3.4 Anticipatory Guidance
Oral Trauma and Injury
Oral trauma and injury from falls or accidents occur more frequently in children with seizure disorders or cerebral palsy. Emphasize to parents that injuries require immediate professional attention, and explain the following procedures to follow if a permanent tooth is knocked out:
- Find the avulsed tooth.
- Hold it by the crown (top or exposed part) only, not the root.
- Rinse it under cold water; do not scrub.
- Reinsert it into the socket quickly, making sure that the front of the tooth is facing you. If this is not possible, place the tooth in cold milk or cold water and take the child and the tooth to a dentist immediately.
Because of the danger of damaging the underlying permanent teeth, explain to parents that no attempt should be made to reinsert an avulsed primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone. Consult with a dentist for follow-up care.
Physical abuse, which is reported more frequently in children with special health care needs than in the general pediatric population, often presents as oral trauma. (See section 3.3, Child Abuse and Dental Neglect.)
Children who engage in self-injurious behaviors may be receiving care from a therapist or psychologist. If these harmful behaviors have not been diagnosed, refer the child to the primary care health professional, who will in turn make a referral for assessment and treatment. If appropriate, oral health professionals should recommend protective oral appliances to assist in combating self-injurious behavior. (See section 3.2, Oral Examination, Oral Trauma and Injury.)