• Nearly 50% of all children have some type of injury to a tooth during childhood. Mouth injuries are also common. Tooth and mouth injuries often occur after a fall, motor vehicle accident, sports injury, or fight. In most cases, tooth and mouth injuries are not life threatening. Rarely, a child may develop serious complications.
• The most common injury site is the maxillary (upper) central incisors, which account for more than 50% of all dental injuries.
• Injuries to the teeth and mouth can also have long-lasting effects on the child's appearance and self- confidence.
• Dental trauma during childhood leads to present and future oral health problems, which cause pain and distress. Children encounter accidents in their routine activities, such as running, skating, and cycle riding.
• Oral injuries are the fourth most common bodily injuries among the 7-30 year age group. Traumatic injuries can thus have a significant effect on a child's quality of life.
• Tooth loss in children commonly occur due to dental trauma, which may be caused by violence, accidents, falls, and sport-related activities.
• The incidence of trauma exceeds that of dental caries and periodontal disease in young population.
• There is a lack of awareness among parents regarding the emergency management of dental trauma.
• 97.7 % of the traumatic injuries did not result in dental visit to assess the problem.
• 41% of dental injuries occur at home, so mothers play an important role for appropriate decision making.
• Patient and their parents need to be educated about the use of protective devices such as mouth guards which may help to reduce the incidence and severity of dental injuries during sports.
• Boys are more affected by trauma than girls. This may be attributed to the behavioural factors, with the boys tending to be more energetic, more physical and inclined toward vigorous outdoor activities as compared to girls.
• The observed prevalence of dental trauma was higher in boys (58.1%) than in girls (41.86%).
• The permanent maxillary central incisors were the most common teeth affected due to trauma and accounted for approximately 93.75%, out of which, the permanent left maxillary central incisor accounted for 57.8% of the injuries followed by the permanent right maxillary central incisor with 35.93% .
• Enamel fracture (65%) was the most common type of TDI in both arches, followed by fractures involving both enamel and dentin (27%) and only (8%) involving pulp.
• Regardless of the dental injuries, it was found that 88.37% of the patients did not receive any dental evaluation or control of the problem.
• The perception of mother towards avulsed teeth, i.e., if they had found the avulsed tooth inside the mouth about 91.2% of the mother responded that they would remove the tooth from the mouth and if found outside the mouth, about 50.7% of mother responded that they would discard it.
• There is a lack of mothers knowledge regarding the immediate management of dental trauma. Only 7% of the mothers were aware of the immediate re-implantation of an avulsed tooth. Therefore, the mothers need to be educated more in this aspect.

Did you know that calcium and phosphorous found in cheese is healthy for your teeth – it reduces the pH level in plaque and re-mineralizes the enamel

Did you know that a sore jaw, when combined with chest pain, can signal a heart attack- especially in women.

Did you know that dental pain can range from minor gum irritations to severe tooth infections. As a general rule, pain needs to be addressed quickly if it happens spontaneously, keeps your child awake at night, or doesn’t respond to pain relievers.

Did you know that saliva prevents tooth decay. Saliva contains components that can directly attack bacteria which cause decay, and it is also rich in calcium and phosphates that help to remineralise tooth enamel. Saliva contains antimicrobial components, as well as minerals that can help rebuild tooth enamel after attack by acid-producing, decay-causing bacteria.

Did you know that if you cut or bite tongue, Lip or Cheek to apply cold compresses to injured areas to help control swelling and bleeding. If bleeding cannot be controlled by simple pressure, rush to a hospital emergency room.

Did you know that if you Knock-Out a permanent tooth you should handle the tooth by the crown, not by the root. Rinse the tooth with water to remove dirt. Inspect the tooth for fractures. If it appears whole, try to reinsert it into the socket. The tooth should displace the blood clot relatively easy. If excessive force is needed, do not continue to reinsert the tooth. Rush to the dentist.

Did you know that if a primary (baby) tooth is knocked out then do not try to reinsert the tooth. You may apply cold compresses to injured areas to help control swelling and bleeding. Baby teeth are not reinserted because of the potential for damage to developing permanent tooth buds. Usually this type of injury does not need immediate follow-up.

Did you know that in case of Chipped or Fractured permanent Tooth rinse the mouth with water and apply cold compresses to reduce swelling. Locate any broken tooth fragments, place them in milk, and bring them with you to the dentist.

Did you know that Chipped or Fractured primary (Baby) Tooth usually does not require immediate attention if the fracture only involves the outer shell of the tooth. If a larger part of the tooth is fractured you should contact your dentist. Small fractures of primary teeth are very common. This is particularly true when children are learning to walk.

Did you know that in case of severe Blow to the Head rush to the nearest hospital emergency room immediately, especially in cases of loss of consciousness or experiences vomiting.

Did you know that in case of possible Broken or Fractured Jaw keep the jaw from moving and rush to the nearest hospital.

Did you know that people with Gum disease are at higher risk for developing heart disease, stroke, uncontrolled diabetes, pre-term births and respiratory disease.

Did you know that periodontal bacteria can enter the blood stream and travel to major organs and begin new infections.

The most effective intervention is prevention. We are in a unique position to help families prevent accidental trauma, including oral trauma, by providing anticipatory guidance here at our web site.

Risk Factors for Trauma

• Children with compromised protective reflexes or poor coordination
• Hyperactivity
• Child abuse or neglect
• Malocclusion, or an abnormality in the coming together of teeth
• Failure to use protective face and mouth gear

Tooth injury can be divided into the following classifications, ranging from mild to severe injury:

Mild Injury \ Evaluation by the Dentist

Injury to the tooth and its supporting structures without causing abnormal loosening or displacement of the tooth. Tooth is tender to percussion.

Advise: Stick to a soft diet for 2 weeks. Monitor for changes in tooth color. There may be possible injury to developing permanent teeth from trauma if a primary tooth is injured.

Preventive caresafety gates and furniture protectors are very important and mouth guards while playing sports.

Subluxation

Injury to the tooth and its supporting structures with abnormal loosening but no displacement. Tooth is tender to percussion, with bleeding at gingival margin.

Advise:Rinse with cold water. Stick to a soft diet for 2 weeks. Monitor for changes in tooth color that may indicate pulp necrosis.See the dentist immediately.

Moderate Injury Promptly Visit to Dentist

Lateral Luxation Injury to the tooth and its supporting structures, resulting in tooth displacement. Injured tooth is at risk for pulpal necrosis and root resorption.

Advise: Rinse with cold water. Keep an ice pack over the lip and mouth if swelling is present. Stick to a soft diet for 2 to 4 weeks, depending on type of injury. See the dentist immediately.

Intrusion Tooth is pushed into the socket and the alveolar bone. May appear shortened or barely visible. Offers poor prognosis and high risk for complications, including root resorption, pulp necrosis, and infection. May require a root canal.

Advise: This type of injury may damage underlying permanent teeth, especially if an infection develops. Teeth may re-erupt in 2 to 6 months. If a primary tooth does not re-erupt, it will require extraction to not interfere with permanent tooth eruption.

Extrusion Tooth is partially displaced from its socket. This type of injury will require repositioning and stabilization. Immediate dental visit is needed.

Severe Injury Calls for the Patient to be Rushed to the Dentist

Avulsion Tooth is completely out of the socket. Management will depend on tooth type.

Uncomplicated fracture of the enamel Fracture (crack) of the enamel without involving the dentin or the pulp. May have a sharp edge.

This type of fracture is rarely painful

Uncomplicated fracture of the enamel and dentin An enamel-dentin fracture that does not involve the pulp and can be recognized by the yellow to pink color of the dentin. Potential complications include pulp death or infection.

Advise: The child can rinse the oral cavity with warm water. Provide a soft diet, avoiding temperature extreme.

Uncomplicated crown fracture An enamel-dentin fracture with pulp exposure. The fracture site has a reddish tinge or will show some bleeding. This type of fracture can cause extreme pain and may lead to pulpal necrosis. It also presents a risk of root resorption and infection in exposed pulp.

Advise: The child can rinse the oral cavity with warm water. If facial swelling is present, use cold cloth or ice pack to reduce swelling.

Root fractureA fracture with pulp exposure. Potential complications for a root fracture include root resorption and pulp necrosis.

Advise:Refer to dentist as soon as possible (within 12–24 hours) fr evaluation, where diagnosis is made radiographically. Excessive mobility of the tooth should lead to suspicion of root fracture. Treatment consists of reduction and splinting for permanent teeth, or extraction, depending on the extent of the traumatic lesion.

Trauma to soft Tissue

Injury to the Lip Swelling and bruising of the lips are common after oral trauma, even in the absence of laceration.

Injury to the frenum The frenum is likely to be torn as a result of a fall that causes trauma to the mouth or teeth. A torn frenum heals spontaneously without long-term consequences.

Advise: Avoid citrus or acidic foods.

Why regular dental visits are important?

The dental visit is essential in order to establish a complete and correct diagnosis of all soft and hard tissue injuries. For this the dentist will follow the below mentioned procedure:-

• Clean the face and the oral cavity with water or saline. This cleaning will make you feel more comfortable and facilitate extra-oral and intra-oral examination.
• Take a short medical and dental history. The medical history will reveal possible allergies, blood disorders and other information that may influence treatment. The dental history will indicate previous dental traumas, information which may explain radiographic findings such as pulp canal obliteration or apical pathology.

The Dentist will Ask Questions Relating to the Injury

• Where did the injury occur?This information may on occasion indicate the possibility of contamination.
• How did the injury occur?This may lead to identification of the impact zones i.e. a chin injury is often combined with crown or crown-root fractures in premolar and molar regions.
• When did the injury occur? This information may be essential in relation to many injury types. In relation to a tooth avulsion the extent of time and the extra-oral storage condition becomes very decisive for later treatment.
• Was there a period of unconsciousness? If so, for how long. Amnesia, nausea and vomiting are all signs of brain damage and require medical attention.
• Is there any disturbance in the bite? An affirmative answer may indicate a luxation injury with displacement, an alveolar or jaw fracture or a fracture of the condylar region.
• Is there any reaction in the teeth to cold and/or heat exposure? A positive finding indicates exposed dentin and/or pulp.

Clinical examination

• Examine the face, lips and oral muscles for soft tissue lesions.
• Palpate the facial skeleton for signs of fractures.
• Inspect the dental trauma region for fractures, abnormal tooth position, tooth mobility, and abnormal response to percussion. Furthermore registration of direction of displacement in case of luxation injuries. In case of fractures their relation to the gingival sulcus area is noted as well as possible pulp involvement.
• Pulp testing (usually electrometric) completes the clinical examination.

Radiographic examination

• The completed clinical examination has now identified the trauma region and this site should now be examined with relevant radiographic techniques. Multiple radiographic procedures are needed to detect displacement of the tooth in its socket as well as presence of root fractures.

With advanced skills, techniques and technologies we can save injured teeth. Find an emergency dental Centre right away!