Dental emergencies are common in children and it can refer to pain, bleeding and other kinds of trauma to kid’s teeth. A serious dental emergency can be caused by falls, accidents and fights resulting in a knocked out, broken, chipped or cracked teeth.  Milder to severe forms of dental emergencies include dental pain, swelling and bleeding caused by various kinds of bacterial diseases such as pulpitis, painful caries, pericoronitis and abscess.

Dental Trauma

Dental trauma is very common in children (especially between 5 to 12 yrs old). Up to one-third of five year olds lose one or more baby teeth due to trauma.  Up to one-fourth of twelve year olds lose or damage one or more permanent teeth due to trauma. Different types of dental trauma include: knocked out teeth (called "avulsion"), cracked, chipped or broken teeth, and loose teeth.

1.      Knocked out teeth

If the child’s permanent tooth is knocked out, parents should ensure that they preserve the tooth. First, the tooth should be rinsed gently in water. It should not be cleaned with soap or any other liquid. It should not be rubbed or touched in order to prevent removal of ligament fibers required for successful re-implantation.  If possible (and if the child cooperates) the tooth should be placed back in the socket. If this is not possible, the tooth should be placed in milk, water with a little salt, or simply a moist cloth. The child (plus the tooth) should be taken to the pediatric dentist’s office or the emergency room immediately. The quicker this is done, the higher the chances for saving the child’s tooth.

In the case of a knocked out baby tooth, the child should be evaluated by a pediatric dentist. However, the child’s baby tooth will not be replanted due to the potential damage caused to the developing permanent teeth.

2.      Cracked or chipped or broken teeth

In case of cracked or chipped tooth, parents should ensure that they find the tooth fragment(s) and place them in cold milk, water or in a wet cloth. The child’s mouth should be rinsed with warm water and made sure that no fragments are caught between the other teeth or gums. Cold compression can be applied to reduce swelling if the lip is injured as well. Often teeth fractures like chipped or cracked teeth, limited to enamel and dentine damage may not require admission to ED. However, it is recommended that the child be evaluated by a dentist to make sure that the pulp of the tooth (centre of the tooth) is not affected and for verifying the viability of fixing the cracked or chipped tooth.

If the tooth is broken badly affecting the centre or the pulp, it may require immediate action to prevent infection and to ease severe pain. The child’s (plus the preserved tooth) should be taken to the pediatric dentist office or the emergency room immediately for tooth extraction and for the possibility of fixing the broken tooth.

3.      Loose teeth

Sometimes dental traumas may result in loose or displaced teeth. In cases where the tooth is extremely loose affecting normal chewing, then it may require extraction or repositioning. This should be discussed with the child's dentist

Dental Disease

1.      Pulpitis

Cavities or tooth decay (dental caries) is a bacterial disease of the teeth which when worsens becomes dental reversible pulpitis (mild inflammation) affecting the center of the teeth. Signs of dental caries may appear as opaque white areas in centre of the tooth while signs of pulpitis are severe plagues and cavities. Usually pulpitis is not considered a dental emergency for pain emerges only when exposed to hot or cold liquids or sweet stimulants and often resolves on its own. However, if reversible pulpitis is left untreated it may develop into irreversible pulpitis causing severe inflammation of the pulp and persistant pain. Irreversible pulpitis is a dental emergency requiring tooth extraction or root canal treatment.

2.       Periodontitis

Periodontitis is a disease which affects tissues surrounding the teeth such as gums, gum line, bone and ligament. Irreversible pulpitis sometimes lead to periodontitis affecting the roots of the teeth.  Periodontitis is severe inflammation causing excruciating pain which is constant and spontaneous. Immediate treatment is root canal treatment and tooth extraction.

3.      Abscess

When a bacterial infection develops between the root of the teeth and the gum line, it results in abscessed teeth. Abscessed teeth cause swelling in the gums and gum line with or without pus formation.  If the pus drains a little on its own, pain may be mild. Other symptoms include redness and irritation of the gums, swollen neck glands, general feeling of illness and bad breadth. Immediate treatment would require draining of the pus along with root canal treatment and tooth extraction.

Preventing dental diseases and trauma

Dental diseases and dental trauma can be prevented in children by following certain guidelines:-

Dental disease prevention

• Parents should develop the habit of brushing teeth in children with fluoride toothpaste.
• Children should be limited soft drinks or fruit juices which are high in sugar
• The milk children drink should be high in calcium and low in fat and sugar
• Regular dental checkups for kids is essential

Dental trauma prevention

Parents should ensure that children use mouth guards and face shields when indulging in sports activities like rugby, baseball, football, etc. Parents should also make sure that children wear helmets when riding bikes. Many falls while riding bikes or skates result in dental trauma which can be serious. Wearing seat belts in cars is a must for kids.

A note for parents

If the child has a cavity, gum problem or other kind of dental problem, seeing a pediatric dentist is essential. Early dental evaluation is better than delayed treatment. The pediatric dentist will determine the treatment plan based on the child’s age, extent of the disease and other medical history. The child’s tolerance for treatment, therapy and medication will also be considered before arriving at the treatment plan.

Parents should not hesitate seeing a pediatric dentist assuming that their child is too young for dental treatment. Regular dental checkups and following the treatment plan as suggested by the pediatric dentist is best for the child’s oral health and overall well-being.

Written by: Irene J

Edited by: Michael K. Davis, MD

References

1.      American Academy of Family Physicians, 2003, Common Dental Emergencies,

http://www.aafp.org/afp/2003/0201/p511.html

2.      American Academy of Pediatric Dentistry, 2010,  Emergency Care

http://www.aapd.org/publications/brochures/ecare.asp

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