Teeth are more than simply a means to break food down into manageable, digestible, nutritional size in polite company.
Their function is much broader than the marvels of mastication: teeth maintain an open and unobstructed airway to allow us easy breathing; they shape the kinetics of our speech. They’re the vertical foundation for the dimensions of the face we present to the world.
And whether we like it or not, the aesthetic appeal of that face relies heavily on the appearance of our teeth.
For an adult, it’s indescribably humbling to slowly lose the attractiveness of a beautifully straight, white smile through nativity and neglect. Regaining it would require enormous amounts of both courage and cash; not an enviable position for anyone to find themselves in.
Imagine instead, being a kid.
Losing what they haven’t even had much of a chance to have; and not gradually, but in one traumatic moment. An instant of wrong timing, wrong place, wrong balance, wrong speed. An irreversible wrong. A wrong that a million heartfelt wishes from family and friends are impervious to its undoing.
It’s a sobering statistic that before they reach adolescence, around three-in-ten children have suffered dental trauma of some kind.
Naturally, the most affected teeth are the front ones (the upper central anterior) because of their prominent position. The highest occurrence is in the 8-to-10 year old age group; and it used to be more prevalent in boys than girls. That’s not necessarily the case any longer. With girls more involved in contact sports and less fearful of risk-taking activities, it’s a gap that’s closing.
Like the one dentistry deals with where their front, or eye teeth once were.
The most common causes are trips, slips and falls, bike and scooter accidents, sports injuries, and playground mishaps. The severity covers quite a range, with all requiring emergency dental treatment.
The least serious are cosmetic, where the enamel fractures with cracks or chips. Deeper fractures involve not only the enamel but dentin too – the layer of tooth underneath – and they can be painful.
Then we move on to the significant injuries, of which there are heartbreakingly too many. Each necessitates truly urgent clinical care.
Because of their immature roots, young patients with crown fractures exposing tooth pulp are typically treated by capping and a wont to preserve the inner tooth. Delaying treatment can mean inflammation or infection, and a partial or complete pulpotomy.
Root fractures affect tooth stability. If splinting isn’t a viable option, extraction becomes the only choice.
Any displacement of a tooth from its socket is known as a luxation injury, and these can be anything from slight movement to having the tooth completely knocked out. Immediate re-implantation gives the best chance of saving the tooth, but unfortunately it’s not always the outcome.
Intrusion trauma pushes a tooth into the jawbone. It’s a horror image and an extremely serious injury. Damage can occur to the dental nerves and the developing permanent teeth, if in fact it isn’t one.
Early diagnosis and intervention are critical with any oral injury.
Preserving nerve viability and preventing further complications of chronic pain or sensitivity, are paramount. Tooth nerve damage can have dire repercussions – including inflammation and necrosis of dental pulp, and disruption to the normal progress of permanent teeth. (If in fact it isn’t one.)
Internal resorption is also a risk, where there is tooth structure loss from inside the tooth.
They’re terrible injuries with intricately involved restorative procedures. Management extends beyond the dental rehabilitation: the psychological health of these children is also greatly impacted. The combination of shock, pain and intervention processes would all be more than challenging for an adult to deal with, let alone a little kid.
Dental trauma treatment plans of course depend on the severity and type of injury, in conjunction with the child’s age and tooth being either primary, or permanent.
Initial assessment comprises clinical examination, intraoral imaging and pulp vitality tests.
The cleaning and sealing of exposed pulp, repositioning and splinting of any displacements, and reinsertion of permanent teeth are some of the emergency interventions that are carried out.
Rarely, are antibiotics and pain relief avoidable.
Regardless of the probability of treatment being a combination of the likes of surgery, pulp therapy, composite bonding, crowns, veneers or orthodontry there’s long-term monitoring, and often sustained trauma.
The hugely distressing event, the emergency experience, and the visible difference in the way a child looks to themselves and others are aspects dentists are acutely attuned to, and professionally skilled in managing. They hold a crucial position in the physical and psychological outcomes, and work with paediatric therapists to achieve optimal results for their young patients and their parents.
Child-friendly explanations and gentle communication are just the basics of many techniques in which dentists are trained to alleviate fear and anxiety. A child’s self-esteem can certainly be impacted by such a miserable ordeal.
Surrounding and supporting them with empathetic clinicians and their teams transforms bewilderment to bravery. It’s a place where the awful incident is absolutely acknowledged, and what’s commended and focused upon is their incredible and ensuing courage.
These professional adults that they’ve grown to trust, take them by the hand to both figuratively and physically walk them from past and present discomfort and pain, to an awaiting future that’s free of all that; excited to see a small person with such giant fortitude and huge determination.
It’s a huge journey no kid should have to take.
Nor would they, were it at all possible to prevent dental injuries in their entirety. It’s not; there are only risk-reducing strategies.
Mouthguards for sports. Suitable supervision. Encouraging spacial awareness. Education on emergency response.
Stuff that would be perfectly easy in an ideal world, because in an ideal world kids don’t get hurt.
They are resilient though. They can, and they do recover. What helps them most is how their parents and the people around them respond. It’s a matter of whether they see them moving through it, or sitting hopelessly within it.
All you can do is prepare. If you’re ever at the front end of front end dental trauma, you want to have already mapped the best road. It’s a helluva ride.
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