A PARENT’S GUIDE TO PEDIATRIC EMERGENCIES
To round out a series of blogs on child and adolescent dentistry, I would like to include a discussion on pediatric dental emergencies. Traumatic and non-traumatic dental emergencies can be stressful not only for the child but for the parent as well. Tooth emergencies can occur suddenly and can lead to significant pain and discomfort if not treated right away. Sports, running, jumping, climbing and bicycling are just a few of the activities that increase the risk for medical and dental emergencies in children. Also, 80% of all dental injuries affect one or both front teeth.
Traumatic injuries can be accompanied with bleeding lacerations, knocked out, dislodged, or fractured, broken teeth. What is done immediately following an injury can make the difference in saving or losing a tooth. The following recommendations will help save teeth and minimize pain and further complications.
In the event of any dental emergency, it is recommended to see a dentist as soon as possible. If lacerations, cuts, and bleeding are present, it is recommended to go to the emergency room.
AVULSION: KNOCKED OUT TOOTH
When a permanent tooth is knocked out completely, it is important to:
1. Find the tooth. TOUCH ONLY THE CROWN. DO NOT TOUCH THE ROOT.
2. Rinse the tooth quickly (10 seconds) under running water and reposition the tooth into the socket, as straight as possible.
3. Have patient bite on towel or cloth to help hold the tooth in place
4. If it is not possible to replant the tooth, place it between the gum and cheek in patient’s mouth, or submerge in milk and transport to the dental office. DO NOT SOAK IN WATER.
Save-A-Tooth is an over- the-counter tooth saving kit that can be purchased and kept closely available in the event of an emergency at home or sporting event. For approximately $20 the tooth is stored in a container with a preserving solution while transporting to the dental office.
REMINDER: Do Not Touch the Root if possible.
It is not necessary to replant a baby tooth. Try to locate the tooth and bring with you to the dental appointment ASAP. The dentist will assess treatment recommendations after examination.
INTRUSION/EXTRUSION: DISPLACED/DISLODGED TOOTH
It is recommended to reposition the tooth gently. Additional movement may cause the tooth to be lost so limit movement and stabilize.
Lightly rinse mouth of any debris. Seek help immediately from a dental professional. The dentist will properly and minimally relocate the position of the tooth and stabilize.
Lightly, softly rinse mouth of debris if present. If possible, locate the fractured piece and take with you to an emergency dental appointment. There are occasions when the fractured piece may be bonded to the existing tooth. Evaluation of the depth of the fracture will be determined by the dentist. If the fracture includes the nerve of the tooth, a root canal may be necessary to save the tooth.
If the jaw bone is suspected of being fractured, it is important to support and stabilize the jaw and minimize movement. Visible signs MAY include a shift of the jaw to one side or an inability to close at all. It is important not to force the jaw into any position. Seek medical attention immediately.
TRAUMA TO LIPS, CHEEK OR TONGUE
Trauma may come from a blow or hit but includes biting trauma, especially for a young patient after a dental appointment where anesthesia was used. Falls are common among younger patients, leading to split lips and tongue bites. It is recommended to:
1. Try to clean or softly rinse the laceration
2. Use COLD compresses to help control bleeding and swelling
3. Seek medical/dental attention immediately
It should be reassuring to remember that the mouth is highly vascular, giving way to the appearance of a significant amount of bleeding with trauma. This can be unsettling. Bleeding can be controlled with light to moderate pressure with a cold compress. The increase in vascularity helps the mouth to heal quickly and completely.
A TOOTHACHE: NON- TRAUMATIC
A toothache that develops suddenly and without trauma can often be associated with decay. Treatment can range from a simple filling to a root canal, crown, or even extraction. Ibuprofen is known to work well with toothaches and control nerve inflammation and pain. In some cases, an over-the-counter numbing gel may help to reduce discomfort, especially with primary or baby teeth. Make a dental appointment immediately to address infection concerns and to control pain.
Do not place an “aspirin” on the tissue, next to the tooth, as that will burn the tissue, creating more trauma and pain.
Reducing the degree of dental trauma and potential for crisis-oriented treatment is possible by purchasing quality mouth guards and making sure the athlete is WEARING them. Seeking regular dental care will allow for early detection of cavities and prevent the occurrence of toothaches. And finally, the avoidance of chewing hard items that may increase the likelihood of tooth injury is strongly urged. Chewing ice, popcorn kernels and hard candy are just of a few of the culprits contributing to fractured or chipped teeth. It is also recommended to avoid sticky substances (certain candies, some gum) that may help to loosen or pull out existing fillings and crowns.
Remember, we are always here for your dental needs. In the event of an emergency, please call our office. If after hours, you will be directed to an emergency number that will reach the doctor on call.
by Julia Guerra, RDA, BA