When a student loses a tooth at school, the event can be quick, easy, and painless. After all, children, particularly elementary aged, are losing teeth all the time, and rarely are the events anything more than mundane. But when the events turn traumatic, “the school nurse must act simultaneously to relieve that child’s pain, minimize the panic of a traumatic incident and most important, prevent the loss of a tooth,” noted Chamois Beal Lopez, author of “What a Student Loses a Tooth at School” in the November issue of School Nurse News. Many times if a tooth is knocked out at school, the proper reactions by the nurse and other faculty can mean saving the tooth.
The article references studies reporting 25% of school-aged children undergo some type of dental trauma each year, and 16% of school-aged children have teeth knocked out. These percentages are significant, signaling, “every school nurse and staff must be ready to face the challenges of dental trauma and injuries in school-aged children—especially the emergency of an avulsed tooth.” An avulsed tooth is severed and detached from the socket, exposing ligaments. The root separation means that cells are vulnerable to decay, a possibility that increases the longer the cells are exposed. An avulsion is a true trauma, and demands quick, and careful care.
Lopez provides the three A’s in dental trauma to aid school faculty & nursing staff: assessment, action, and awareness
Assessment: Initial examination is key. The nurse should determine what caused the event, and how severe it is—the child, or adult present at the injury, should try to describe how the event occurred. Routine dental pain is resolved quickly and easily. However, if bleeding does not stop after 15 minutes, or if it appears the child suffered other head trauma, the child requires further assessment. Depending on the severity of the head trauma, the child may be taken to the emergency room, and image tests should be conducted. If it is determined the trauma is merely to the tooth, the child can be taken to the dental office.
Action: In young children, saving a tooth is not as imperative simply because they lose primary teeth. In older children, when the tooth is permanent, replantation is important. To save the tooth, it must be handled very carefully:
- Rub the tooth gently with warm water, but do not scrub
- After the tooth is replanted, apply pressure with a tea bag until the child arrives at the dental office
- Transport the tooth carefully, holding by the enamel, not the roots
- Submerge the tooth in Hank’s Balanced Salt Solution (better than milk or saline), which provides 40 hours of storage and transport
Awareness: Because many school systems do not have official guidelines for dental emergencies, it is imperative for nurses to stay abreast of proper care to avoid liability. Nurses and schools can also lessen the likelihood of dental traumas by educating parents and students, and encouraging the use of mouth guards. Schools should also be aware that beginning in third grade, children become significantly more active in organized sports and recess games, making them more vulnerable to dental trauma.