Intrusion

Baby Teeth and Dental Trauma

In this section, we will cover:

What is a dental intrusion?
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 a dental intrusion?

A dental intrusion is an injury to the structures supporting the tooth in which the tooth:

has been pushed further into its socket and looks shorter than before
is not wobbly
there may be bleeding around 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.
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?

Teeth which have suffered from an intrusion do not need any immediate treatment but they will need to be monitored for signs of infection (see below). In some cases, the tooth will naturally re-erupt to its natural position within 6 to 12 months.

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. They will also send an urgent referral to a specialist who is experienced in managing dental trauma in children (usually a paediatric dentist).

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:

1 week
6-8 weeks
6 months
1 year
For severe intrusion injuries, your dentist will also review your child at the age of 6 years old (when the adult teeth should start to erupt)

An x-ray is not usually needed at follow up visits unless your dentist is concerned about damage to the nerve/infection.

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.

Favourable outcome

Baby tooth:

No pain
Normal colour of the tooth
Temporary darkening of the tooth to red/grey/yellow
Tooth repositions itself to original position

Underlying adult tooth:

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

Unfavourable outcome

Baby tooth:

Pain
Abscess on the gum
Increased mobility (but this can be normal as the adult tooth starts to come through)
Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
No improvement in the position of the tooth
Tooth is very firm in the jaw (this is called "ankylosis" which is where the bone fuses to, and replaces, the root of the tooth)

Underlying adult tooth:

Doesn't erupt at expected time (usually 6-7 years old)
Discoloured or thin enamel

Dental abscess

What are the long term complications?

In most cases, there will be no long term complications.

If the baby tooth becomes painful, infected or ankylosed (see "unfavourable outcomes" above), it will need to be removed (see dental extraction). There will be a gap here until the adult tooth erupts at around 6-7 years old.

Treatment can be done under local anaesthetic, inhalation sedation or general anaesthetic depending on the age and cooperation of your child.

Complications to the underlying adult tooth are more common in intrusion 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.