Dental and Oral Injuries

In this lesson, we'll take a look at dental and oral injuries and how you can apply first aid to treat them.

Dental and oral injuries, such as tooth, tongue, or lip injuries, can occur unexpectedly and may require immediate first aid. Knowing how to assess and provide initial treatment can help alleviate pain and prevent further complications.

This lesson will guide you through the assessment phase and first aid treatment options for some of the more common dental and oral injuries.

However, in minor cases, you can provide initial first aid to alleviate discomfort and help the healing process.

First Aid Treatment for Tooth, Tongue, and Lip Injuries

If a permanent tooth is lost, follow the first aid steps below.

1. Try to locate the tooth and handle it only by the crown.
2. Avoid contact with the root – the part that is hidden in the gums - as touching this could damage the tooth.
3. If the tooth is dirty, gently and quickly rinse the tooth with water. Do not scrub or remove any tissue fragments.
4. Gently reposition the tooth back into its socket and have the patient bite on a clean cloth, such as a piece of gauze, to hold it in place.

If the first option is not possible, place it in a suitable storage medium, such as milk, saliva, or a tooth preservation kit, and seek dental care immediately, as the chance of saving a knocked-out tooth decreases with time.

Additionally, according to the latest guidelines of the International Association of Dental Traumatology, it is not recommended to replant a primary tooth. It is still advisable to place the tooth in a storage medium and seek further evaluation by a dentist.

There are many other dental injuries that could occur, but there is very little we can do about these. The best recommendation is not to move or irritate the area and seek immediate dental care.

If there's bleeding from the tongue or lip, have the person rinse their mouth with water to clear any blood. You can gently clean the injured area with a damp cloth or gauze pad to remove debris. This will allow you to assess the extent of the injury.

Apply direct pressure to the wound with a clean cloth or sterile gauze to control bleeding. If there is significant bleeding or the wound is deep, seek immediate medical attention since this may lead to breathing problems as blood can make breathing increasingly difficult. It may also cause the patient to swallow blood which can quickly lead to nausea and vomiting, further compromising the airway.

Encourage the person to avoid hot or spicy foods and to maintain good oral hygiene. Remember, while these first aid measures can provide relief, seeking professional dental or medical care is always essential.

A Word About Dental Avulsion Injuries

A dental avulsion injury - also known as a knocked-out tooth - can damage both the tooth and the supporting soft tissue and bone, resulting in the permanent loss of the tooth.

Dental avulsion is relatively uncommon compared to other dental injuries but can occur in various age groups, particularly among children and young adults involved in sports or accidents.

It most commonly affects children and adolescents, often due to falls or sports-related injuries. The peak incidence is seen in the 7-14 age group.

Studies suggest that dental avulsion accounts for approximately 0.5 to 3 percent of all dental injuries. It tends to affect males more frequently than females, possibly due to higher participation rates in contact sports. Participation in contact sports (e.g., football, hockey, and basketball), inadequate use of mouthguards during sports activities, and accidents (falls and collisions) are significant risk factors.

Immediate reimplantation of an avulsed tooth is believed to result in the greatest chance of tooth survival. The longer a tooth is out, the more likely it will be permanently lost.

In situations that do not allow for immediate reimplantation of an avulsed tooth, it is beneficial to temporarily store it in a variety of solutions that are shown to prolong the viability of dental cells.

If available, place the avulsed tooth in Hanks' Balanced Salt Solution or in another oral rehydration salt solution, or wrap the tooth in cling film to prevent dehydration and improve the likelihood of successful replantation by a dental professional. This should always be done as quickly as possible.

If an avulsed permanent tooth cannot be immediately replanted in either Hanks’ Balanced Salt Solution, oral rehydration salt solutions, or cling film, store the tooth in cow’s milk or saliva, as these are your best secondary options. Keeping the tooth "safe" in the saliva inside the person's mouth is also not suggested as the patient will often keep moving the tooth around which can further damage to the roots of the tooth.

An avulsed tooth should never be stored in tap water. 

The viability of an avulsed tooth stored in any of the above solutions is limited. And reimplantation of the tooth within an hour after avulsion provides the best chance for tooth survival.

Following the loss of a permanent tooth, it is essential to seek rapid medical assistance for reimplantation.

The long-term success of replantation depends on various factors, including the extra-alveolar time (time the tooth is out of its socket), the storage medium used for transporting the tooth, and the condition of the tooth and surrounding tissues.

Complications may include pulp necrosis (death of the tooth's inner tissue), infection, root resorption (breakdown of the tooth root), and periodontal issues.

Prevention is often a key to avoiding oral injuries while playing contact sports. The proper use of mouthguards is highly recommended.