Seems to be a silly question — after a child breaks his tooth, where could it go?. Anybody would say that broken tooth would fall on the ground -that’s all. No, i am afraid that it may not be right always. Let me explain it with the example of a 3-year old boy who was brought to me recently.
Dental injury in a 3-year old boy
This 3-year old boy goes to a play school. His father told me that a day ago he fell from the bicycle in his school. As you see in this photograph his upper lip and inside portion (gums) is swollen. There is ulceration of inner side of upper lip.
When i asked him has the tooth fallen off. His father confirmed that it had fallen off. Poor litlle kid was too small to answer. When i asked his dad if he has the tooth. He replied -“No”. He told me even his teacher did not see the tooth. He thought it must have fallen in the sink where the child rinsed his mouth after fall (at school).
I was not satisfied. During all these years i have hardly come across a case in which at this age a milk tooth has been completely knocked out from its place. Secondly, there was a big swelling above the ‘missing’ tooth’s seat. It raised my suspicion that impct of the fall must have pushed the tooth deep into the jaw bone. However, any portion or even tip was not visible.
Milk Tooth in a 3 -yr old boy gets pushed deep inside jaw due to fall from bicycle
A dental x-ray was done which confirmed that the tooth has been pushed deep inside the jaw bone.
The child was prescribed Syp Amoxycillin with syp Ibuprofen+Paracetamol alongwith some analgesic antiseptic dental gel (eg Dentogel, Dologel, Zytee, Emergel — these are some good brands available in India — i always use any of these). Hot fomentation of the swollen area is also extremely soothing. Next day his dad told me that the child is quite comfortable and swelling and pain is going down. Fine, he was also told about some dietary precautions during next 3-4 days.
Now, question of its treatment. I have come across some such cases earlier. I remember some of kids used to be elder than this kid –may be 5 or 6 yr olds. In those cases also the impact of trauma was so big that both front teeth got pushed into the jaw bone. As soon as the swelling subsided say within next couple of days tips of those ‘pushed’ front milk teeth became visible and then after few days these were easily removed under local anaesthesia (by making the surrounding area numb).
Those kids were around 6years or above and in any case they were supposed to fall off naturally within a couple of months to make room for permanent front teeth (incisors). However, since this child is just 3 years old and if we remove the ‘pushed’ tooth after a few days, he would be without tooth for about 4 years and child would be quite conscious about his looks amongst his peer group.
Hence i thought a second opinion is in the best interest. So, i told his dad to consult some Pedodontist ( a dentist who specializes in treating children teeth). He may advise something else. He may opt to pull out the tooth and try to ‘replant’ it and fix it with dental wiring etc. Well, i am not sure about it. I have not undertaken any such treatment — pedodontist is the best person to advise/guide further in this case. Let’s see what he suggests!
However, one thing is certain, the ‘pushed’ tooth would become visible in just a few days as the swelling goes down. Even after listening this, his father felt so relaxed.
Now, coming to a question that might be coming in a reader’s mind —if the tooth is to be pulled out, why not immediately on the first day itself? ………….well, i dont know, different dentists must be following different approaches. My approach is waiting for just a few days — when the child and his parents are already in agony, there is swelling, pain etc, we can cool down everything when most likely tip of tooth pushed deep inside becomes visible and can be very easily removed –without any need to cut the overlying gum.
If a pedodontist read this, could he please give his remarks and tell me about his approach in the management of such cases.
Ok, wishing safety of all particularly little kids ……………….afterall, they get injured and we feel pain, am i right?
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