Friday, December 3, 2010

Oral Injuries in Children

Injury Prevention

Injuries to the head, face, and mouth are common among infants and young children. Estimates indicate that up to 30 percent of young children may experience injuries to the primary teeth. Injuries to the primary teeth occur most often in children ages 18 through 30 months. Because children in this age group are unsteady on their feet, as they begin to walk, run, and climb, accidents occur that result in oral injuries.

Types of Injuries

In infants and young children, the teeth most often affected by oral injury are the upper front primary teeth. The most common type of injury is a displacement (tooth is pushed out of position) injury with gingival (gum) bleeding. Intrusion injuries, in which a primary tooth is driven into the bone, are also common. Avulsion (tooth knocked completely out of the mouth) of the tooth can also occur.
Oral soft tissues — including the lips, tongue, palate, and gingiva can also be injured. Impalement injuries can occur when an infant or young child falls with an object in the mouth and the object penetrates the oral soft tissues.
Jaw fractures, while uncommon among infants and young children, can occur, especially with a significant blow to the face or the chin. Jaw fractures result in difficulty opening and closing the mouth, facial asymmetry, and/or paresthesia (a sensation of pricking, tingling, or creeping).
Infants and children who experience an oral burn as a result of chewing on electrical cords should be referred to a burn specialist for assessment and possible intervention. Early referral is crucial to reduce the risk of scarring and fusion of the corners of the mouth. The risk increases with delayed care.

Managing Injuries

The roots of the primary teeth are close to the crowns of the permanent teeth; therefore the force of the impact to a primary tooth can be easily transmitted to the underlying developing tooth. Infection caused by primary tooth damage may harm the permanent teeth as well. The intervention strategy for injured primary teeth is dictated by a concern for the permanent teeth.
Bleeding should be controlled with direct pressure.


Swelling can be reduced by placing ice in a zip-lock bag or a bag of frozen veggies like peas will work also. Popsicles and other frozen food items can help also. 
For pain Acetaminophen (Tylenol etc) or Ibuprofen (Advil etc) may be used. Follow label directions for dosage. (Note Ibuprofen has been linked to a rare but possibly fatal condition called Steven Johnsons Syndrome.)
All oral injuries should be assessed as soon as possible. If unable to see a dentist, an emergency health facility or family doctor may be the next best starting point.

Avulsed Tooth

Because of the danger of damaging the underlying permanent teeth, no attempt should be made to reinsert an avulsed (tooth completely knocked out) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
However, an avulsed permanent tooth should be reinserted immediately or as soon as possible, with appropriate splinting and follow-up by a dentist. If you are not sure if a tooth is permanent or not, treat it as one. 
  • Find the avulsed tooth.
  • Hold it by the (top part) only, not the root.
  • Rinse it under cold water; do not scrub.
  • Reinsert it into the socket quickly, making sure that the front of the tooth is facing you. If this is not possible, place the tooth in cold milk or cold water and take the child and the tooth to a dentist immediately.

Chipped/Cracked Tooth

If you can locate the chipped portion, treat it the same as the avulsed tooth and bring the pieces to the dentist as he/she may be able to reattach the chipped portion with bonding.

Follow up

The dentist may x-ray the area to see if there is root damage or a fracture of the underlying bone. He/she may splint the teeth until they stabilize. If the tooth/teeth injured have damage to the Pulp (nerve), the dentist may recommend  tooth canal treatment on either the permanent or primary teeth. If there is significant laceration of tissue, a few stitches may be placed.

Long Term Complications

The gingiva (gums) ad other oral soft tissues are remarkable in their healing ability. Teeth however can be quite unpredictable. The dentist will advise you that even though healing looks good initially, there could be several problems that occur in the future including: 
  • A primary or permanent tooth turning dark.
  • an abscess requiring extraction or root canal therapy.
  • A fracture to a permanent tooth root complicating any orthodontic movement.
  • Failure of a reattachment of a tooth chip and bonding.
  • The need for a crown.


Wearing a mouthguard during any activity where oral injury can occur will greatly reduce these types of injuries. Furthermore, after an injury occurs, wearing a mouthguard will greatly improve prognosis and prevent re-injury.

Your comments and questions are welcome.

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About Me

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Born in the Midwest. Married with 6 children and 3 grandchildren. Attended Maine West High School, Harper Jr College, Northern Illinois University, the University of Illinois College of Dentistry. Practice in Crystal Lake, Illinois.