Children

Dental trauma, primary teeth

Trauma to the primary teeth is most common during the toddler years, when the child is first learning to walk. Most commonly, coffee tables are the source of direct trauma, and the maxillary incisors are the usual victims. Since the developing jaw bones of a toddler are relatively pliable, like a green tree branch, trauma to the primary teeth most often displaces them through the jaw rather than breaking them. This is not always the case, however.

Luxation Injuries

Forceful displacement of a tooth from its normal position in the jaw is known as "luxation". There are four common types of luxation injury: intrusion, extrusion, labial luxation and lingual luxation. The latter two are sometimes called "lateral" luxation injuries.

Intrusion Injuries

Intrusion injuries occur when the tooth is driven further into the jaw along its long axis, making the tooth appear shorter. Intrusion of primary teeth can be one of the most dangerous types of luxation injuries, because of the potentially harmful effects on developing permanent tooth buds in the jaw beneath them.

A lateral anterior radiograph (an X-ray image exposing the child's profile) is generally used to assess the position of the intruded tooth relative to the underlying permanent tooth. If an intruded primary incisor tooth is contacting a permanent tooth bud, the primary tooth generally requires removal. If damage has been done to the developing permanent tooth's crown, it will often not be evident until the tooth erupts into the mouth a couple of years later.

The most common complication noted in the underlying permanent tooth when it erupts is a discolored spot, where inflammation from the intruded tooth dissolves away a portion of the permanent tooth's crown. Treating it is generally straightforward, and can be accomplished by bonding of composite resin filling material, or placement of a veneer. Sometimes discolored spots can be bleached when the patient is older (assuming they are not treated with a filling or veneer first).
Learn more: Glossary › Bonding
Learn more: Glossary › Composite resin
Learn more: Procedures › Bleaching
Learn more: Procedures › Veneers
Learn more: Diagnoses › Enamel hypoplasia

If the intruded primary incisor is not touching the permanent tooth bud beneath it, but instead its root is displaced labially (toward the child's lip), the tooth is generally allowed to re-erupt on its own, without treatment. Approximately 90% will re-erupt within 3-6 months, although the injured tooth's root canal may be completely calcified with reparative dentin produced by odontoblast cells of the pulp. This means little or no living tissue remains inside the injured tooth, and its hollow interior is now virtually solid. With primary teeth, this is generally of no consequence, and the tooth will usually resorb and exfoliate (fall out) normally.

Patient follow-up for intruded teeth is usually recommended on approximately monthly intervals until the tooth is completely re-erupted. After re-eruption is complete, the follow-up interval is commonly about 3 months. Often an occlusal or periapical radiograph will be exposed at each visit to evaluate the tooth for signs of inflammation or infection at its root tip. This will generally be visible as a dark area around the injured tooth's root tip. The dentist will also check for a "parulus", or gum blister, which indicates infection.

If either of these is noted, the tooth will generally be removed. Frequently primary incisor teeth which are lost prematurely will not be replaced. If esthetics are a concern, a removable denture or fixed denture called a "Nance" appliance can be made for the child. Removable dentures are usually not made for children under 3 years of age, because young children are usually incapable of understanding the purpose or complying with proper use of a denture.

Lateral Luxation Injuries

Labial and lingual luxation injuries (collectively known as "lateral luxation injuries") generally involve serious damage to the tooth's periodontal ligament—a suspensory apparatus consisting of elastic fibers that hold the tooth into the jaw bone, and cushion it against minor forces like those applied by chewing. The attachment fibers are not designed to cushion the tooth against forceful blows. The periodontal ligament also houses blood vessels and nerve tissue.

Lateral luxation injuries also frequently damage the tooth-supporting alveolar bone, although in primary teeth and incompletely developed permanent teeth, pulp death occurs less frequently. It is common for pulp canal obliteration (through rapid reparative dentin formation) to occur following luxation injuries of primary teeth and incompletely formed permanent teeth.

If a primary tooth sustains a lateral luxation, the dentist may recommend re-positioning it and splinting it in place for approximately two weeks. Some dentists prefer to remove the tooth to avoid the potential of it falling out and being choked upon or aspirated (inhaled into the lungs), either of which can be a serious consequence.

The decision is based on how far the tooth has been displaced, which direction, how much remaining root structure is present, the age of the patient, the presence and proximity of the underlying permanent tooth, and the dentist's treatment philosophy. Other individual factors may apply.

Concussion Injuries

Primary tooth concussion injuries occur when a tooth sustains a relatively minor blow that neither displaces nor chips it. Often, the tooth is not mobile, but is tender to percussion and often to biting. If the tooth exhibits minor mobility, it is generally not splinted, and avoidance is the only treatment necessary.

If the child complains of pain, the bite can be adjusted such that no direct chewing pressure can be applied to the tooth. Avoidance of the tooth during chewing will typically prevent the child from complaining further. Generally, concussion injuries have a good prognosis, but follow-up is important to rule out development of infection and/or chronic inflammation.

As with all types of dental injury, it's a good idea to have a baseline X-ray exposed soon after the injury occurs, if a recent image is not available (how soon depends on the severity of the injury). A baseline X-ray image is the standard against which potential changes due to the injury can be compared. The earliest radiographic changes would appear no sooner than 3-4 weeks, and often longer than that. Usually, once the tooth has been diagnosed with a concussion injury, the first follow-up occurs at about 6 weeks following the injury. A second follow-up with an X-ray image occurs at around 3 months, a third at six months and then annually after that. Your dentist's recommended follow-up schedule may vary from this.

Avulsion injuries (tooth knocked completely out)

Information about avulsed primary teeth is located under Symptoms.
Learn more about avulsion of primary teeth: Symptom checker › Avulsion injuries