Dental Trauma hits home, because I am an orthodontist that suffered a serious accident as a child during my routine bus ride to school. It created a career passion and something that I am considered to be an expert in my profession, based on my specialized training to manage accidents.
Dental Injuries – Epidemiology
- An average of 22,000 accidents occur annually among children, less than 18 years of age
- Over 80% of all dental injuries involve the upper teeth
- 30% of Pre-school age children have a dental injury of some kind
- The most common sports injuries are in baseball, basketball, fights, vehicular & women’s volleyball reporting high numbers
- Children with primary teeth, less than 7 years of age, sustained over half of the injuries in activities associated with home furniture
- Outdoor recreational products and activities with related dental injuries are among children ages 7-12 years of age (ie. trampolines)
Trauma (Tooth CPR) Immediate Response
A Quick 5 Step Guide to help you determine what to do:
- If there are any concerns for medical attention- Always seek first by calling 911 or visiting your closest trauma center/emergency facility. Never dismiss a head injury, even if there is blood involved.
- Partially Avulsed teeth/fractured teeth- call your orthodontist or dentist immediately. If the trauma involves the loss of tooth -determine if it is a baby tooth or permanent. Baby teeth should never be reimplanted, but consult immediately with your general dentist or call your orthodontist that specializes in trauma. If a tooth cannot be located, mandate a chest x-ray to rule out aspiration(inhaling tooth) at your local ER center.
- The key factor to dental trauma success is minimizing the amount of time that the permanent tooth is outside of the mouth(avulsion). Success rate is directly related to re-implantation within 5-30 minutes. Rule of thumb- 1% of successful reimplantation lost for every 1 minute out of socket (dry). NEVER dry /clean tooth or clean(even if dirty). Immediately submerge tooth in any isotonic solution which could include: milk, contact solution, or breast milk, or room temperature water(poorer result) to name a few. Storage of tooth in a liquid medium will buy you time. Regular milk has been seen in cases to be almost as good as an immediate re- implantation. Do not handle root surface- only touch clinical crown if possible. If tooth is outside of mouth, call your oral surgeon or periodontist for reimplantation.
- If tooth is partially avulsed(not out of mouth) -Call your dental specialist and inquire if they technology to take a 3D radiographs orCBCT(Cone Beam) to determine if tooth is fractured and if splinting is necessary. Splinting is stabilizing the tooth for 2-3 week period with a semi-rigid medium/wire. Orthodontic braces count as stabilization, if seen by a trained specialist in the recommended time above. There are a high number of false negatives reported with traditional dental x-rays
- Root resorption(deterioration) is directly associated with the amount of time the tooth is outside of the mouth or untreated(storage medium dependent) For example: Shorter time = Better Prognosis. Root resorption should be monitored by your dental specialist. NO activities are suggested during splinting of teeth.
Tips for success:
- A mouthguard must be worn immediately following injury
- Root Canal Therapy is a high possibility and your dental specialist should guide you when to seek a consult. The endodontist will traditional follow guidelines/protocols associates with the AAE(American Association of Endodontists)
- Remember that a hopeless tooth is not a Worthless tooth, because children typically cannot have dental implants placed until after the cessation of the individual’s craniofacial growth around the age of 19-22
- Locate a Board Certified Specialist by researching online
Thanks to Dr. Joseph K. Vargo, a Board Certified Orthodontic Specialist from Vargo Orthodontics, for his insight into dental injuries.