How can I prevent injuries to my children's teeth? I have a very busy toddler in my home, and I am concerned he may knock his teeth out one day when I am not there to supervise him all the time. My older son is very athletic and I do not want him to look like some professional hockey player who is missing teeth.
Approximately 25% of toddlers can be expected to sustain dental injuries. The most common age for these injuries to take place is between 2 and 4 years old. The prevention and treatment of these injuries matters a great deal because close to one third of injuries have been shown to cause permanent consequences.
Injuries to permanent teeth occur more commonly in boys; they are twice as likely as girls to suffer dental trauma. The two top causes of dental damage are sport related and fighting. The upper and central incisors are the most likely to get injured, but maxillary (upper) teeth protruding more than 4mm are three times more likely to suffer dental trauma than normally aligned teeth.
The three most common dental injuries are when a tooth is knocked out (avulsion), pushed in (intruded), or broken. When the latter occurs it is important to note if there is an exposed nerve or not. When there is nerve exposure, complications are more common.
Children between the ages of 7 and 10 years are more prone to suffer avulsion because of the elasticity of the bone at this age. When a permanent tooth is knocked out one should look for it and hold it by the crown (the white part), not the root (the yellow part). It is ideal to get a dentist to see the patient within a two hour time period; the quicker the tooth gets re-implanted the better.
If the dislodged tooth gets contaminated it can be rinsed under cold tap water; it should never be scrubbed or handled roughly. If the tooth cannot be placed back in the dental socket, one can put it in a cup of milk or salt water. This will prevent dehydration of the very sensitive periodontal ligament cells, which are important to preserve for a good outcome. When there is no milk, place the tooth in the child's mouth between the cheeks and gums. Keeping a tooth in contact lens solution is not acceptable. If the dental socket is contaminated with debris then tetanus prophylaxis should be considered.
If a tooth is pushed in with a younger child, there may be times when the injury is so severe that the tooth may not be visible. It then makes it uncertain for a parent if the tooth was knocked out or pushed in. An X-ray may be the only way to determine if the tooth was knocked out and lost or pushed deep into the socket.
If a permanent tooth gets broken, and if the piece or pieces can be picked up and put in a glass of milk, there may still be hope. A piece can be glued back, but only by a dentist - and the sooner the better. In case of a fall that affects the permanent tooth, early dental attention is critical. The earlier a dentist sees the patient the greater the possibility of conserving the tooth's vitality; the prognosis is better, and future complications and high costs of treatment can be avoided.
The age of a child at the time of injury is important because the treatment between primary (baby) and permanent (adult) teeth differs greatly. Primary teeth are very closely related to the permanent teeth which are forming inside the bone. Injuries to the primary teeth may affect the aesthetics of the permanent teeth. Once a primary tooth has been knocked out it should not be placed back into the socket. Trying to reimplant the primary tooth may compromise the developing permanent tooth bud, which may appear later at approximately 8 years of age with white marks or deformation in the crown.
Childproofing the home of a toddler learning to walk is critically important. Small things like getting rid of a coffee table or keeping the child away from the edges of a fireplace may make a big difference. Since baby walkers were banned, there has been a drop in the number of dental injuries to babies and toddlers.
Other suggestions to consider are: use the stairs when getting out of a swimming pool; avoid sliding backwards down a swimming pool slide; teach children not to push each other when playing; stay seated on a swing; do not jump off when the swing is in motion; and remove objects than may easily cause tripping.
For older children it is important to ensure the use of protection such as helmets and mouthguards. Hockey may be an obvious example, but other activities such as rugby, karate, biking, skiing, and roller blading all put a child at an increased risk for dental trauma. Though it may not be practical to use a mouthguard for all of these activities, a heightened sense of awareness may prevent some trauma.
When experts calculated the cost of dental injuries - factoring in also the time that parents had to take off work - the financial burdens were staggering. Many of these children often visit a medical office or emergency room before they see a dentist.
Last year at the annual meeting of the American Academy of Pediatrics, there was a half-day educational event aimed at general pediatricians. These doctors were educated not only on the early detection of tooth decay, but also on how to handle children who sustained dental injuries. Dr. Daniel Ravel DDS has a great resource on the management of dental trauma: www.dentalresource.org/topic50trauma.html.
There is also more information for parents on the website of the International Association of Dental Traumatology: www.iadt-dentaltrauma.org/.
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