UNDERSTANDING DENTAL TRAUMA

Knocked-out tooth (dental avulsion)

• A dental avulsion occurs when a tooth is completely displaced or knocked out of the dental socket.

FIRST AID
I. BABY TOOTH: A primary tooth that has been avulsed is usually not reimplanted. The risk of injury to the developing permanent tooth bud is high.

II. PERMANENT TOOTH
1. Do not touch the root of the tooth. Handle the tooth by the crown only.
2. Rinse the tooth off only if there is dirt covering it. Do not scrub or scrape the tooth.
3. Attempt to reimplant the tooth into the socket with gentle pressure, and hold it in position.
4. If unable to reimplant the tooth, place it in a protective transport solution, such as Hank's solution, milk, or saline. This will hydrate and nourish the periodontal ligament cells which are still attached to the root. A small container of Hank's Balanced Salt Solution can be purchased in dental emergency kit form at many drug stores. Contact lens solution is not an acceptable storage medium.
5. The tooth should not be wrapped in tissue or cloth. The tooth should never be allowed to dry.
6. Take the child to a dentist or hospital emergency room for evaluation and treatment.
7. Radiographs may need to be taken of the airway, stomach, and mouth if the tooth cannot be found .
8. Tetanus prophylaxis should be considered if the dental socket is contaminated with debris.

Tooth displacement (luxation, lateral displacement, extrusion)

Luxation involves displacement of a tooth in a labial, lingual, or lateral direction. If the displacement is less than 5 mm, the dental pulp will remain vital in about 50% of the cases.
Lateral luxation is an angular displacement of the tooth while it remains within the socket. There is usually an associated fracture of the supporting alveolar bone, especially with labial and palatal luxations.
An extrusion occurs when a tooth is only partially removed from the socket. In the primary dentition, the alveolar bone surrounding the tooth is relatively elastic, so the most common injury in toddlers is a dental luxation (displacement injury) – with gingival hemorrhage. The primary upper incisors are often pushed toward the palate during a fall.

FIRST AID
I. PRIMARY TOOTH: Place a cold wet cloth over the mouth, and bring the child to a dentist. Provide pain relief by giving children’s Tylenol.
II. PERMANENT TOOTH
Rinse with cold water, and keep an ice pack over the lip and mouth to reduce swelling. Give Tylenol for pain relief. Try to reposition the luxated tooth back to its normal position using gentle to moderate finger pressure. The patient is then instructed to gently hold the tooth in position. Obtain definitive dental care as soon as possible.

Tooth fracture (infraction, Ellis class I, Ellis class II or III)

Crown fractures comprise about 33% of injuries to primary teeth, and about 75% of injuries to permanent teeth. A crown fracture is classified based on the location of the fracture in relation to the enamel, dentin, or pulp tissue of the tooth.
An Ellis class I fracture involves the enamel portion of the tooth, is rarely painful, and is not a true emergency.
An Ellis class II fracture involves enamel as well as dentin, allowing the entry of bacteria into the dentin tubules, as well as chemical or thermal irritation of the pulp canal. Ellis class II fractures are recognized by the yellow to pink color of the dentin.
In an Ellis Class III fracture (severe), the dental pulp is exposed – requiring immediate care. The fracture site will have a reddish tinge or will show bleeding. In an Ellis class III dental fracture, exposure of the pulp’s nerve endings can cause extrement pain – even if exposed only to air. Exposure of the pulp in an Ellis class III fracture will eventually lead to pulpal necrosis from bacterial infection, if left untreated.

FIRST AID
I. PRIMARY TOOTH
Have the child rinse with warm water. Use a cold cloth or ice pack to reduce swelling. Use acetaminophen for pain, not aspirin. Cover any severe fracture with a biocompatible cement or dressing until a dentist can treat the problem.
II. PERMANENT TOOTH
Have the child rinse with warm water. Use a cold cloth or ice pack to reduce swelling. Use acetaminophen for pain, not aspirin. Cover any severe fracture with a biocompatible cement or dressing until a dentist can treat the problem.