Suggestions for Dental Trauma in Children

So, unfortunately our family has a lot of experience in this area and we recently gained some more experience when our little 8 year old fell on a concrete floor, didn’t put his hands out, and fractured both front teeth and nearly knocked them out.  This happened a month ago, and the dentist was surprised at our follow-up appointment yesterday that our son hasn’t had to have double root canals yet nor has he lost the teeth.

So, I am NOT a doctor or a dentist or anyone important. I am just a mom and sharing my experience in case this ever happens (hopefully not) to one of your children so you can be prepared.

If you don’t know much about teeth, this is my understanding of dental trauma.  The tooth is covered by white enamel and a hard layer under that called the dentin.  Inside of the dentin is a soft layer called the pulp that contains blood vessels, nerves, and connective tissue.  The pulp extends from the crown of the tooth to the tip of the roots where it connects the tissues surrounding the pulp. Usually adult teeth that have been dislodged  will need a root canal.   A tooth can survive without the pulp, which is the basis for something like a root canal.  The root canal, especially in adults,  is usually started within a few days of the injury. The pulp is cleaned out ( so all those vital structures such as blood vessels, nerves, etc are removed, because if things are traumatized or dying or dead, it generally leads to infection, the body reabsorbing the nerves and losing the tooth permanently and other things) and a medication is put in with a permanent root canal filling placed later.

However, children ages 7-12 may or may not need a root canal since the nerve roots are still developing. In this case, the child needs very careful long term follow up because sometimes the nerves of the teeth will die off without a lot of symptoms, the body will re-absorb the root and the permanent tooth will fall out.  So, in a way, a root canal “saves” a tooth, but the tooth is not alive and becomes a  sort of a placeholder.  There is new research (I am guessing experimental still at this point???)   that in young people stem cells present in the pulps of the teeth can be stimulated to complete nerve root growth and heal the pulp, but I don’t know anywhere doing this in practice in my area.

ANY dental injury should be seen by a dentist immediately.  Again, I am not a dentist but it seems that you cannot tell from the tooth or the bleeding how damaged the pulp is.  Neighboring teeth that were not directly  hit are often affected as well.   If a tooth is completely knocked out, is it important to handle the tooth gently, not touch the root and it needs to be placed back into the socket immediately by the dentist.  There are solutions you can buy at the drugstore to keep the tooth in until you can get to the dentist.  If the teeth are luxated, or moved, due to trauma, you need to see a dentist right away as well.

So, before something happens, talk to your dentist.  What do they advise you to do in dental emergencies?  Do they have emergency hours?  An emergency phone number?  If a 6-10 year old knocks out or badly hits a permanent tooth, do they treat it different than a 12-15 year old knocking out a permanent tooth?  Would you need to follow up with an endodontist right away?  What does the endodontist they refer to typically do?

So, now I want to share some things that we did that I think were helpful,things that were  a little out of the box.  Traditionally, since we don’t have stimulation of stem cells in teeth present in my area that I know of, which is probably experimental I guess but being mentioned in literature,  is just sort of  “wait and see”.  This is very stressful, and I  personally couldn’t accept that the nerve roots might just die or he might just lose his permanent teeth at only 8 years old. I thought even if I could save one tooth from a root canal that would be important.   So, the three main things we tried included cold laser therapy, chiropractic adjustments, hyberbaric oxygen therapy, and ozone therapy. Mainly we tried these things because I was familiar from hyberbaric oxygen therapy from working with burns and wounds and injuries, and the other things we learned about from friends and health care professionals.

One thing I would recommend is to locate who does ozone therapy for teeth in your area. If injury happens, you want to run to your pediatric dentist right away because most likely the teeth need to be splinted and xrays taken. They may use a local numbing agent as well because with this type of injury, especially to both front permanent teeth, it is exceedingly painful.

We had an ozone shot one week after injury but I wish I had known about it and done it within 48 hours after injury.  I learned about ozone therapy, not through our dentist, but through the place where we initally went for hyperbaric oxygen some days post-injury, but then it took me time to find a dentist who did it and to get an appointment.  There doesn’t seem to be much of a protocol on using ozone with injured teeth, but it does increase circulation and healing.  We only had it once, and I am not sure about whether or not it would be effective now that we are one month post injury to have it again.

We started cold laser therapy about 36 hours after injury. Our chiropractor happened to have one available so that is how we got to start so soon.   Many cold laser protocols say 10 sessions as a general protocol, but consult with your practicioner as there are different protocols out there and different cold laser systems.   We also started using hyperbaric oxygen therapy 72 hours after his injury. We went to a hyperbaric oxygen place for the first few sessions, but I  had a wonderful friend who let me borrow her tank so we can use it at home.    Most hyperbaric oxygen places seem to say “40 hours” in response to many traumas, so we are aiming for 40 hours or more during the next few months. We have about 15 hours in so far as we had some lag time in between what we could afford and in receiving and setting up the tank that we borrowed.

We went back to the dentist yesterday, one month after injury, and the splint was removed.  The teeth still feel a bit wobbly, which the dentist said is not totally unexpected after splint removal.  Our little guy will have to be carefully followed up through the next six months to a year with xrays to make certain that the root hasn’t died (which you can’t really tell by an xray, but you can tell if the body is re-absorbing the nerve that at that point must be dead).

We also had follow up with an endodontist and will have to continue to see him as well over the next six months to a year as we don’t know for sure if root canals will be needed or not (although it’s a good sign they were not needed yet!).  The first endodontist we went to wanted to do double root canals one week post injury due to lack of sensation to cold but the second endodontist we went to said that sometimes this is not completely uncommon one week after injury and in a small child there would need to be other indicators in addition to lack of cold sensation.  So, again, sometimes things can happen with the nerve root with no symptoms,which is why close follow up with xrays is important,  but many times there are symptoms of nerves dying such as discoloration to the tooth, pain with hot or cold liquids, pain with eating.  I think although a root canal only takes a small amount of time, because it cleans out vital structures, it is important to have more than one opinion and if necessary, to have someone who will be willing to follow your child closely, especially if they are under 12 years of age.

The homeopathics we used  for the first 72 hours after injury included arnica pellets, hypericum pellets, and yes, old fashioned ibuprofen for pain relief.  I didn’t have any helichrysum essential oil (it is expensive), but a knowledgeable friend knew it was good for inflammation and helping nerves heal. I had a topical only blend for skin care that had helichrysum in it and used that topically on the upper lip area, but will be getting this oil soon and will use it in a mouthwash type preparation to help over the next few months.

The other thing we had was a lot of prayers and healing touch from people we knew who were prayer warriors, positive wishes from many, and healing touch practicioners who healed from afar.  Our son was even prayed for at the Kurst Root Icon, which comforted me to no end, and I thank my Orthodox readers.  Our parish has said healing prayers  (he was also bit by a dog several weeks ago above his upper lip and needed stitches), and we had a wonderful discussion with our Children’s Director who  was invaluable in knowing just what to say!   Our parish has healing services with holy oil, so that also is comforting to us.

We have a long six months to a year ahead of us, but I hope by sharing this experience it helps someone else if their child is hurt in this way. Get second opinions, and don’t ever accept just “wait and see.”  We are made wonderful, and while complete healing is not always possible, it is always possible to try.

Blessings and love,
Carrie