TRAUMATIC INJURIES IN CHILDREN AND MANAGEMENT OF

AVULSED TOOTH
Seema Raina

Abstract
Injuries to childs teeth can be very distressing for children as well as their parents.
The peak period for trauma to the primary teeth is 18 to 40 months of age, because this is a
time of increased mobility for the relatively uncoordinated toddler. Injuries to primary teeth
usually result from falls and collisions as the child learns to walk and run.1
With the permanent teeth: school-aged boys suffer trauma almost twice as frequently as girls.
Complete extra articulation of the tooth
from the socket is called as avulsion.
In this article the various causes of trauma and treatment modalities of the avulsed tooth have
been discussed.

Introduction
Injuries to childs teeth can be very distressing
for children as well as their parents. Dental
trauma may occur as a result of a sports mishap,
an altercation, a fall inside of the home, or other
causes. The peak period for trauma to the
primary teeth is 18 to 40 months of age, because
this is a time of increased mobility for the
relatively uncoordinated toddler. Injuries to
primary teeth usually result from falls and
collisions as the child learns to walk and
run.1With the permanent teeth: school-aged boys
suffer trauma almost twice as frequently as girls.
Sports accidents and fights are the most common
cause of dental trauma in teenagers. The upper
(maxillary) central incisors are the most
commonly injured teeth. Maxillary teeth
protruding more than 4 mm are two to three
times as likely to suffer dental trauma than
normally aligned teeth.Prompt treatment is
essential for the long-term health of an injured
tooth. Obtaining dental care within 30 minutes
can make the difference between saving or
loosing a tooth. 1,2
Associate Professor ,
Department of Paediatric and Preventive Dentistry,
Dr.D.Y.Patil Dental College and Hospital Nerul,
Navi Mumbai.

Scientific Journal

Dental Avulsion
Complete extra articulation of the tooth from
the socket is called as avulsion.
Dental Office Treatment For An Avulsed Tooth
I. Primary Tooth
The primary avulsed tooth is generally not
reimplanted to avoid injury to the developing
permanent tooth bud.
II.Permanent Tooth Reimplantation Guidelines
1. For A Mature Tooth With A Closed Apex: If
the extraoral dry time is <60 minutes,
reimplantation is as soon as possible. If the
extraoral dry time is >60 minutes, soak in citric
acid or curette the root; then soak in stannous
fluoride for 10 minutes. Rinse with saline.
Perform root canal therapy one week following
the trauma.
2. For An Immature Tooth With An Open Apex:
If the extraoral dry time is <60 minutes, soak in
doxycycline (1mg/20 ml saline) for 5 minutes. If
the extraoral dry time is >60 minutes, provide
the same treatment as for a closed apex.
3. Apply a flexible, functional splint for 7 to 10
days. If an alveolar fracture is present, provide a
very rigid splint for 4-6 weeks.
4. After reimplantation, gently compress the
facial and lingual bony plates. Suture any
lacerations.
5. Provide antibiotic coverage for 10 days to
prevent
infection.
Consider
prescribing

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Traumatic Injuries In Children ----------------------------------------------------------------------------- --------Seema Raina

tetracycline or penicillin. Penicillin is prescribed

as: PenVK 500mg, 4X per day, for 10 days.
6. Prescribe chlorhexidine gluconate rinses, and
provide oral hygiene and diet instructions.
7. Provide analgesics to control pain. For
children, consider prescribing acetaminophen
and codeine (Tylenol #3) for mild to moderate
pain. The dose is 15 mg/kg/dose of
acetaminophen, every 4 hours. Do not exceed
2.6 g/day of acetaminophen.
8. Arrange for tetanus vaccination if the wound
was dirty, or if the vaccination requires
updating.3,4,5
Follow-Up Care After 7 To 10 Days
1. For a tooth with an open apex, the goal is
revascularization of the pulp. For a tooth with an
open apex and extraoral dry time <60 minutes:
no endodontic treatment is initially required. Reevaluate every 3-4 weeks for pathosis. In case of
pulp pathosis, begin an apexification procedure.
2. For a tooth with an open apex and extraoral
dry time >60 minutes: begin an apexification
procedure.
3. For a tooth with a closed apex: provide
traditional endodontic treatment and obturation.
This is done to prevent and to eliminate toxins
from entering the root canal space.
4. Remove the splint at this 7 to 10 day
treatment visit.
5. Patients are recalled to the dental office every
3-4 weeks for sensitivity testing. Thermal tests
using difluorodichloromethane or Endo Ice
may be used.
6. Long-term follow-up is essential for 2 to 3
years after the reimplantation procedure.
Endodontic Obturation For Avulsed Teeth
With Closed Apices
1. For a tooth with endodontic treatment started
7 to 10 days after avulsion, obturate after 1 to 2
months of treatment with calcium hydroxide
paste.

Scientific Journal

2. For a tooth with radiographic signs of

resorption or pathosis, or for a tooth which had
endodontic treatment started more than 14 days
after the avulsion, treat long term with a dense
mix of calcium hydroxide. The calcium
hydroxide is changed about every 3 months.
Obturate when an intact lamina dura can be
visualized.4,5,6

Conclusion
Although traumatic injuries are very common
and distressing for children, it is the prompt
treatment that is essential for the long term
health of an injured tooth. Obtaining dental
treatment within 30 minutes can make a
difference between saving or losing a tooth.

References
1. Bourguignon C, Sigurdsson A.Preventive
strategies for traumatic dental injuries.
Endodontics and Dental Traumatology Clinic.
2. Anderson and Anderson .traumatic dntal
injuries and managment
3. Qin M.Hua Xi Kou Qiang Yi Xue Za Zhi.
2009 Jun;27(3):237-40. Chinese. PMID:
19637466.
4. Factors associated with traumatic dental
injuries among 12-year-old schoolchildren in
South India.
David J, Astrm AN, Wang NJ.Dent Traumatol.
2009 Oct;25(5):500-5. Epub 2009 Jul 9.PMID:
19614932
5. Customized mandibular orthotics in the
prevention of concussion/mild traumatic brain
injury in football players: a preliminary
study.Singh GD, Maher GJ, Padilla RR. Dent
Traumatol. 2009 Oct;25(5):515-21. Epub 2009
Jul 9.PMID: 19614931
6. Traumatic injuries of the permanent maxillory
incisors at Dental Department, Pakistan Institute
of Medical Sciences Islamabad: a retrospective
study.Khan NA, Qazi HS, Maxood A, Khan
AM, Abbas I.J Ayub Med Coll Abbottabad.
2008 Jul-Sep;20(3):84-7.PMID: 19610526

Vol. III - 2009