Dental Trauma

Fractured Incisors

The most common teeth to be damaged during an accident are the upper central incisors. Primary incisors can be damaged especially when infants are learning to walk. The most common injury sustained to baby teeth is intrusion, i.e., the tooth is pushed up into the gum. This type of traumatic injury in young children can also result in damage to the underlying, developing permanent tooth.

Approximately one in 11 children in Ireland will have broken one or more of their permanent teeth before they reach the age of 15 years. Damage can range from a small chip off the enamel to a fracture involving the dental pulp. Occasionally, the tooth can also be displaced (subluxed) or, more rarely, knocked out completely (avulsed). Traumatic injuries to teeth can be complicated to treat and can have long term financial, aesthetic and functional problems for the patient.

Prevention and Management

Most traumatic injuries to teeth arise from accidents during normal everyday activities such as informal play and prevention in these circumstances is difficult. The wearing of mouthguards or helmets with face shields during organised contact sports can reduce the likelihood of fracturing a tooth. The 2012 GAA Congress passed a motion making it mandatory for all juvenile players as of 2013, and for all senior players as of 2014, to wear a mouthguard during football games and training. The wearing of safety helmets (e.g., for cycling, skate boarding) and of car seatbelts should also be advised. Children who have prominent upper incisors are more prone to dental injuries and early orthodontic correction for these children is advisable. When a tooth is accidentally damaged, it is important that professional advice from a dentist is sought immediately.

What to do if a tooth is knocked out

In the case of a primary (baby) tooth that is knocked out completely:

  • Parents/carers should make no attempt to replant a primary (baby) tooth that is knocked out as they could damage the permanent (adult) tooth that is developing under the gum – the child should be brought to a dentist to be checked.

In the case of a permanent tooth that is knocked out completely:

  • Make sure that the tooth knocked out is a permanent tooth – primary (baby) teeth should not be replanted!
  • Keep the injured person calm. 
  • Find the tooth and pick it up by the crown (the white part).
  • Avoid touching the root as this can damage the membrane which is essential to saving that tooth.
  • If the tooth is dirty, wash it briefly (10 seconds) using milk, saline solution or cold running water.
  • Encourage the injured person/parent to replant the tooth, using the shape of the teeth at either side of the gap as a guide to positioning.
  • The injured person should bite on a clean handkerchief for 15–20 minutes to hold the tooth in position.
  • If the tooth cannot be replanted immediately, it can be carried inside the injured person’s mouth between the back teeth and the inside of the cheek, or in milk or a special storage medium for knocked out teeth, if available. Avoid storage in water.
  • Seek emergency dental treatment immediately; phone ahead to tell your dentist you are on your way.

For easy reference, see Save That Tooth! poster; http://www.dentalhealth.ie/download/pdf/savethattooth__website_final.pdf