Managing Dental and Oral Trauma

Dental and oral traumas are relatively common occurrences. The most common causes are physical injury due to a fall, sports related injury, and motor vehicle accident.

For a pediatric (child) patient, falls are common when first learning how to walk. Most coffee tables happen to be about the height of a child of that age, making it a common point of contact. This can cause injury to either the soft tissue, such as the lip, gingiva (gum) and tongue, or the hard tissue, such as the bone or teeth.

Dental and oral injuries differ in their severity and their management. Therefore, a professional evaluation is needed. The dentist is usually the first point of contact to proper management of these injuries. Generally speaking, when a dentist feels that the extent of injury requires a higher level of intervention, the patient is referred to an Oral and Maxillofacial Surgeon for definitive treatment.

Important things to know about dental and oral injury:

1. If there is bleeding, applying pressure to the bleeding area will help to slow and stop the bleeding. Pressure can be applied using sterile gauze, which are usually available commercially at the pharmacy.

2. Timing of injury is important. The sooner the patient seeks care, the less blood loss and the better the outcome of the intervention will be.

Management of a tooth:

  • If a tooth is injured and has some mobility (loose tooth), do not attempt to remove it. A tooth’s natural environment is the oral cavity. However, the patient needs to be very careful as having a loose tooth can make it a risk for swallowing it by the patient.
  • If the tooth is dislodged out of the mouth, attempt to find the tooth. The tooth should be kept in the appropriate environment to be able to rescue it. There are many commercially available products to place a tooth in if it gets dislodged, such as Save – A – Tooth preserving system. If no solution is present, keeping a tooth in a small container in the patient’s own saliva is reasonable until the patient receives care.
  • Do not dry the tooth! Some patients may hold the dislodged tooth and dry it with a tissue; this will dehydrate the tooth and minimize the chances of its survival.
  • Do not place the tooth in water. The tooth requires an electrolyte balanced solution, such as saliva or commercial products designed to help preserve the vitality of tooth. Water is NOT an adequate environment for this.

Management of the patient:

  • The oral health provider will perform an evaluation of the patient’s injury and review the patient’s medical history. Based on this evaluation, a unique plan for the proper management of the patient should be developed.
  • In the case of a dental injury, generally speaking, a determination to know if a tooth is salvageable or not is needed. If the tooth is salvageable then it may require some form of fixation to keep it in the proper position for healing to occur. Time of fixation should be determined by the oral health provider. Primary teeth (baby teeth) are not usually repositioned if they are dislodged.
  • If a tooth is not salvageable then it may require extraction and possible management of adjacent tissues in preparation of future replacement.
  • Soft tissue injury usually requires careful inspection to remove any debris and determine the layers involved. After proper debridement and cleansing of the tissue and management of any bleeding, the tissue may require suturing for healing to occur.
  • The oral health provider will determine the need for any pharmacologic agents, such as antibiotics, analgesics, ointments, or mouth rinses.
  • Patients are usually instructed to remain on a soft diet to prevent repeat trauma to the tissue to allow proper healing to occur. There are usually detailed instructions provided by the oral health provider on how to do that.

Long term follow-up and future intervention may be required, such as root canal therapy, restorations, and management of occlusion or discoloration.