happens between 7-9 years of age, when the bone surrounding the tooth is softer and more resilient. This means there is less of a chance of a bone fracture around the tooth. Your dentist should then see your child to check and verify that everything else is fine.
The first thing you should do is try to find the tooth and put it in a cup or baggie with either your own saliva, milk or saline (to keep it hydrated) and bring it immediately to your dentist (Do Not Touch the root of the tooth, handle it by its crown). Time is of the essence. With each minute that passes the chance of reattachment becomes less and less. DO NOT SCRUB the tooth. If you do it will wipe away its outer ligament and prevent its reattachment within your empty tooth socket. If you are in a place where dental care is not accessible, then gently rinse in cool water (no scrubbing or using soap) only if there is dirt on it (otherwise leave it alone), and slowly replace the tooth within the socket immediately and hold it there with gauze. Remember, the faster you act, the better your chances of saving the tooth. Almost all replanted teeth will show some signs of root resorption and ankylosis (where the root fuses with the surrounding bone). It is possible that this may affect one’s bite later on.
If a tooth sustains a fracture or chip from a traumatic accident, you should contact your dentist immediately for an x-ray and evaluation. Keep the mouth clean and if there was any trauma to the lip you should apply cold compresses to reduce swelling. If you can’t find any broken tooth fragment, check the lips to make sure the fragment didn’t get imbedded in that area. Simple chips can be smoothed or repaired with tooth colored bonding. A more serious fracture may require root canal therapy (if the nerve is involved) or extraction (if the fracture happens along certain areas of the root surface. Moderate fractures may be bonded for now, and later restored with crowns, veneers or onlays. For children you should try to hold off on these more advanced restorations until your child has completed their growth.
A toothache occurs when the nerve within the tooth gets damaged or inflamed. This is usually caused by bacteria from tooth decay communicating with the nerve of the tooth. Cavities (tooth decay) are usually brought about by a combination of poor oral hygiene coupled with eating a lot of sticky, sugary and starchy foods. This bacteria feeds on the sugars and starch left over from poor brushing and flossing. As a result acids are produced that will slowly eat away at the good tooth structure until the nerve becomes damaged, causing the toothache. Another way the nerve can get damaged is from dental trauma (i.e. sports injury, rough play or fights, severe teeth grinding, or extensive dental work on hypersensitive teeth).
What are the symptoms of a toothache?
The signs and symptoms of a toothache include: lingering sensitivity to cold (that persists even after the stimulus is gone), sensitivity to hot, spontaneous and constant throbbing pain, discomfort or pain when chewing or touching the tooth, swelling or tenderness around the area that hurt, and possibly fever as well.
What should I do if a severe toothache develops?
Prescribed or over-the-counter pain medication (dosed for children according to weight and age) may temporarily quiet the symptoms. In case the toothache is originating from the gums, rinse with warm salt water and floss the teeth to remove any food or substance that may be stuck between the teeth or in the gum pocket around the tooth. Antibiotics may become necessary; however, it is recommended that you contact your dentist to help make that determination. Once seen by the dentist, an examination and x-rays should be performed to verify damage and to help determine the treatment. A comprehensive medical and dental history should also be taken. Once seen, the decay and/or affected nerve tissue may be cleaned out and replaced with a sedative or permanent filling. If there is an abscess (pus filled swelling) it may need to be drained. And if the tooth is not restorable, an extraction may become indicated.
What should you do if you tell your dentist that you have tooth pain, but after taking an x-ray nothing is found to be wrong?
An X-ray is only one tool that is used to help diagnose a problem. They are 2-dimensional images that may or may not lend a clear picture as to what is going on. Sometimes, if an X-ray is taken from a different angle, more information can be detected. When teeth overlap in a picture, cavities can be missed. If an x-ray is over-exposed (darker) or under-exposed (lighter) it may not reveal what needs to be found. If X-rays are taken at the wrong angle the teeth may appear longer or shorter than they are and distort the picture. If an X-ray does not reveal any information to help your dentist determine your pain, then other diagnostic tests must be performed, including:
- Percussion (tapping the tooth)
- Palpation (feeling the gums around the tooth)
- Pocket depth probing (to measure the pockets around the teeth for gum problems)
- Checking Occlusion (to see if your bite needs to be adjusted)
- Testing for fracture of the tooth or cusp of the tooth
- Hot and Cold Sensitivity tests (indicating if the nerve is damaged)
- Pulp Tester (an electronic measure of nerve vitality)
- Checking for sinus problems that can masquerade as tooth pain
- Checking other areas for referred pain (pain originating from another area)
- Determining Stress levels and possible teeth grinding and clenching
- Clinical Exam (Performed by the dentist to evaluate the complaint)
If an X-ray and all the above tests still don’t explain why you might have developed your discomfort, do not lose hope. Sometimes it may take a while for the true cause to manifest. Follow-up consultations and exams may be necessary before the cause becomes clear.
What should be done if a jaw fracture or severe trauma to the head is sustained?
If this should happen you must seek medical attention immediately. A severe head injury can be life-threatening, and facial fractures may block the air passage and affect their breathing. Keep in mind that an emergency medical team will most likely reach you faster than you can get to the hospital. Facial fractures usually involve the lower jaw, but may also include the upper jaw, cheeks, eye sockets or nose. For children, their bones are still somewhat soft and the fractures are usually incomplete and heal quickly with few complications. If you suspect the jaw may be fractured, stabilize the jaw with a necktie or towel around the head. Do not allow it to move. Apply cold compresses, and go to an oral surgeon or hospital emergency room immediately.
What precautions can I take to prevent dental injuries from occurring?
The risk for dental injuries can be greatly reduced by doing the following: First, make sure that protective athletic gear, including a sports mouth guard, is worn to prevent severe injuries to the mouth. Second, check to see that you and your child are properly secured in the car, using the appropriate car seat, booster or seatbelt. Third, be aware of your surroundings, and prevent unnecessary injuries at home but taking precautions and child-proofing the house for younger kids. And fourth, advise your children to avoid rough play and to not run fast in confined or slippery spaces. Note that many traumatic injuries occur from 18 to 40 months of age, because this is a time where your uncoordinated toddler is learning to walk and run.
What should I do if my child’s tooth gets displaced outward, inward or to the side (luxation), pushed up (intruded) or pushed down (extruded)?
After assessing the injury, making sure your child is conscious and breathing well, contact your child’s dentist for immediate evaluation. For toddlers, the most common type of tooth displacement is a luxation, because the bone around the baby teeth is very soft, and teeth can move more easily within the socket. When this happens, there is usually a lot of bleeding from the surrounding gums. During a fall, a child’s tooth is usually pushed inward, towards the palate. This is less damaging to the developing tooth bud because as the crown portion of the tooth moves inward, the roots are pushed away from the developing tooth. The most damaging type of displacement is intrusion (when the tooth is pushed upward), because the root of the baby tooth can be forced into the developing tooth bud, causing possible developmental issues and color changes with the developing adult tooth. If the baby tooth is pushed up less than 3mm, it has an excellent prognosis and chance of re-erupting on its own. Allow the baby tooth to spontaneously erupt over a 2 to 3 month period – as long as the developing adult tooth bud is not injured. If re-eruption does not begin within 2 months, the baby tooth will need to be removed. If the baby tooth is pushed up more than 6mm, the tooth is hopeless. If the baby tooth is displaced into the developing adult tooth, it should be extracted to prevent further damage to the adult tooth bud. It is very important to take an x-ray to see if the tooth is present, because a severely intruded tooth may be pushed all the way inside and appear to have been knocked out.
If an adult tooth gets displaced, gently try to reposition the tooth back into the right place if possible and hold the tooth in place and seek immediate dental care. If a tooth gets displaced less than 5mm, there is a 50% chance that the nerve won’t be damaged. These teeth may reposition themselves, but may also require orthodontic repositioning. It is possible that there could be a fracture of the bone surrounding the tooth during these luxations. If the tooth is very loose, and can be moved more than 2mm, a flexible wire and composite splint may be placed for 7-10 days to help stabilize it.
What should be done for a laceration (cut) inside the mouth?
All lacerations (cuts) within the mouth must be cleaned well and checked for any foreign bodies. A tongue laceration usually requires stitches if the edges of the tissue does not line up cleanly. Any tears to the frenum (muscle attachments) will usually heal well, without any long-term complications. Use icepack to minimize swelling, and give the appropriate pain medication if necessary.
What does it mean when a tooth turns dark or discolored?
Discoloration or the darkening of a tooth usually results from a tooth that has been traumatized from an injury and caused damage to the nerve. This discoloration usually happens 2-3 weeks after the accident. If the tooth turns dark after an injury, it is because the blood supply got damaged. Baby teeth usually do get lighter over time (about 6 months on average), and if the tooth doesn’t bother him/her you can leave it alone. Usually the color change bothers the child’s parents more because of the esthetics. Adult teeth are handled differently. If an adult tooth changes color, that implies that the nerve inside is dying, and root canal therapy will be indicated. An adult tooth that shows no signs of color change after an accident may still turn color in the near or distant future. Your child’s dentist should keep monitoring the tooth for change and any signs of any infection. A pink tooth indicates either internal resorption (where the internal aspects of the tooth start to resorb), or the presence of blood pigments within the tooth. The pink tooth needs to be monitored closely.
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