Injury to primary (baby) teeth is very common, especially among children aged two to three years old. This is because at this age, they begin to walk. However, their incomplete motor coordination (hand and leg movement) often leads to multiple falls.
As young children have only basic defence reflexes, they are vulnerable to head and tooth injury during fall. In addition, at this age, the brain of the child is developing. Hence, the size of their head is relatively bigger compared to their body size (high head:body ratio).
This physiological development stage puts young children at risk for head and dental injury. Reports show that the prevalence of traumatic injuries to baby teeth among children less than six years old varies, ranging from 11% to 30%.
Studies also report that the most commonly affected teeth are the upper deciduous incisors (front teeth) owing to their front position in the dental arch, with the most common cause being accidental falls during walking.
Among the types of injuries to baby teeth, intrusive luxation represent about 4.4%-22%. Intrusive luxation is the displacement of a tooth into the bone socket (tooth is pushed into the socket) and is usually accompanied by an alveolar bone (surrounding bone) fracture.
Intrusive luxation is considered one of the most severe types of tooth injuries. A case in point: A three-year-old boy accidentally fell down at home while running with his siblings, his face hitting the floor.
The mother brought him to a dental clinic immediately and upon check-up, his upper front teeth were intruded. The teeth were not loose and did not interfere with his bite.
A dental radiograph (x-ray) was taken to make sure there were no other injuries. He was reassured and reviewed accordingly.
In managing such types of injuries, it is important for the dentist to discuss and explain to parents the treatment options and possible complications. The most common choice of treatment is either extraction or monitoring for spontaneous re-eruption.
Dentists should also consider the behaviour of the child, any underlying health concerns, and associated injuries, if present, before proposing treatment options to the parents.
Children presented immediately after trauma are usually still in shock, and mostly not cooperative for invasive, extensive treatment. In this case, if there are no urgent concerns, it is best to delay the treatment.
Extraction of the intruded tooth can be carried out if the tooth is loose and/or interfere with occlusion (bite).
As the tooth is pushed into the gum, not much of the crown can usually be seen. This poses difficulty in holding the tooth with dental forceps, making extraction difficult. Extraction may also cause further damage to permanent tooth buds, which lie very close to the root of baby teeth.
If the tooth is not loose and there’s no occlusal interference, it is best to wait for spontaneous re-eruption. Studies show that re-eruption can occur within one to six months after injury.
During this period, clinical signs such as pain, loosening and change of colour of the tooth should be observed. In the case of an intruded baby tooth, developmental disturbances of the permanent tooth bud occurs in up to 69% of all the cases.
This is due to the close relationship between the developing permanent tooth bud and the root of the baby tooth. At six years of age, the distance between the root of the primary incisor and the permanent tooth bud ranges from 2-3mm.
The affected permanent tooth may present as hypoplasia (discolouration and/or defects of crown), dilacerations, arrested root formation, odontoma-like malformation or ectopic eruption.
What parents or guardians need to do in an event of a dental injury to children:
1. Don’t panic.
2. Make sure the child is safe and in no harm.
3. Find tooth fragments, if any.
4. Bleeding is expected, and it may be profuse if there is trauma to the lip. Apply pressure to the lip to reduce bleeding.
5. Bring the child to a dental clinic/emergency department immediately.