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Broken tooth: how to take care of a child's dental trauma?

Broken tooth: how to take care of a child's dental trauma?

Tooth injuries are traumatic injuries involving the teeth, supporting bone, gingival tissues and soft tissues (lips, tongue and cheeks).

These lesions can range from a simple fracture of the dental enamel to the definitive loss of an entire tooth with its root (dental avulsion). These traumas occur much in school-age children and in the developmental phase and therefore can affect both the milk (deciduous) and the mixed and permanent dentition. The types of lesions can be:

  • Enamel or enamel fracture and dentin: they occur in the crown of the teeth and the treatment can be done with the collage of the fragment or with the dental reconstruction in resin
  • Fracture between the crown and root : dental mobility occurs and there may be need for endodontic treatment or even dental extraction
  • Concussion: it is a trauma of mild intensity and does not alter dental position, it can provoke a touch sensitivity and should be followed regularly
  • Subluxation: a trauma of moderate intensity that causes tooth mobility without alteration of the position of the affected tooth
  • Dislocation: the tooth suffers displacement of its position in the arch according to the direction of the trauma, and there may be mobility and bleeding of the tissues that support the tooth . The treatment will vary according to the type and direction of the dislocation, such as dental repositioning, endodontic treatment or even dental extraction.
  • Avulsion: the tooth is totally displaced out of the surrounding bone. It has different ducts being a permanent tooth or milk.

If the avulsion of a permanent tooth occurs, the dental reimplantation can be done. Without touching the root, waste must be removed from the tooth with saline or unbrushed milk and the tooth can be gently repositioned. You should seek dental care as soon as possible. If repositioning is not possible, it is important to keep the tooth in a bottle with milk until the dental care, which must be done within 45 minutes after the trauma, so that the procedure can be successful.

In cases of avulsion of teeth, it is contraindicated to make the dental reimplantation, as it can affect the permanent tooth successively.

How to act in trauma situations

The highest incidence of traumas in milk teeth occurs at the stage when the child begins to walk, when she is more curious and restless, wanting to explore the environment and with little motor coordination to avoid falls and promote self-protection. In mixed and permanent dentition, which occurs in the age group between six and eleven, it is the one that deserves more attention.

The dentist should always be consulted so that he can assess the extent of the damage and guide the parents about the future behaviors and the care to be taken

Among the main causes for these injuries we can mention falls, collisions, car accidents, sports accidents, injuries with mistreatment and violence.

Emergency situations involving the teeth and the face often becomes dramatic experiences for parents and children, so it is important to be prepared and calm to have the right attitude in a situation like this.

When there is a cut or bleed, you must first press the wound with a gauze or clean cloth so that the bleeding is controlled. If there was a fracture of part of the tooth, the fragment should be collected to be taken to the dentist.

Even traumatized teeth that have not suffered any type of fracture may have been affected by invisible cracks to the naked eye and may have their vitality compromised and these also need to be accompanied by a professional.

In milk teeth, a trauma that causes dental dislocation may appear simple, but should never be neglected. By the proximity of their roots with the germs of the permanent teeth, they can cause great complications in the future dentition, that range from a simple stain in the permanent tooth until its complete deformation or deviation from the rash of eruption. Therefore, a clinical and radiographic evaluation and follow-up of a professional in any situation of trauma in the region of the teeth is essential.

If dental treatment is not done properly after dental trauma, the consequences may be changes in color, mobility, change of position in the dental arch, pain, tenderness, radicular or bone resorption, necrosis and loss of the dental element. Because it occurs mainly in the anterior teeth, all this can lead to psychological problems and low self-esteem of the children, become the target of jokes, mainly by the absence of the dental element.

Treatment in the office

The treatment chosen for the traumatized teeth will vary according to the type and severity of the impact, the dental maturity, the time from when the trauma occurred until the moment of care and whether or not there was fracture of the bone that involves the tooth. Indications for treatment may be clinical and radiographic follow-up, fragment bonding, resin reconstruction on resin or other materials, and may or may not require endodontic treatment (treating the canal of the tooth).

The dentist should always be consulted so you can assess the extent of the damage and guide parents about future behaviors and care to be taken. It is common for the color change of a traumatized tooth to occur after a few days and this may or may not be associated with loss of dental vitality and the need for endodontic treatment.

Some malocclusions (changes in the shape of the arches and in the tooth inserts) are factors that may increase the risk of dental trauma, such as in children with mouth breathing and a habit of sucking fingers and pacifiers. This causes the upper teeth to be designed anteriorly and become the target of trauma more easily, therefore malocclusion should be treated early.

Prevention of dental trauma

It is important to prevent tooth injuries by measures where some type of accident may occur. Parents should always be alert to children's movements, to avoid dangerous objects and violent jokes. During the practice of sports, it is recommended to use buccal protectors, which are intraoral plaques made by the dental surgeon that assist in dissipating impact forces.

Are important prevention programs to clarify parents, teachers and caregivers regarding to immediate assistance in these types of accidents and to the need for care and follow-up in order to reduce cases of failures in the treatment of traumatized teeth.

Dental trauma is a serious problem and should therefore be considered an emergency situation and requires fast and specialized service.


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