Accidental trauma to baby teeth of infant or young child is the most distressing incidents to befall on a child in his early years. Many of these accidents which affect the baby teeth occur during the first 3 years of child as this is the age when the child learns to toddle and is relatively uncoordinated. Common causes of trauma to baby teeth are falls, collisions and sporting activities. In case of baby tooth injury, mostly the front baby teeth are affected. If a child’s tooth or jaw gets injured or his tooth is knocked out, then dentist should be consulted.
Trauma to baby teeth includes loss of tooth, fracture of tooth or loosening of tooth. Tooth displacement or loosening occurs because the bone to which tooth is anchored is elastic and soft in young kids.
If a primary baby tooth of the child is knocked out, then the first thing which the parent should check is that the baby tooth is not accidentally breathed in by the kid. In children, reflexes are still developing so child may breathe a tooth and the baby tooth may get lodged in child’s throat. Baby tooth which is breathed in will lead to difficulty in breathing and can also lead to lung infection.
Knocked out tooth is placed in a plastic bag. Dentist may want to have a look at the knocked out baby tooth. If tooth can’t be recovered, then child can be taken to a pediatrician for evaluation to rule out aspiration of knocked out tooth.
In case of trauma to teeth and gums, parent can take the child to an emergency room where child’s face, gums and mouth can be checked by a doctor. To control bleeding because of trauma to the tooth, direct pressure can be applied to the gums with rolled up piece of gauze pack or with a clean cloth. Dentist should be called and dentist may advise soft diet to the kid for 2-3 days after tooth trauma. Dentist may also take an x-ray which will help him determine whether any tooth fragments are left or not and to determine extent of damage.
If baby tooth is knocked out, then it should never be re-planted or put back into child’s mouth. There is a developing permanent adult tooth present below the baby tooth which can be damaged if baby tooth is re-planted.
If there is no alveolar bone overlying the adult tooth crown of erupting tooth and there is sufficient space for eruption, then the gap which is left by trauma and loss of baby tooth is kept open. After some time, gap will be filled with permanent adult tooth.
If there is quite a lot of time left for adult tooth to erupt, then space maintainer can be given to the child. Space maintainers are given to maintain space for adult teeth to come in position. Maximum space closure occurs within first 6 months after the tooth loss so space maintainer appliance should be given as soon as possible after tooth extraction.
If only a small portion of baby tooth is chipped off and only enamel is affected, then smoothening of sharp or roughened margins is done.
If the biting edge of tooth is chipped off, then restoration of baby tooth can be done. Tooth colored, esthetic, plastic filling can be used for restoration which will restore the shape and appearance of the tooth. It will further protect the tooth structure from any further damage.
No pain occurs during smoothening of the sharp margins and tooth restoration.
If larger portion of tooth is fractured and the tooth is sore, then filling can be done to repair the tooth. Sensitivity to hot and cold food stuffs will occur if the tooth is not restored. Traumatized tooth should be checked on regular basis to see whether any color changes have occurred or not. If the tooth becomes darker, then it might be because of non-vitality of the tooth structure.
If tooth is infected, then pulpotomy or pulpectomy (Baby tooth root canal treatment) procedure may also be required. In pulpotomy procedure, nerves and vessels which are present in the dental crowns are removed.
If tooth is unrestorable, then extraction of baby tooth may also be required. To provide protection to underlying permanent adult tooth, extraction of infected primary baby tooth is done.
Simple blow to baby tooth happens frequently without even child’s parent knowledge. In case of baby tooth trauma, child will avoid using the tooth and will favor softer foods for several days and will experience soreness. If this behavior lingers for more than a week, then the child should be taken to dentist to get the affected tooth evaluated.
To avoid baby tooth trauma, preventive approach should be used. On bath tubs, non-slip pad can be placed and the edges of table should be padded to prevent baby tooth trauma. Young kids who are learning to walk should be monitored closely.
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