• drToothChampion

5 things about dental trauma in children/teenagers

Dental trauma (aka injury to the teeth) can range from minor to major injuries. In children, the effects of a dental trauma is complicated by growth. The gums, teeth and bone surrounding the teeth will continue to change as the child grows. Careful consideration is needed when planning the restoration of the child’s dentition after a trauma. There are a lot of information available regarding managing dental trauma. In this section, we will explore the lesser known aspects of dental trauma, why treatment may differ for younger patients and what can we do to reduce the risk of dental trauma in some children.


1. THERE ARE LONG-TERM COMPLICATIONS FROM DENTAL TRAUMA

With most dental injuries, the healing that follows soon after the acute management may appear to be ok. However, it is important to follow up with your dentist on the trauma because there are complications which can appear overtime. These complications don’t appear immediately, sometimes taking up to months or years later before they become apparent. Here are the three possible long-term complications of dental trauma:


a. Discolouration

The most common complication is discolouration of the tooth. You may notice that the injured tooth has changed to either grey or yellow in colour. Grey or yellow discolouration may indicate that the tooth is not vital (ie dead) so further investigations and treatment may be necessary. This can happen to either baby or adult teeth.


b. Swelling (or abscess) of the gums

If the tooth does not heal following an injury, the tooth can become dead. One of the notable signs of tooth death is a swelling at the gum above the injured tooth. The swelling may appear white filled with pus or may just look like a little gum pimple. In some cases, the swelling may appear years after the trauma has happened.

Broken tooth (blue arrow) with gum infection (yellow arrow)

c. Ankylosis (fusion of tooth to bone)

For young adult teeth that have been knocked out completely and placed back into socket (termed as avulsed then replanted), or intruded (pushed into the socket) severely, there can be a risk of damage to the surrounding root surface of the tooth. The damaged root surface would fuse to the surrounding bone resulting in stunted tooth growth. This is known as ankylosis. What you will see in akylosis is that the gum level of the injured tooth is higher than that of the gum level of the other teeth. This is because the gum at the affected tooth does not “grow” with the rest of the teeth as the jaw develops. This will present more obviously in children who are growing but it can occur subtly over a period of months to years. Regular review with the dentist is important to identify this issue early and manage it accordingly. If not managed early, the tooth will appear stuck higher up while the other adjacent teeth continue to grow normally as the jaw grows. This will give rise to aesthetic problems in future.

Appearance of early ankylosis

2. REPLACING A MISSING TOOTH IS NOT STRAIGHTFORWARD IN A GROWING CHILD

For a young child, if the permanent tooth had been knocked out of the socket completely, the best solution is to replant the tooth back into the socket as soon as possible. However if the tooth is not replanted back into the socket, the child will have a gap arising from the missing tooth. Although implants are quite commonly used in adults to replace missing teeth, implants cannot be placed in young children or growing teenagers until they are about 21 years old. This is due to growth of the jaw and dentition before 21 years of age so an implant will not grow in harmony with the jaw. Therefore, in the meantime, temporary replacement in children would include a removable plastic denture. A child who has lost his/her permanent tooth early will have to wear a denture for a long while, and it will need to be replaced periodically as the child’s jaw grows and changes. A temporary bridge may be an option when the child is in the teens. It is important for parents or caregivers to continue to motivate the child and help him/her overcome the initial discomfort of wearing a denture or bridge so that he/she can adapt to it well.

A denture to replace 2 missing teeth (marked as black dots). View from front (left) and from roof of the mouth (right)

3. A CROWN IS NOT A FEASIBLE OPTION FOR GROWING CHILDREN

Fracture of teeth can occur during a traumatic injury to the face. Some tooth fractures may be more extensive than others, with some fracturing by more than half of the tooth. To save the fractured tooth and regain aesthetics, a restoration is required. In adults, the management for large fractures is to do a crown (ie a full cap around the whole tooth). A crown is usually stronger and retains better compared to a large normal tooth-coloured filling. However, in young children below the age of 21 years, the restoration would have to be a temporary one. A large filling is placed instead of a crown. This is because of the growth of the jaw complex, which includes the bone and gums surrounding the teeth. If a crown is placed in a growing child, there is a likelihood that the child will require a redo of the crown as the gums will mature overtime and expose the crown-tooth margin, thus compromising the aesthetics. A crown can be done when the child has stopped growing, typically around 21 years old. Therefore, a child with a large front tooth filling will have to be careful in the meantime as there is a risk of the filling fracturing or falling out since it is not very strong.

Restoring fractured teeth (left) in a young patient with an interim tooth-coloured filling material (right)

4. PROTRUDED UPPER TEETH INCREASE THE RISK OF DENTAL TRAUMA

Children who have their upper front teeth sticking out are at a higher risk of dental trauma, that means there is a tendency for these teeth to get injured when the child accidentally hits his/her face against the wall, pavement etc. In some of these cases, the risk can be reduced by having early braces treatment at usually around ages 9 to 11 years old. The early phase of braces may help to modify the jaw growth such that the front teeth will not stick out as much. In the meantime if your child’s teeth stick out but he/she is not ready for braces treatment yet, you may want to consider getting him/her a protective mouthguard if he/she is engaged in contact sports often.


Example of a sports mouthguard that can be moulded

5. CONSIDER THE USE OF A SPORTS MOUTHGUARD

Sports mouthguards are great to protect the teeth especially when your child is involved in contact sports (eg hockey, basketball, rugby, netball, football etc). For growing children, the mouthguards may have to be changed from time to time. Simple mouldable sports mouthguards with varying sizes can be purchased from sports stores. Alternatively, dentists can also make customized mouthguards for your child/teenager but this is a more expensive option although the fit would be better than those bought from a sports store.



93 views0 comments

Recent Posts

See All