For kids, teeth can be a ‘magnet for trauma.’ Here’s what parents need to know about treating dental injuries.

Anthony DeFruscio is a very active 5 year old. Trying to keep up with his two older brothers, he plays sports and roughhouses. Unfortunately, Anthony’s teeth have borne the brunt of his gusto.

“About a year and a half ago, Anthony got hit in the face with a hockey puck that did some damage to his front upper tooth,” recalled his father, Jim, from Glen Mills. “Nothing happened at the time, but eventually it started turning a gray color.”

Anthony’s pediatric dentist took X-rays showing the permanent tooth hadn’t been affected. He said the baby tooth would die due to the impact of the puck, but there wasn’t anything that needed to be done, Jim said. Until it fell out, Anthony had to live with a gray tooth.

Then, this past summer, Anthony was playing with his brothers and that same tooth was hit again.

“The tooth cracked and started bleeding a little bit out in front of the tooth,” Jim said. Anthony’s dentist said the tooth was structurally fine and warned his parents to keep an eye on it.

Just two months ago, while playing football with his brothers in the backyard, the bottom of that same tooth cracked off completely, leaving a jagged edge. Finally, the dentist needed to extract the tooth.

“This tooth seemed to have a magnet for trauma,” Jim said.

In children under age 6, about 18% to 20% of all injuries are dental related, said Angela Stout, vice president of the Pennsylvania Academy of Pediatric Dentistry. The most common age group for tooth trauma is between 1 ½ and 3 because kids tend to fall a lot as they learn to walk and run. The upper front teeth are often most affected, though the risk of permanent damage decreases with age as permanent teeth develop more fully, Stout said.

“So for young children, try to prep your home as best you can,” Stout said. “Coffee tables and nightstands, and hardwood floors while the child is wearing socks, are some of the most problematic causes of dental injury in young children. Playground equipment is another example outside the house. But accidents may not truly be preventable. They’re called accidents for a reason.”

By ages 8 to 12, about half of all children have experienced some sort of dental injury, Stout said.

“That tends to be boys over girls and the most common injury for that age group is a fractured crown of the tooth,” she said. “Sports tend to make up about 39% of those injuries.”

Joseph Napoli, attending plastic and oral surgeon at Children’s Hospital of Philadelphia, said that for children playing sports, mouth guards are extremely important to help reduce the chance of injuries to the teeth.

When dental mishaps do happen, Napoli noted that they sometimes occur along with even more serious injuries.

“We have to make sure the child’s airway is OK and he has no other injuries, like a concussion,” Napoli said.

If it’s only a tooth that has been injured, contact the dentist right away. If a baby tooth is knocked out, you should not try to put it back in because that could injure the permanent tooth that’s underneath it, he said.

For a permanent tooth that’s knocked out, it’s best to rinse the tooth gently and try to put it back into the socket. But do not scrub it clean because there is fine tissue and ligaments on the root and if you scrape them off, it lowers the chance of the tooth surviving. If you aren’t comfortable trying to put the tooth back in, keeping the tooth moist is important until you can get to the dentist.

“Put the tooth in a small container of milk and immediately go to the emergency department or your child’s dentist,” said Napoli. “If no milk is available you can put it in the child’s saliva or a tooth saving kit.”

Napoli said coaches and parents of athletes should have tooth saving kits on the sidelines, which come with a solution for saving a knocked-out tooth, and can be purchased at drug stores. Milk is great, too, but not as easy to keep in a first-aid kit. The kits are inexpensive and can make a big difference.

The last resort would be to put the tooth in water. Less than one hour of “dry time” — time out of the mouth — allows for many more options to save the tooth, Stout said.

“More than an hour of dry time takes us to plan B which keeps the tooth in the mouth but the prognosis is not great and the child will most likely need an implant or replacement of that tooth in the future,” she said.

If you are unable to get to the dentist immediately, teledentistry is an option.

“One of the first things I ask is if the parent has taken pictures of the child’s tooth and mouth,” said Noah Quinn, a pediatric dentist at Pediatric Dentist Associates, with practices throughout Philadelphia. “That’s a pretty easy way to assess whether they need to come in and how soon.”

If a child falls and the tooth isn’t knocked out, it still can be pushed in any direction, even back up into the gums. An X-ray will determine what kind of damage was caused. Oftentimes, baby teeth knocked up into the gums that don’t disrupt the permanent teeth will come back down on their own in time.

Establishing an early relationship between your child and a dentist is crucial, because you don’t want their first interaction to happen after an accident. Quinn urges parents to bring their child to a dentist by their first birthday or within six months of getting their first tooth.

At the first visit, the child sits on the parent’s lap. The visit gives the dentist an opportunity to look in the child’s mouth to see how their teeth are developing. Equally importantly, it begins to build a rapport between the parent, child, and dentist.

“The goal is early intervention,” he said. “It’s to start educating them about oral health hygiene, habits with the bottle or sippy cup and nutrition. We can start to desensitize the kid to what the dentist is. If the first trip to the dentist is a trauma, and you need to do something that isn’t pleasant, you don’t want that to be their first experience.”

True to his nature, Anthony has taken his dental woes in stride, still rough housing with his brothers.

“He was super excited about the tooth fairy coming and the little tooth case the dentist gave him to put the tooth in,” Jim said. “He did not become afraid of the dentist and was just super excited to actually look like a little hockey player because it is his favorite thing.”