Pediatric Dentistry

[Polar Bear]

My boy Noah (3) yesterday let his fast shoes get the best of him. He was running at daycare tripped over a chair leg and put his mouth right into a table. His Upper Left Central and Upper Left Lateral teeth are pushed back. We took him to the dentist and he said the socket is broken. He did not take x –rays to determine this he just looked at it. Said give him Motrin and comeback in 4 weeks. My question is should I be worried about root damage? Will this cause complication when his permanent teeth come in? Should I find another Dentist?

Thank you,
PB

[Sacamuelas]

If the teeth were displaced towards the palate from their original position, then we know with certainty that the bony socket was fractured. No x-ray is necessary for that diagnosis to be made.

The first thing I would do is examine for other signs of not so obvious injury.

1. rule out concussion (very unlikely in this incident)

2. Examine mucosa including lips, buccal mucosa, palatal area for lacerations/bleeding

3. Rule out a Lefort I type fracture of maxilla if blow was with great force(simply place one hand and stabilize patients forehead while using other hand to attempt to move entire maxilla as a complete unit separately from the midface) ***again, not likely in trauma with this minimal level of force
4. Palpate alveolar bone around area of fractured tooth by gently manipulating the area to see if a segment of the maxillary teeth move independently of the rest of the arch.

5. Evaluate the actual tooth or teeth. Evaluate them by lumping it into one of three basic categories of tooth fracture:
___A. Fractured teeth
___B. luxated teeth (displaced from normal position)
___C. avulsed teeth (actually "knocked out")

I am sure your dentist did this, but I would inspect all the adjacent teeth and opposing teeth(lower anteriors) for signs of trauma. I would specifically look for any soft tissue trauma, increased mobility of the teeth, and/or fracture lines.

***Redneck engineering tip: At home, a good thing to use if you have one is a small light that you can put behind the tooth and have it illuminate through the tooth. Any otherwise unnoticed or incomplete fractures in the tooth will be indicated by the appearance of a dark "shadow" line in the tooth where the light can't propagate through the tooth due to the break in the tooth structure. Where the hell can you find a light that will fit "behind" a tooth like this in your home? Well, if I was at home and wanted to redneck engineer something to do an exam, I would use my browning fiber optic bore cleaning light that works perfectly for such an inspection. :D Just a tip that those who will potentially face a similar situation in a walk-in field hospital can use to help ID cracks/fractures in front teeth that aren't easily identifiable under normal visual exam.

Back on Noah's accident, an x-ray might not be a bad idea for any teeth suspected of taking a sharp blow as it could identify a horizontal root fracture (although not likely as they are hard to see on xrays usually) but more importantly to me, it establishes a baseline for what the teeth and bone in the area "look like" before any chance for the trauma to cause changes that could show up on subsequent xrays in the future. This is a prerogative type thing that I like to do myself; your dentist not taking this film wouldn't cause great concern to me. I just like to know what I am starting with when trying to determine 6 months later whether there have been any changes due to the trauma.

As to Noah's teeth, from what you describe the permanent teeth shouldn't be affected by this unless the teeth were pushed "up" into their sockets (intruded) or if in the future the baby teeth "die" from the trauma of being hit and aren't treated for it when they start showing signs/symptoms. The dentist will ID these signs with tests, xrays,etc and treat them to prevent damage to the permanent teeth if needed, but for you as a laymen the most common visual signs of the tooth dying is the darkening color or seeing a gum boil show up around the teeth.

Otherwise, the permanent teeth should be fine. From the sound of things, the teeth didn't get knocked that far back, are not fractured, and are stabile. They will usually move back to their original position over time. Follow-up is essential to check their progress and periodically take xrays and test the teeth that experienced trauma to ensure no further treatment is necessary.

[Air.177]

***Redneck engineering tip: At home, a good thing to use if you have one is a small light that you can put behind the tooth and have it illuminate through the tooth. Any otherwise unnoticed or incomplete fractures in the tooth will be indicated by the appearance of a dark "shadow" line in the tooth where the light can't propagate through the tooth due to the break in the tooth structure. Where the hell can you find a light that will fit "behind" a tooth like this in your home? Well, if I was at home and wanted to redneck engineer something to do an exam, I would use my browning fiber optic bore cleaning light that works perfectly for such an inspection. :D Just a tip that those who will potentially face a similar situation in a walk-in field hospital can use to help ID cracks/fractures in front teeth that aren't easily identifiable under normal visual exam.




Bore light, Great, Be sure you Clean the CLP off of it first, Unless you want the Kid to end up like me :lifter It wouldn't surprise me if AM rubbed Hoppes and LPS on my gums when I was teething


Good times,
Blake

[Polar Bear]

Sacamuelas, Thank You very much. You have put a Papa's heart and mind at ease...When I get home tonight I will tell him we have to knock them out with a hammer. :) Again Thank You

PB