Avulsion

Baby Teeth and Dental Trauma

In this section, we will cover:

What is an avulsion?
What should I do after the injury?
Will I need treatment?
What can I do to help the area heal at home?
Will I need any follow up appointments?
What should I look out for?
What are the long term complications?

What is an avulsion?

An avulsion is an injury in which the whole tooth has completely fallen out of its socket. There will be bleeding from the gum.

What should I do after the injury?

It can be very distressing if your child has suffered trauma to the teeth. The first thing to do is not panic.

Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.

You should:

Take a second to collect yourself and check your child hasn't blacked out.
If your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury).
Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.

You should look for the tooth which has fallen out and bring it with you to your dental appointment so your dentist can confirm the whole of the tooth has fallen out, it hasn't been swallowed and no part of the tooth is inside a cut in the soft tissues. Do not put the tooth back in the mouth.
If there are any cuts in or around the mouth, clean them with warm salty water. If there is any bleeding, dampen a clean handkerchief in salt water and press it firmly on the bleeding area.
If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.

Will I need treatment?

Your dentist will take an xray when you first see them after the injury to make a diagnosis and as a baseline to compare future xrays against.

Teeth which have suffered from an avulsion do not need any immediate treatment. Baby teeth which have been knocked out should not be put back in the mouth for many reasons:

It increases risk of damage to the underlying adult tooth
It increases risk of swallowing/aspirating (breathing in) the injured tooth
It requires a significant amount of time and cooperation from the child to reposition the tooth, place and remove a splint (metal wire used to hold the tooth in place) and provide root canal treatment

If there are any injuries to the soft tissue, you can see here for more information.

What can I do to help the area heal at home?

To help the area heal at home, you should:

Brush the teeth after every meal with a soft toothbrush
Gently brush the injured area to prevent build up of plaque
Use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day
Have a soft diet
Take medicine to help manage any discomfort (ibuprofen or paracetamol)
Avoid contact sports

Will I need any follow up appointments?

Your dentist will want to see your child again for a clinical examination after:

6-8 weeks

Your dentist will also review your child at 6 years old to monitor the eruption of the adult teeth.

What should I look out for?

The long term consequences of dental trauma are unpredictable. You should monitor your child's teeth for any signs of infection as the teeth next to the one which was knocked out may also have suffered a degree of trauma.

Favourable outcome

Underlying adult tooth:

Erupts at the expected time
No discoloured patches on the crown when it erupts

Unfavourable outcome

Underlying adult tooth:

Fails to erupt
Discoloured or thin enamel

What are the long term complications?

Complications to the underlying adult tooth are more common in avulsion injuries and include:

Adult tooth doesn't erupt
Discoloured patches on enamel (hypomineralisation - find out more here LINK)
Thin enamel (hypoplasia - find out more here LINK)

Adult tooth doesn't erupt

If the adult tooth hasn't erupted by 7 or 8 years old, your dentist will take a series of xrays to check where the tooth is and what the root looks like.

Depending on what the xrays show, your child may need one of the following surgical procedures:

Expose and bond. (LINK)
Sometimes the tooth can be brought into the mouth through the gum. This involves a surgical procedure to uncover the tooth and braces to pull the tooth in line with the rest of the teeth.
Dental extraction.
If it is not possible to bring the tooth in line with the rest of the teeth, the tooth can be removed.
Monitor the tooth without treatment.
The tooth can be left under the gum but it will need to be monitored with xrays to ensure it doesn't cause problems over time.

Discoloured patches

A knock to the baby tooth can disturb the development of the underlying adult tooth. This disrupts the formation of healthy enamel and causes discolouration.

Treatment options:

microabrasion
resin infiltration (for white spots)
tooth whitening
composite bonding
dental veneer (more appropriate for adults)

Thin enamel

A knock to the baby tooth can disturb the development of the underlying adult tooth resulting in only a thin layer of enamel being formed.