First aid for dental accidents

Eight-year-old Jessica hit her chin hard on the handlebars when she fell off her bike. «She bit her lip open, which bled a lot,» says her mum, «and two of her front teeth were out too!» The parents immediately drove to the emergency centre. Once the wound had been treated, the emergency doctor spoke to a dentist because Jessica already has permanent front teeth. Her father had soaked the knocked-out teeth in milk and taken them with him. The dentist was able to put them back in straight away.

Jessica's parents did everything right in the initial treatment of their daughter: they pressed the wound with a gauze bandage and placed the teeth in a «physiological», i.e. body-like, solution. Incorrect handling would have destroyed the surface structure of the teeth, which would have made it impossible to reinsert them. Jessica's reinserted teeth will be kept stable for some time with a splint. It looks like she will not suffer any long-term consequences.

Teeth that have been knocked out must be transported in milk or saliva.

Chipped permanent teeth? To the dentist immediately!

«Older children who come to the emergency department because of a dental accident with permanent teeth have usually fallen off their bikes or slipped in the swimming pool,» says dentist Hubertus van Waes from the Clinic for Orthodontics and Paediatric Dentistry in Zurich and head of the Zurich School Dental Clinic.

If permanent teeth are knocked out in an accident, it is important to act correctly: «Go to the dentist immediately,» says van Waes. «If possible, the teeth should be replaced at the scene of the accident.» If this is not possible, transport the tooth in milk or in a plastic bag with a little saliva. Never use alcohol or disinfectant and don't simply put the tooth in your trouser pocket. If a tooth can be replanted, it is fixed in place with a splint for around two weeks. Nature takes care of the rest.

Dental accidents often occur in younger children because they trip, fall and hit an edge. According to van Waes, «broken bones in the face and knocked out teeth» are also typical. Depending on the accident, teeth can also come loose, shift or be knocked in.

If milk teeth are knocked out, a visit to the dentist is not necessary on the same day because they are not put back in as this could hinder the permanent teeth from breaking through. Van Waes knows that children have no problems with a gap in their teeth due to knocked out milk teeth.

«They can adapt well.» The upper front row is not a problem, but with the lower front row it can happen that a child has a gap. «That's why we sometimes insert a replacement tooth in the case of braces.»

Due to possible consequential damage, dental accidents must always be reported to the insurance company.

However, if milk teeth are displaced, you need to go to the dentist immediately so that the tooth can be pushed back into position, says Hubertus van Waes. «This is only possible on the same day.» The same applies if a child is in severe pain or can no longer bite. Dental accidents should always be reported to the insurance company, emphasises van Waes, as consequential damage is often only seen years later. «Compulsory basic insurance covers the costs incurred for children.»

Good monitoring of children and young people

Tooth injuries themselves hardly bleed at all. However, if the tongue or lip is injured, it will bleed heavily. The wounds must be covered with compresses or clean cloths and compressed. According to Professor Martin Rücker, Director of the Department of Oral and Maxillofacial Surgery at the University Hospital Zurich, fractures of the midface bones are rare in children. «The periosteum is thicker and the bone is even softer.» However, in the event of a fall onto the chin, which often happens in cycling, scooter or roller-skating accidents, the articular process of the lower jaw, for example, can break.

Depending on the course of the fracture, conservative treatment - primarily with soft food to relieve pressure - or surgical treatment may be considered. Endoscopically assisted techniques allow operations without externally visible scars. «The earlier such a hernia is treated surgically, the better,» says Martin Rücker.

The clinic's head doctor, Harald Essig, explains that they work with computer-assisted surgery in this area. This allows him to simulate the operation and customise implants. «If a tooth is missing, it can first be replaced provisionally and then permanently once growth is complete - in other words, at the very earliest at around the age of 16 for girls and two years later for boys.»

Oral surgeon Rücker recommends that all children with oral injuries should also be monitored for craniocerebral trauma and, depending on the fall, whether the cervical spine has been injured. And: «Open wounds need to be vaccinated against tetanus.»

Where are the dangers lurking?

Rücker mentions football as the first high-risk sport. «It's a common sport, you can easily get an elbow in the face.» Horse accidents are also high on the list. Harald Essig explains: «When horses turn their heads quickly, it can be very violent.»

Ice hockey, boxing, mountain biking and «aggressive» team sports such as rugby also harbour risks. «In these sports, however, everyone wears protection these days,» says Harald Essig. «Ideally, this is customised by a specialist.»

However, dentist van Waes and the two oral surgeons put these dangers into perspective, as most dental accidents happen in normal everyday life.