Dental trauma in children: distressing for everyone but there are efficient, ethical solutions
Featured Products Promotional FeaturesPosted by: Dental Design 15th May 2021
Dental trauma occurs when a tooth has been damaged or knocked out completely. The term is also used to describe an injury to the soft oral tissue, or to the alveolar bone. There are lots of reasons why trauma occurs; one main cause is an accident that led to a blow to the mouth. Children and adolescents are particularly prone to accidental dental trauma, which can happen while they play sport, or when they fall.
Solutions for dental trauma must endure, with correct maintenance. Treatment planning and management must consider all the risks for failure and the patient’s oral health needs over “many decades” if they are very young; the aim should be for a restoration that “closely mimics the functional and aesthetic qualities of an intact tooth for as long as possible”.[i]
All is (not always) lost
When an injury to the mouth and/or jaw has occurred, the young patient must receive swift dental intervention. Even if the injury is to a primary or deciduous tooth, a dentist will still need to make a clinical assessment, to avoid complications that could affect the permanent tooth underneath. These might include delay in eruption time, malformation, or speech defects – all of which could have a significant, subsequent impact on the child’s quality of life and emotional wellbeing.[ii]
The parent or carer must make no attempt to temporarily re-implant a primary tooth that has been knocked out; if it is a permanent tooth and it has been retrieved, it should be held by the crown to be quickly cleaned, then gently tried back in the hole it has made. If this isn’t possible, the tooth can be stored in milk, or the child’s saliva, until they can see a dentist. If a parent or carer does not think the tooth can be temporarily held in place before a dental appointment without risk of it being swallowed, it should be stored, as above.
Accident-proof childcare isn’t possible
Accidents can never be completely avoided, particularly when small children are involved; it can take just seconds when an adult’s back is turned for a six-year-old to misjudge the height of a sofa they decided to leap off. It’s a similar story in the playground, although schools and nurseries these days have more stringent protocols regarding health and safety, and acceptable boundaries for boisterous play, than some of us will remember! Also, many schools have made the use of mouthguards for contact sports like rugby, hockey and cricket compulsory.
Many children will end up at your practice because they have fallen off a bike, or scooter. At time of writing, the Child Safety (Cycle Helmets) Bill 2019-21 has not yet had its second reading in the House of Commons. This will make it compulsory for children under the age of 16 to wear a safety helmet when riding a bicycle on a public highway; there is evidence to support the role of helmets “in the prevention of injuries to the middle third of the face and some dental injuries”.[iii] There have long been opponents to the compulsory wearing of bike helmets for all age groups though; one theory is that the illusion of “safety” may lead to risk-taking. A study into dental injuries and scooters in six to 12-year-old children found that 11% had sustained a dental injury while scooting.[iv] The study also suggested that the face and mouth are “prone to scooter-associated injuries because of the T-handlebar of the device and the fact that the centre of gravity is located high and to the front”. Will parents and carers stop their children riding their scooter to school for fear of injury? Unlikely. Even if they take care, accidents happen so it’s about being realistic and offering quality solutions that can be delivered efficiently, helping the young patient to get on with the business of being six without having a terrible time at the dentist.
It should be noted that, for children under 12, even if the pulp has been exposed as a result of dental trauma, endodontic therapy isn’t always necessary; careful assessment will be needed for these patients. And it isn’t just children you’ll be seeing either, as in a literature review from 2016, epidemiological studies indicated that approximately “one‐quarter of adolescents have experienced dental trauma”.[v] When only restorative treatment that is required, COLTENE has a range of quality prosthodontic materials whatever the needs of
the patient. MIRIS™2 is a conventional composite that can mimic the shades and translucency of natural teeth in adolescent patients; COLTENE also has products for outstanding bonding including One Coat 7 Universal and other tools to support a comfortable, efficient restorative treatment process.
Dental trauma can be unpleasant at any age, but when it happens to children, it is important that parents and carers do know that, with prompt action, there will be an efficient, ethical solution to restore the child’s smile, beautifully. An experience of childhood dental trauma can be distressing for everyone involved, but a professional will be able to find the right fix.
For more on COLTENE, visit: www.coltene.com,
email info.uk@coltene.com or call 01444 235486.
[i] Liddelow G, Carmichael G. The restoration of traumatized teeth. Australian Dental Journal. 2016 Mar; 61:107-19.
[ii] Dua R, Sharma S. Prevalence, causes, and correlates of traumatic dental injuries among seven-to-twelve-year-old school children in Dera Bassi. Contemporary Clinical Dentistry. 2012 Jan; 3 (1):38.
[iii] Shepherd, J. Bicycle helmet use and preventing dental injury. Br Dent J 196, 539 (2004). https://doi.org/10.1038/sj.bdj.4811241
[iv] Baumgartner EN, Krastl G, Kühl S, Filippi A. Dental injuries with kick‐scooters in 6‐to 12‐year‐old children. Dental Traumatology. 2012 Apr; 28(2): 148-52.
[v] Lam R. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Australian Dental Journal. 2016 Mar; 61:4-20.
