First aid: Oral trauma (mouth and teeth injuries) in infants and toddlers

• What is oral trauma?
• Types and causes of oral trauma
• Essential first aid for all oral injuries
• Minimising emotional trauma
• First aid for oral cuts
• First aid for tooth injuries
• First aid for mouth and lip burns
• Emergency dental treatment for oral trauma
• Follow-up care

What is oral trauma?

Oral trauma refers to injuries to the mouth and/or teeth. It is common in early childhood, particularly when babies and toddlers are learning to walk and remain unsteady on their feet. Giving appropriate and timely first aid is essential, particularly where a tooth has been affected. Knowing how to administer first aid for oral trauma means that children have the best chance of recovering quickly, if an injury occurs.

Types and causes of oral trauma

Oral trauma in babies and toddlers includes:

• Cuts and scratches on the inside of the mouth (e.g. to the gums or tongue) or the lips;
• Injuries to the teeth, including chipped and displaced teeth and teeth being knocked out; and
• Burn to the lips or inside of the mouth.

Cuts, scratches and teeth injuries often occur when children fall over. They are particularly likely if a child falls over while they have an object in their mouth. Children may burn their lips or inside of their mouths if they touch something hot or inhale steam or a chemical (these are known as inhalation burns).

Essential first aid for all oral injuries

When a child sustains an oral injury, it is also common for them to injure other body parts, including their heads. Sometimes the other injuries are more serious, and require more urgent attention, compared to the oral injuries.

An important first step in providing first aid for a child with an oral injury, is to assess them for other, more serious injuries.

• Check the child’s head for signs of swelling or bleeding, before administering first aid for the oral injury.
• Continue to check the head for signs of swelling for some hours after the accident.
• Check the child is breathing normally.
• If a head injury is noticed, or the child’s breathing is disrupted, go to the emergency department.

Minimising emotional trauma

If the child has not injured themselves seriously, the next step in providing first aid is to comfort the child. For most minor injuries a cuddle and some soothing words will be sufficient. If the child is bleeding, they should be comforted while their injuries are assessed.

If the injury is more serious, the child may require pain relief. Applying an ice pack can relieve pain and reduce swelling. The child may be given pain relief medication if an ice pack is insufficient to relieve their pain.

First aid for oral cuts

If a child cuts their lips, gums or tongue, pressure should be applied to the cut using a clean cloth. The pressure should be maintained until the bleeding has stopped. If there is blood in the child’s mouth but the injury is not visible, pull back their lips and inspect their gums to identify the site at which pressure should be applied.

Bleeding should stop within 15 minutes when pressure is applied continuously to the wound. If bleeding does not stop within 15 minutes, the child should be taken to the emergency department for medical attention.

First aid for tooth injuries

When a child has a tooth injury, the dentist should be contacted immediately after the child is comforted and their bleeding controlled. Visiting the dentist is important for all tooth injuries, including when a tooth has been displaced (moved) but not knocked out. A displaced tooth that remains in the child’s mouth may cause damage to the permanent teeth. The dentist will assess the likelihood of a permanent tooth being damaged and may need to remove the displaced primary tooth (milk tooth).

If a child’s tooth is knocked out, place it in milk to keep it moist and visit the dentist immediately. When handling the tooth, only touch the crown (the part that is visible in the child’s mouth) and not the root (the part that sits in the child’s gum). If the tooth is dirty, it should be rinsed in milk. Fragments of tissue and gum that remain attached to the tooth should not be removed. The tooth should not be allowed to dry out or be in contact with water for more than 2 seconds.

The tooth should be taken to the emergency dental appointment (or the hospital emergency department if an emergency dental appointment cannot be arranged).

Never try to push a dislodged or knocked out tooth back into its socket. It may cause infection or damage the permanent teeth that are sitting beneath the child’s gums, waiting to emerge at around six years of age. Because of the risk of damage to the socket and permanent teeth, primary teeth are never re-inserted, even at the emergency dental visit.

First aid for mouth and lip burns

Oral burns include burns to the lips or inside the mouth. First aid for minor lips burns involves running cool water over the burnt area and providing pain killers if required. Once the lip burn has been cooled with cool running water irrigation soft white paraffin or lanolin should be applied to the lips.

Never apply ice or ice slush to a burnt lip (or other burnt skin) as they may cause further damage. Burn gels should only be used if running water is not available.

The inside of the mouth may be burnt if a child inhales hot steam or gas. Internal oral burns are potentially life threatening as they may prevent the child from breathing. Difficulty breathing is the most common symptom of burns to the inside of the mouth. Visit the emergency department immediately if a child burns the inside of their mouth by inhaling a hot substance.

Emergency dental treatment for oral trauma

When a child is taken to a dentist for emergency oral trauma treatment, the dentist will assess the injury by looking at and feeling the child’s mouth. Depending on the nature of the injury the dentist may perform:

• A 3D x-ray of the mouth called an orthopantogram (if a fracture is suspected);
• A chest x-ray (if the child is suspected to have swallowed a tooth); and/or
• A dental x-ray (to view occluded oral structures).

If the child’s injuries indicate they may have experienced additional injuries, the dentist may refer them to a doctor. The child may need to see a doctor if they experience:

• Loss of consciousness or altered consciousness;
• Breathing difficulties;
• Nausea or vomiting;
• Bleeding that does not stop.

Follow-up care

The dentist or doctor will typically provide instructions for follow-up care, which may involve a second dentist or doctor appointment. It is important to follow the dentist or doctor’s instructions to minimise the likelihood of the child experiencing complications, and ensure the wound heals as quickly as possible.

For minor injuries it is important to continue checking the wound for some time, to ensure they do not get infected. Visit a doctor or dentist if the wound becomes swollen.

Oral hygiene is particularly important while the wound is healing. Monitor the child to ensure they maintain good oral hygiene (e.g. continue cleaning their teeth) while the wound is healing.

Children that have knocked a tooth out may be upset or embarrassed. Be positive and prepare them for questions that their friends might ask. For example, suggest they could tell their friends that the tooth fairy visited early for their tooth, rather than talking about the accident.

 

More information

For more information on good dental hygiene, regular dental check-ups and other things you can do to help maintain your child’s primary teeth, visit Dental Health in Children.

 

References

1. Australian Dental Association. Oral Trauma for Babies and Toddlers. 2013. [cited 14 April 2016]. Available from: [PDF]
2. American Academy of Pediatric Dentistry. Guideline on Management of Acute Dental Trauma. 2011. [cited 25 April 2016] Available from: [PDF]
3. Women’s and Children’s Hospital. Guidelines for the Management of Pediatric Burns. 2010. [cited 19 April 2016]. Available from: [PDF]
4. Royal Children’s Hospital. Dental injuries. Undated. [cited 18 April 2016]. Available from: [URL]
5. Australian Dental Association. Dental First Aid. 2014. [cited 21 April 2016] Available from: [URL]
6. The Royal Children’s Hospital Melbourne. Burns/Management of burn wounds. Undated. [cited 19 April 2016]. Available from: [URL]