My child’s tooth is broken or knocked out

Before any thing we have to say that these cases need to be managed by the pediatric  dentist  as soon as possible in a matter of minutes if possible so don’t waste time don’t wait an appointment with a busy dentist just find the nearest and the most available one.

Causes of teeth trauma and breaking in children:

Teeth trauma begins when child is able to move and run. So it begins about 18 m of age.causes includes toddlers trips and falls,older children bicycle accidents and school fights even contact sports in early teenagers.

Trauma in children can affect both milk (primary) and permanent teeth prognosis and treatment differ according to wither the traumatized tooth is permanent or milk teeth .

First we have to know what is milk teeth. Milk teeth is temporary teeth which is replaced later by others (permanent teeth)

Trauma to permanent teeth in children:

Trauma can break the child the tooth  in different ways

• Breaking can happen to tooth enamel (external layer of tooth hard material) only.
• Breaking in tooth enamel and dentine(the internal layer of tooth hard material) without pulp(tooth nerve) exposure.
• Breaking in tooth enamel and dentine(the internal layer of tooth hard material) with pulp(tooth nerve) exposure.
• permanent child tooth root breaking.
• permanent child Tooth traumatized but not loosened.
• permanent child Tooth move little in it’s place without getting out.
• Tooth is knocked out from the mouth(avulsed).

So the case management depend on he degree and position of fracture

If the traumatized child tooth remain in place:

Rule of mother in broken or loosened child tooth :

1-Don’t panic it will be treated with no problems at all.

2-Try to visit your dentist as soon as possible(matter of few hours) any delay can cause the tooth pulp( nerve )to die which will cost more time and money.

what will the dentist do to treat broken tooth:

Role of pediatric dentist:

Immediate treatment:

The dentist will relief the pain first then if the fracture is within the dentine or exposing the child tooth nerve the dentist will try to protect the pulp by covering it with special therapeutic material .

If there is any lip tongue or cheek wounds the dentist will have to suture it .

Fixation of mobile teeth if present.

Intermediate treatment:

If the tooth pulp is affected the dentist will have to perform root canal treatment of the broken tooth.

Permanent treatment :

crown, replacement of the lost teeth, orthodontic therapy to close the spaces or removable or fixed prosthodontics.

If the broken tooth is AVULSED (the tooth knocked out completely with its root  ):

Role of mother in case of avulsed tooth of the child:

1-put the knocked out child tooth quickly in milk or normal saline  without touching the root(to conserve the cells that present on the root surface from dying )

2-You have to reach to the dentist in less than 30 min- 1 hour maximum to give him a chance to reimplant the tooth in place again if the knocked out child tooth is reimplanted in more than 2 hours the reimplantation will probably fail.

Role of the dentist:

The dentist will just place the tooth in its place again and fix it in any way giving the tooth a chance to heal. then may be the tooth will need root canal treatment afterwards.

Trauma or breaking of child milk (primary) teeth:

The main concern here is to protect the growing permanent  tooth germ that is located just behind the milk teeth root. The injury to child milk teeth due to trauma is usually pushing of the tooth inside into bone, or the tooth knocked out completely out of the mouth or child tooth loosened

the treatment in that cases is usually extraction if the x ray show that there is a problem close to the permanent tooth germ . If the permanent tooth germ is away from the root then the case should be left with no interaction and the dentist have to check the case periodically till the milk tooth is replaced by the permanent one .

The author

MY LOVELY WIFE

Dr R. Nagaty

pediatric dentist