Introduction

Accidents in children causing injury to the face, mouth and teeth are common. This happens either indoors or outdoors during fall, knocking against each other during play, sporting activities and road traffic accidents. According to a study, 1/3 rd of children below 5 years old and about 20-30 percent of children 12 years old had experienced injury involving teeth, and it affects males more than females.

If it happens to your child, you should consult a dentist as early as possible to ensure proper dental treatment is given.The dentist will examine the injured area and investigate further with taking radiograph.

Early care if injury were to happen

Immediate and prompt actions taken at the site of incident can reduce anxiety and pain and also salvage injured teeth. This can prevent early loss of teeth in the most important stage of growth and development of the child.

• In cases of bleeding, compress the bleeding area with cotton or clean cloth.
• In cases of pain, pack the area with ice wrapped in towel for 20 minutes.
• In cases where the area around the lip or face swells resulting from the injury, compress the area with cold towel to reduce the swelling.
• If pain persist, painkillers such as paracetamol or brufen can be obtained over the counter.
• As for mobile teeth, do refrain from taking hard food but instead substitute with porridge, bread and so forth.

In cases where the accident causes your child?s teeth to crack, chip or fracture, the tooth fragment can be kept and brought together to the clinic when you see the dentist. Cracked or fractured tooth must be treated immediately to prevent further damage. Usually, fractured tooth can be fixed to normal shape with the addition of tooth coloured restoration to the fractured site.

When to bring your child to the Emergency department?

In most hospital in Malaysia, there will be a dental doctor on call that will give emergency treatment after office hours.They will usually provide treatment at the accident and emergency department.

Bring your child to the emergency clinic if :

• You think that your child need to be seen or has a serious injury
• Bleeding uncontrolled even after you have compressed the bleeding area with gauze or cloth for ten minutes.
• Both the permanent and deciduous teeth are mobile when touched
• Teeth are out of its socket
• Teeth are out of position and causing difficulty in biting (deviated to the lips, deviated to the palate or intruded into the jaw bone
• Tooth is completely out of its socket.
• Experiencing unbearable pain.
• Your child is below one year old.

Managing anterior tooth that is knocked out of its socket.

If an accident happens to your child and cause the anterior tooth to get knocked out of its socket (avulsed), you can still save the tooth by putting it back into its own socket.This technique is called ‘reimplantation’. There are tips available to ensure success of the technique.

Important Steps

• Hold the tooth by its crown
• If the tooth is clean, gently push it back the right way round into its socket.
• If debris is present, gently rinse with running water
• Once the tooth is in place, get the victim to gently bite on a clean handkerchief to hold the tooth in place
• Go to the dentist immediately to seek treatment.

Don’t / Never

• Never touch or handle the root portion of the tooth
• Never scrub the tooth and root surface.
• Never clean it in disinfectant or detergent
• Never wrap the tooth in tissue paper or a handkerchief.
• Never waste time in seeing a dentist .
• Never bring the tooth dry,wrapped in cloth or tissue paper.
• Never bring/transport in tap water.

Note: The most suitable transport medium for the tooth before taking it to the clinic is the tooth own socket.

In Cases Where It Is Not Possible To Re – Implant The Avulsed Tooth Into Its Original Position Immediately:

• Keep tooth in a proper fluid before taking it to the clinic

The Suitable Transport Medium:

• Fresh or UHT milk and not condensed or powdered milk.
• Phsiological saline ( 0.9 % sodium chloride ) . Do not attempt to make your own saline solution.
• Saliva-get the child to spit into a clean container.

In the event that the above media are unavailable,

• The tooth should be placed in a clean plastic bag for transportion to ensure that the tooth is kept moist.
• The tooth may also be placed in the buccal sulcus, However, this is not recommended for fear of accidental swallowing or aspiration

REMINDER : The critical factor for transportation is to keep the tooth moist at all times.Never transport the tooth dry.

Conclusion

Quick and appropriate actions taken at the site of accident can result in reduce anxiety and pain and the tooth being “saved” for a considerable period of time. It can prevent early loss of the tooth during the important growth and development period of the child.