Small children, while learning to move around, are relatively prone to having accidents and tooth trauma in the primary dentition. Falls, whether while walking or riding a bike, on the playground or in Kindergarten are not uncommon. Externally, scrapes, cuts and bruises are usually the result. In addition to internal injuries such as a craniocerebral injury, fractures or bleeding, the primary teeth can also be injured. Besides damage to the soft tissue, teeth and bones, trauma to the primary teeth presents a risk of injury to the existing, developing permanent teeth. Because of the often unforeseeable subsequent damage and long-term effects, a consultation with a dentist is necessary.
For any dental trauma: Remain calm, look for and collect any teeth / fragments that have been knocked out to bring along. Even apparent “minor injuries” need to be examined by a dentist. Permanent teeth are best stored in a tooth rescue box or cold milk to prevent drying out. Stop the bleeding, cover and cool the wound if necessary.
The dentist documents the exact circumstances of the accident, checks tetanus protection and conducts a thorough examination and x-ray diagnostics to evaluate tooth and/or bone fractures. Injuries to the teeth can affect the tooth structure and / or the periodontium. Hard tooth tissue injuries include fractures, which can be associated with exposing the neurovascular trunk (pulp). Because of the force involved with dental trauma, injury to the gums can also be expected. Stronger forces can cause loosening and displacement of a tooth and in extreme cases, result in avulsion of the tooth. These accidents always involve injury to the surrounding tissue and destruction or compression of the neurovascular trunk. Also, tearing the frenulum is often a result of falling. This often causes heavy bleeding but usually does not require stitches.
Based on the injury, every dental trauma can lead to a number of consequences such as infection, colour change of the tooth crown, necrosis of the tooth, resorption (dissolving) of the root or adhesion of the tooth to the surrounding bone. At the same time, the following tooth bud can be either damaged directly or displaced. The extent and the nature of the injury, as well as the age of the child at the time of the accident decisively determine the possible subsequent damage. The younger the child is at the time of injury, the greater the effect will be on the permanent teeth. Mineralisation of the crowns of the permanent incisors occurs during the first 3 years of life so the risk for subsequent damage is especially high within this time frame. This can affect the colour and shape of the subsequent crowns.
Generally, it should be noted that the treatment of dental trauma in the primary dentition differs slightly from treatment for trauma in the permanent dentition. On one hand, treatment options are reduced because of the resilience and developmentally limited cooperation of children while on the other, protecting the developing permanent tooth is a priority. Extremely loose or displaced primary teeth, as well as those with deep fractures, should be removed to protect the permanent teeth that follow. Due to the risk of complications, re-implantation of an avulsed (knocked out) primary tooth is not recommended.
As a rule, parents should be informed of the possible consequences for every dental trauma and children should receive regular follow-up dental examinations. Besides giving soft foods for 7 to 10 days, it is essential to ensure good oral hygiene.