What to do if your child loses a tooth in an accident

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Talking about traumatic oral injuries, one of the most distressing experiences for a child is to have a permanent front tooth knocked out. This may happen as a result of a sports mishap, a fall inside a home, or other trauma.

Every tooth has a protective layer surrounding the root, which is called the periodontal ligament. The periodontal ligament is very sensitive, and will quickly dry out and die unless the tooth is immediately placed in a protective solution, such as milk or saline.

With every minute that the tooth is left out of the mouth to dry, more cells in the periodontal ligament will die. The best way to preserve a tooth which has been knocked out (avulsed) is to put it back into its socket as quickly as possible. If that is not possible, the tooth should be placed into a protective solution.

The goal of reimplanting the tooth into the socket is to preserve the health of the tooth's outer periodontal ligament. If the cells of the periodontal ligament are allowed to die, the child will eventually loose the tooth. If it is replanted within 30 minutes after injury, a greater than 90 percent success rate may be achieved; whereas if delayed more than two hours, the failure rate approaches 95 percent.

Parents confronted with this emergency situation can: * Find the tooth; * Handle the tooth by the top only, do not touch the root of the tooth. Don't rub it or scrape it to remove dirt; * Gently rinse the tooth in a bowl of tap water. Do not hold it under running water; * Insert the tooth into the socket gently. Then bite down gently on gauze or a moistened tea bag to help keep it in place. Do not be concerned if the tooth extrudes slightly; * If you cannot replace the tooth in the socket, immediately place it in cow's milk, your own saliva or a warm mild saltwater solution. Milk is the best transport medium to maintain periodontal ligament viability; * Go to the dentist immediately.

After the tooth is reimplanted, it must be immobilized (splint) to stimulate reattachment. Complication can happen one week later or as late as several years later. Close dental followed up is indicated. In children most dental injuries will happen while the child is participating in a contact sport, i.e. football, basketball, baseball, rugby, and American football.

To minimize dental injuries every child who plays contact sports should always wear a mouth protector. Infants most commonly suffer trauma from falls that involve contact with furniture. Consequently it is particularly important to child proof the areas of the house where the infant may be playing and running.

Dental injuries occur about twice as much in children with protrusion of teeth (bucked tooth) compared to children with normal occlusion and should be evaluated by a pediatric dentist or orthodontist.

An important consideration to remember when children have dental trauma is that they may have also sustained head trauma, hence neuralgic assessment is warranted.

Tetanus prophylaxis (tetanus shot) should be considered with any injury that disrupts the integrity of the tissue lining the oral cavity.