Tooth injuries in older children factsheet

Introduction

Children are often at risk of injury from things like falls, accidents, rough play, and sports. Teeth can often take the full force of a hit or fall, especially the upper front adult teeth.

Baby teeth will grow from the ages of 6 months to 3 years. Baby teeth will start to fall out around the age of 6 and, eventually, all be replaced with adult teeth by the time your child is 12.

Losing a baby tooth early from an accident is not usually a cause for concern, and treatment will focus on managing any pain or infection that an injury to the tooth or gum has caused. This factsheet contains information about injury to and loss of adult teeth in children.

Signs and symptoms

Children can often damage their teeth after a fall or hit during sports and play. If your child is injured, check their mouth for signs of a dental injury.

Signs can include:

bleeding in the mouth and gums
ache and pain coming from the gums or in the jaw
swelling of the mouth and jaw
difficulty opening the mouth and jaw properly
visible chipping or damage to the tooth
the tooth coming away from the gum completely with the root intact.

Cracked or chipped tooth - first-aid

If your child has chipped or cracked their tooth with sharp edges, you must try to find the piece of tooth and have your child bite on a damp washcloth or tissue. This will help them to avoid injury to their mouth and tongue.

Knocked out tooth - first-aid

If your child’s tooth has been knocked out of their mouth, you must:

find the tooth and pick it up, only touching the top or crown
if dirty, gently rinse in milk, saline, or your child’s saliva
if you can, place the tooth back in its spot in your child’s mouth, making sure it is facing the correct direction
if you cannot put the tooth back in your child’s mouth, put it in a glass of milk or a small amount of your child’s saliva
see your local dentist as soon as possible, or head to your nearest emergency department.

Never scrub or rinse the tooth root with plain or tap water as it can damage the tissue cells on the root that help the tooth to reattach to the jaw.

Diagnosis

Let your child’s dentist know if you cannot find the tooth or pieces of tooth, as your child may have swallowed them.

The dentist will check your child’s mouth for any signs of injury to the teeth and gums, including cracks and chips in the surrounding teeth. They will also take a medical history and ensure your child has been vaccinated against tetanus.

Tetanus is a serious infection caused by bacteria that live in soil and can be common in injuries that have not been cleaned well. It causes painful spasms and stiffness in the muscles, especially the jaw.

Treatment

If your child has chipped, cracked, or broken a tooth, the dentist will try to repair it and stop any further damage or infection. Depending on how severe the injury is, the tooth may need a:

filling – where different substances are used to fill in or repair the structure of a tooth
crown – where the tooth is covered with a special cap
root canal – where the roots of the tooth are completely cleaned out, and all pulp is removed to prevent further pain, damage, and infection.

If your child has knocked their tooth out, the dentist will attempt to put the tooth back in.

They may need a small splint to hold the tooth in place while it heals.

At home, you will need to make sure your child keeps their mouth clean by rinsing with warm salty water or antibacterial mouthwash as recommended by the dentist. After 2 weeks, the dentist will check the tooth and decide whether the splint can come off or if further treatment is needed.

Management

Problems with reattaching lost teeth

Teeth are made up of a hard outer layer with a soft inner layer called pulp. The pulp contains all the nerves, tissue and blood vessels that keep the tooth healthy. The tooth is connected to the jawbone by prongs at the bottom, called the roots. The roots are held in place by tiny bits of tissue called the periodontal ligaments.

When a tooth is knocked out, the periodontal ligaments are torn away. Some of the ligaments will still be attached to the roots of the tooth. When the tooth is replaced quickly, the periodontal ligaments have a better chance of reattaching and healing.

If enough of the tissue cells have died, your child’s body might reject the tooth. This is why it is important to:

find and replace the tooth quickly
only use milk, saline, or saliva to rinse the roots
never scrub the roots.

If your child’s body rejects the tooth, they may have symptoms like:

severe pain
swelling
gum recession – where the gum pulls away from the tooth and exposes the roots
difficulty eating and moving the jaw
the tooth becoming loose or falling out again.

If this happens, see your child’s dentist as soon as possible or head to your nearest emergency department.

Mouthguards

Dental injuries can be prevented by encouraging your child to take care during play and wearing a mouthguard during sports.

Mouthguards fit over the teeth and protect the teeth, lips, and gums during sport.

Mouthguards can be:

custom fitted to your child’s mouth by a dentist to give the best protection – the best for comfort and protection
bought from the chemist and semi-fitted to your child’s mouth by boiling the soft plastic – can be uncomfortable and should be replaced every few months
purchased ready-to-wear – can be very uncomfortable and provide the least protection.

A child can still wear a mouthguard even if they have braces.

The Australian Dental Association recommends custom-fitted mouthguards for the best protection in sports like:

The Australian Dental Association strongly recommends the use of custom-fitted mouthguards for sports, including:

basketball
BMX biking
cricket
gymnastics and trampolining
hockey – field and ice
horse riding
martial arts
netball
skateboarding
soccer
volleyball
water polo
water skiing
wrestling.