Front tooth pushed back

Yesterday my 19-month-old son fell off our bed and hit the carpet face down. His right front tooth was pushed back and there was a great deal of blood. We took him to the emergency room where they did nothing except recommend he see a pediatric dentist. I took him in this morning and the dentist did not take x-rays but he did look at the tooth and decided to do nothing at this point. He will follow up in three weeks. In the meantime, my son is playing normally, eating normally and sleeping normally as if nothing has happened. I am devastated! Do you think that it's possible he did not break the root? Is it possible the tooth will move back into position? I'm heartbroken that he may lose a tooth at this early age and have a gap until age six or seven? Is there anything I should keep an eye out for?

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When the position of a tooth is changed due to trauma, several factors must be monitored. You should consider the effect the trauma may have on the permanent tooth and its developing follicle. If the primary tooth is displaced, which is a relatively common injury in the primary dentition, it needs to be carefully watched. A lingual displacement (tooth is pushed back) can cause problems with the permanent tooth, such as an enamel defect in a certain area of the tooth or a "weaker" tooth which is more prone to cavities. These problems are more notable if the tooth is also intruded (pushed up).

While obtaining a radiograph on a 19 month old may be difficult, a lateral radiograph may be helpful in determining the position of the primary root in relation to the permanent developing follicle. If it is noted the primary tooth is close to the permanent follicle, this must be closely monitored as any fracture of the bone may cause the enamel problems mentioned above. I have had a few children in my practice with the injuries you describe, and, so far, none of these problems have arisen. My experience also has been that the teeth do not go back to their original positions, although this could be a possibility.

If the root of a primary tooth is fractured (which is uncommon in the primary dentition), it may not be necessary to extract the tooth. If the fracture is in the apical portion of the root, the tooth may be splinted for four to six weeks, and healing may occur. If the root is fractured elsewhere, however, the tooth should be extracted. If extraction at this time becomes necessary, the tooth can be replaced with a "fake" tooth. It may be possible to construct a space maintainer with a false tooth attached, or a "kiddie" partial could be fabricated. There are some considerations to these treatment options which include: 1) The appliances may need to be remade as your son grows, and 2) placing a removable appliance in such a young child's mouth may not be the best option.

Follow-up on these injuries is very important for several reasons. The tooth may become discolored due to the trauma. If this occurs, it may not be necessary to perform any treatment, unless your son complains of pain or signs of infection, such as swelling or redness on the gum tissue around the tooth, are noted. It is possible the tooth will need to be removed prematurely if resorbtion of the primary root is not occurring normally. If abnormal resorbtion is noted and judicious extraction of the primary tooth is performed, this may prevent displacement of the permanent tooth.

The fact that your son is acting normally is a good sign. Sometimes waiting to do further evaluation until some healing has occurred is better. In this way, it may be less traumatic, hopefully creating a better dental experience for your son.

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