Dental injuries are a common source of trauma in young children. Injury to the primary teeth is most likely to occur between the ages of 1-1/2 to 3. Given young children’s natural propensity for exploration, as well as their inherent lack of coordination, it is no surprise that dental injuries are so common at this age.

Older children often suffer tooth injury due to sports activities or falls from skateboards, roller blades, or bicycles.

Because dental injuries are common, it is important that caregivers and parents know how to prevent it, as well as be able to provide first aid and determine if medical treatment may be needed.

Potential Injuries

The most common dental injuries are teeth that have been knocked out due to trauma or a chipped tooth as a result of a fall. Dental injuries in young children tend to be to the upper maxillary region and central incisors, or the upper front teeth.

In addition to the teeth, however, injuries may also occur to the jaw, soft tissue or gums, and the alveolar bone, which is a thin layer of bone that forms sockets for the teeth and surrounds the roots.

Childcare providers often witness common events in childcare settings that can cause dental or oral injury such as falling from playground equipment; tripping and hitting the mouth on the floor or a piece of furniture; or getting hit in the mouth with a ball or other play object while participating in a group activity.

Such incidents may result in inflammation of the gums, a chipped or broken tooth, or even a knocked out tooth. If the impact is hard enough, the jaw could be damaged or knocked out of alignment.

For this reason, many physicians and dentists recommend that medical follow-up be standard for all dental trauma. Tooth loss or long-term damage can result if injuries are untreated.

Symptoms of Dental Injury

More than likely, if a child sustains a dental injury while in a childcare setting, the caregiver will know it has happened. However, a child might enter childcare with an injury that occurred at home or on the way to your facility.

Observation is important. Be on the lookout for the symptoms that may signal dental injury, such as:

• Sudden and sometimes severe pain
• Fever
• Tooth loss or discoloration
• Swelling of the face or jaw
• Sore and/or bleeding gums; or
• Loss of appetite or inability to eat and drink.

Some of these symptoms also may be indicators of another illness or condition. Regardless of the underlying cause, these symptoms warrant immediate notification of the child’s family and medical evaluation.

Treating Dental Injuries

If a dental injury occurs, follow standard precautions and administer appropriate first aid.

• Position the child to prevent blood from going down the airway. Help the child sit up with head tilted slightly forward, or lie on his side.
• If necessary, help the child rinse the mouth with water so you can identify the injury site.
• If bleeding, apply direct pressure to the area with gauze or a clean cloth.
• Give the child a cold compress to hold on the injured area or hold a cold compress on face in the area of the injury. (Always place a soft cloth between the child’s skin and the cold pack to prevent "frostnip" skin damage.)
• If a tooth is broken or knocked out, attempt to find all pieces of the tooth. Hold the tooth by the crown (the top), not the root and gently rinse with water.
• Keep the tooth moist. For an older child, and if the child can cooperate, replace the tooth gently in the socket, then have the child bite down on a gauze pad or cloth to keep it in place; or, let the child hold the tooth in his mouth, between his lower lip and gum. For young children, or if there is concern that the child might swallow the tooth, then put the tooth in a cold wet cloth or a container of milk.
• Call the child’s dentist immediately. Professional dental care within one-two hours may save the tooth.

If dental work is performed, caregivers and families should observe the child for a week or so after treatment for symptoms of infection, such as an abscess, fever or swelling, or tenderness or bleeding of the gums. Other symptoms such as appetite and activity level also may serve as a gauge for how well the child is healing.

Finally, unexplained or repetitive injury to the mouth may be a sign of abuse. If this is a concern, early care and education programs should address the matter in accordance with individual state policies and procedures for reporting suspected child abuse.

Safety Guidelines

The best way to prevent dental injury in young children is to take the necessary precautions to remove hazards. Consider the following suggestions for dental injury prevention from the American Academy of Pediatrics (AAP) and Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care.

• Prevent children from climbing on non-approved surfaces such as furniture or railings.
• Prohibit the use of equipment such as walkers or trampolines that may be associated with dental injuries.
• Keep all walkways and doorways free of toys, debris, and electrical cords.
• Attach corner protectors to furniture and counter tops.
• Be sure playgrounds have approved resilient surfaces under and around all play equipment.
• Make sure children wear helmets when riding tricycles or other wheeled toys. Teach them the appropriate way to wear helmets (secured on the head and covering the forehead).

Trips and falls are common causes of dental injuries. Injuries also can occur when children jam their mouths into the spout of a water fountain as they drink

A safe environment and appropriate supervision while children are at play will help prevent injury.

A dental injury that occurs in a childcare setting may require that a child injury report be completed and filed with the state’s childcare licensing agency.

Diona L. Reeves
Consultant, American Academy of Pediatrics, Early Child Care & Education Initiatives

Internet Resources

American Dental Association, www.ada.org/public/manage/emergencies.asp

American Academy on Pediatric Dentistry, www.aapd.org/publications/brochures/ecare.asp

American Academy of Pedatrics, policies on walkers, trampolines, pediatrics.aappublications.org

Caring for Our Children, nrc.uchsc.edu/CFOC

Healthy Childcare, injury reporting, www.healthychild.net/articles/sf26injuries.html

Oral Health in America, A Report of the Surgeon General, www2.nidcr.nih.gov/sgr/sgrohweb/home.htm

Save Your Smile, www.saveyoursmile.com/parents/dentalemergency.html