I got a call this morning from a friend. Her 8-year-old child had just come in from playing outside: crying, face grazed, recently erupted, beautiful, adult top front teeth visibly broken, blood everywhere. Her regular dentist was away. What could she do?
This situation, permanent traumatic damage to the new adult teeth of a child, is every parent's nightmare. Unfortunately, it's not uncommon amongst growing kids who fall off bikes, out of trees, skating, get hit by balls, bats, other kids, or in this case, falling face-first onto ocean-front rocks. Devastating.
Here are some helpful tips to assess the situation and get the best help and outcome for your child if it were to ever happen in your family:
1. Check the child for loss of consciousness or concussion. Head injuries are particularly prone to this happening. Call an ambulance (000 in Australia) for loss of consciousness, or for a concussion, keep the child awake and take them to the nearest hospital or medical centre immediately for professional medical attention.
2. Control the bleeding. Most injuries on the face and in the mouth bleed a lot! But this can usually be stopped quite quickly with firm pressure applied to the area. Call an ambulance or get the child to the nearest hospital if bleeding cannot be controlled.
3. Look at the broken teeth. If the tooth has completely come out of the socket (avulsed), wash your own hands first. Rinse the tooth in milk or salt water to remove any debris, for example gravel. You may use tweezers to carefully remove any gravel pieces. As quickly as possible, put the tooth back into the socket facing the same way as the adjacent tooth. Don't worry, it usually only goes in one way. Do not rinse the tooth under tap water, do not dry it, do not clean off the tissue fibres attached to the root. Usually the tooth will stay there, occasionally the child may need to hold it in with gentle finger pressure.
4. If fragments of the teeth crowns have broken off, collect the fragments if possible, place in milk or salt water or even the child's saliva. These may or may not be able to be used by a dentist later.
5. Look for any bruising or blood pooling under the eyes, around the temples, over the cheeks, or under the tongue in the mouth. If present, this can be an indicator of a facial bone or jaw fracture. In this case, take the child to a hospital, with any teeth and fragments, for full medical attention.
6. If your child is cleared of any of the above reasons to go to a hospital, call a local general dentist immediately for a same-day emergency appointment. Explain to the receptionist what has happened; whether the tooth has been avulsed or not; whether the teeth are broken above, equal to, or below the gum line, and whether you have the tooth fragments. This helps the dental team to prepare for your visit. All dentists are able to handle this kind of emergency. Even if it's not your regular dentist, they'll be able to stabilise the situation until you can return to your regular dentist for full restorative treatment.
7. Even if your child only has a slight chip to the front teeth following a trauma, they should be assessed by a dentist as soon as possible. The root of the tooth may have fractured below the gum line that can only be properly detected on a radiograph.
8. Even if your child sustains no significant damage from a significant knock to a tooth, it's not uncommon for the blood supply to the tooth to be damaged and for the nerve to die in the tooth. This may begin to show up years later. If you ever notice your child's tooth changing colour - getting darker yellow, green or blue, or your child begins to complain of a sore tooth - visit a dentist for a professional assessment as soon as possible, for best treatment results.
9. Investment in a custom-fitted, dentist made mouthguard for skating, bike-riding and sports-play for your child is a cheap preventive strategy that could save your child from this experience.
My friend's child got to a dentist and is going to need several appointments, but will be OK. She herself may take a little longer to recover from the realisation her child's perfect smile will never be the same again!
NB: this information is for general guidance purposes only and doesn't replace the professional advice provided by your dentist for your specific situation.
By Dr Christine May (Oral Health Content Writer @beFaceWell)
