Children, this word brings in lot of thoughts and cheer in mind, unexpected and astonishing list of endless questions, selfless, always happy, it wouldn’t be exaggeration to call them walking angles around us.  At the same time they bring in lot of responsibilities of their safety and well being.

Their inquisitive nature mostly put them in to trouble and they end up meeting minor/major accidents.  To keep a vigil on children is a tough job and in Indian scenarios this job is mostly given to mother or other lady members of the families.

Though each elder member is caring and loving for the children in families, but sometimes due to lack of knowledge or incorrect information they end up giving wrong treatment to their loved ones in case of accidental emergencies.

Here I would like to throw some light on dental emergencies which might occur with children in their early years.  This is very much important to give full attention and apt treatment to children in case of dental emergency, as in case of incorrect/non treatment the problem will also grow as the child grows and treatment becomes much complex/painful/expensive and comparatively less effective.

At the following part of my article I have segmented the different dental emergencies and respective correct treatment.

These tips will tell us what to do in case of a dental emergency.

Knocked Out Teeth

If a child’s tooth is knocked out, we should try to preserve the tooth and should bring it to the dentist as soon as possible. In such cases, every possible attempt should be made. Time plays an important role as in, the sooner the tooth is brought higher will be its chances for successful reimplantation and hence the tooth can be saved.

Child Knocked out Tooth
 

As soon as the tooth is knocked out, we should try replacing it back in its socket in mouth. But if unsuccessful, direct pressure using gauze is to be applied to control the bleeding. Then, the tooth should be rinsed gently in water.  It should not be rubbed, especially the root portion of the tooth so as to prevent the injury to tooth ligament fibers which are essential for successful placement of tooth in its socket

Transportation of the tooth to the dentist is very important and so mediums such as milk, patient’s saliva can be used for the same.

Now a day’s commercially available solution called as  SAVE A TOOTH can also be used as transport media.

In cases of knocked out tooth in children, certain complications can occur and so follow up is mandatory to determine its success.

The quicker this is done, the higher the chances for saving the child’s tooth. Time is important for saving the tooth, less than 30 minutes is the best. Handle the tooth only by the crown (chewing edge).

First, the tooth should be rinsed gently in water. It should not be cleaned with soap or any other liquid. It should not be rubbed or touched in order to prevent removal of ligament fibres required for successful re-implantation.  If possible (and if the child cooperates) the tooth should be placed back in the socket. The child (plus the tooth) should be taken to the paediatric dentist’s office or the emergency room immediately.

Use one of the following options to transport the tooth:

  1. Try to replace the tooth in the socket, to the level of adjacent teeth. Bite down gently on gauze or a wet tea bag to help keep it in place. The surrounding teeth can be used as anchors. Care must be taken not to swallow the tooth.
  2. If the tooth cannot be replaced in the socket, place it in a container and cover with a small amount of whole milk or saliva.
  3. The Save-A-Tooth storage device can be purchased at many pharmacies. It contains a travel case and fluid solution.
  4. For primary (baby) teeth - Teeth are not re-implanted

See a dentist immediately if:

  1. A permanent tooth has been knocked out.
  2. A tooth has been partially fractured and pain and swelling results.

After the dentist places child's permanent tooth back into his/her mouth and stabilizes it with a wire, the tooth will still require follow-up evaluations for 2-3 years to determine the success of the treatment.

A successful outcome for the tooth cannot be guaranteed even if the tooth was replaced in a timely manner.

Potential complications following an avulsion include changes near the root of the tooth, submergence of the tooth, or infection, which may all result in future loss of the tooth.

First Aids Steps in Knocked Out Tooth

Do’s

  1. Apply a cold compress to the mouth and gums for pain.
  2. Apply direct pressure, using gauze, to control bleeding.
  3. Get dental help immediately. The sooner dental attention is received, the better the chances are for successful reimplantation.

Don’t

  1. DO NOT handle the roots of the tooth. Handle only the chewing edge -- the crown portion of the tooth.
  2. DO NOT scrape the root of the tooth to remove dirt.

Maxillofacial Injuries

Broken jaw following trauma is often distressing for both child patient and parents. The child should be carefully examined. Many children who sustain fracture of jaws will also suffer from loss of teeth. Such children may be presented with the symptoms of pain, inability to open the mouth, swelling, face asymmetry, inability to clench his teeth.

Conservative management should be done.  First aid should be given to the patient. Every attempt should be tried to control the bleeding.  Cold compression can be done to control the swelling.   

But if it is involving other facial bones and in cases of children when it is further complicated by anxiety, growth considerations;  surgical management should be carried out which further involves reduction, fixation. Splints can also be used effectively.

Subsequently strict mouth care is must and hence follow up should be done. Prophylactic antibiotic therapy must be started and child’s parents should be instructed about the post operative instructions.

Facial Swelling

In case of children, it may occur as sequelae of trauma, dental abscess and is accompanied by redness, swelling, pain. In certain cases, fever can also occur.

Though facial swelling is most frequently present because of infected tooth in children. If not treated at right time, it can have serious complications.

Foremost Conservative treatment such as endodontic therapy may be appropriate if it is because of infected tooth. A dental extraction may precede definitive treatment if it makes management easier. A child with raising of floor of mouth requires immediate admission to hospital.

Institution of Drainage and prevention of spread are supportive treatments. Child should be put on antibiotic therapy.  In addition, analgesia and adequate hydration of the child must be maintained.

Luxations- Tooth Pushed Out Of Place

If a tooth is pushed out of its place, it may be displaced in the bone surrounding it. We should try to reposition it back to its position in its socket. It can involve either permanent or milk teeth.

It is important to discuss with parents the sequelae of luxated teeth. Periapical Radiographs are taken as baseline to know about the status of the tooth and the type of intrusion but here, care should be taken not to force the tooth. Rather very light pressure should be used to reposition it back. Since such type of injury can cause further hamper the developing permanent tooth so, to prevent it, we may have to remove that milk tooth.

To relieve the pain of the child, analgesics should be prescribed. The child should be advised soft diet for a week.  

But if following treatment patient presents with fever, vomiting, inability to swallow, emergency treatment has to be planned for the child.

Broken Tooth

In case a child’s tooth is broken, he should be brought to pediatric dentist immediately. To make sure that no fragments are left in the mouth, we should ask the child to rinse his mouth properly.

 Treatment for Child Broken Teeth

Radiographs should be taken to assess the status of the tooth and to plan the treatment modality for the child. Conservative treatment involving the endodontic therapy may be done to prevent the further damage and infection.

If the tooth is badly broken and can’t be saved, tooth should be extracted out.   Analgesics and antibiotics should be prescribed. The outcome of the treatment should be evaluated by subsequent follow ups.

Bleeding

Most injuries are caused by falls and play accidents. Any injury which occurs around oral cavity can cause bleeding from soft tissues and teeth. Child should be reported to pediatric dentist. Child may be presented with pain, pus, traumatized teeth.

 Child Bleeding Teeth

For bleeding around gums, it should be compressed using gauze. Suturing may be required in certain soft tissues injuries. Child should be kept on soft diet for next few days so as to not to hamper the soft tissues.  

Further follow ups should be done to determine the treatment outcome and child should be monitored for complications, if any.

Broken Braces and Wires

Broken Braces and Wires

A broken appliance which harms and bothers the child patient is considered as an emergency condition.

If possible, should try to take it out but if it unsuccessful or stuck in gums, cheeks of patient, we should not try to remove it. Rather should report to dentist. In such cases, surgical approach has to be implemented so as to remove the broken wire components of appliance.

Tooth Ache

Pain in tooth can have many reasons. It may include trauma, deep cavities, dental infections etc.

When a child is reported to dental clinic, should examine it carefully. As a part of baseline treatment, radiographs are mandatory and conservative therapy should be implemented.  The cause of the pain should be ruled out. If it occurs because of infected tooth, it should be restored following endodontic therapy. If prognosis is bad, extraction is planned.

 Child Tooth Ache

Analgesics and antibiotics are prescribed. And following extraction if any, post operative instructions are must.

The prevalence of such dental emergencies can be prevented using precautions involving educating parents and caregivers. Risk for oral injuries during play activities can be prevented using mouth guards.  Regular oral check up should be done.

Cracked or Chipped or Broken Tooth

In condition like cracked tooth, the patient complains of discomfort on biting.  Other symptoms can be pain to hot and cold stimulus which can cause mild to intense pain.

The child should be referred to pediatric dentist. Rinsing the oral cavity with warm water should be done and we should make sure that no tooth fragments are left over. Radiographs should be taken to rule out the presence of possible cause.

If the tooth is restorable, it should be covered with calcium hydroxide and glass ionomer cement. Pulpal involvement should be assessed at this stage.  If pulp is involved, we should proceed with root canal treatment. Any part of tooth which exhibits frank mobility should be extracted out.  Along with it, if facial injury is also there, cold compression can be given to the patient.

Loose Tooth

In children, loose or displaced teeth usually occur due to trauma. In emergency, child should be reported to dentist.  The cause should be ruled out. If it occurs due to trauma, the injured area should be thoroughly rinsed and cleaned with warm water to check out for broken tooth fragments, if any.

Child Loose Tooth

The affected traumatized tooth should be gently touched to check for its mobility.  It may require extraction if tooth is extremely mobile.

The child should be kept on soft diet so as to prevent the damage to tooth and its surrounding soft tissues.  The tooth should tighten over a period of time. The gauze can be used to apply pressure over the bleeding area. Analgesics should be prescribed to relieve the pain.  Cold compression can be applied to the swollen area.

Abscess

Dental abscess appears as a soft tissue swelling. The cause can be trauma or dental infection. Following bacterial infection, there occurs accumulation of pus.

Child Abscess

When there is no passage for the pus to drain out, an abscess is formed on the gums. Usually it is preceded by pain. The inflammation can progress to extra oral swelling.

Clinical examination, radiographs should be done. The passage for drainage should be established. Incision should be made at the most fluctuant part of the swelling to elicit the drainage. The infected tooth should be extracted out. Antibiotics should be prescribed

Bitten Tongue or Lip

Self inflicted trauma to the lips or tongue is frequently caused by the child patient inadvertently biting or chewing these tissues while still anesthetized.   Such kind of trauma can lead to swelling and significant pain when the anesthetic effect goes off.

Child Bitten Tongue or Lip

Though more common in younger children and in mentally disabled child, it may occur in all age groups.  So, it is necessary to keep a watch on children. Childs parents should be warned against eating, drinking, or biting on the lips or tongue.

Analgesics for pain are prescribed. In case of infections, antibiotics are also to be prescribed. Patient is asked to do lukewarm saline rinses as it aids in decreasing the swelling.

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