A tooth intrusion is a dental injury where a primary (baby) tooth is forcefully pushed into the gumline and underlying jawbone. This often happens from a fall or direct impact to the mouth, and it can appear as though the tooth has vanished since the crown may no longer be visible. While alarming, this is a common dental injury in young children. The impact can sometimes fracture the bone that holds the tooth.
Immediate Steps After an Intrusion Injury
After an injury pushes a tooth into the gums, remain calm and comfort your child. Gently rinse the child’s mouth with cool water to clean the area. Applying a cold compress to the outside of the mouth can help reduce swelling and ease discomfort. You can offer a children’s pain reliever, such as acetaminophen, as needed for pain.
Do not attempt to wiggle the tooth or pull it back down into its original position. Manipulating the tooth can cause further damage to the gum and the developing permanent tooth underneath. Contact a pediatric dentist immediately for an emergency assessment, as professional evaluation is needed even if the child does not seem to be in significant pain.
Professional Assessment and Management
The dentist will conduct a clinical examination of the child’s mouth, checking the injured tooth and surrounding soft tissues. A dental X-ray is almost always necessary to fully understand the injury’s extent. This imaging shows the intruded tooth’s position in relation to the developing permanent tooth bud and reveals any fractures to the tooth’s root or the surrounding bone.
In most cases of primary tooth intrusion, the recommended course of action is “watchful waiting.” This involves monitoring the tooth to see if it will re-erupt on its own. A majority of intruded baby teeth descend back into a normal position within two to six months without intervention. Regular follow-up appointments will be scheduled to track this progress.
There are situations where the dentist might recommend extracting the intruded tooth. If the X-ray shows the baby tooth has damaged the developing permanent tooth, removal may be the best option. An extraction might also be necessary if the tooth’s nerve dies or if an abscess or infection develops.
Potential Effects on Permanent Teeth
A primary concern is how an intrusion injury to a baby tooth might affect the permanent tooth developing beneath it. The outcome depends on the intrusion’s severity and the permanent tooth’s developmental stage at the time of injury. In many instances, there is no damage to the permanent successor, which later erupts normally.
When effects do occur, they often manifest as cosmetic imperfections on the new adult tooth’s enamel. These can appear as white or brown discolorations, a condition known as enamel hypoplasia, because the trauma disrupted the cells that form the enamel. The shape of the permanent tooth can also be altered.
More severe intrusions risk disrupting the permanent tooth’s normal path of eruption, potentially causing it to come in crooked, be delayed, or become impacted. The force of the injury can damage the tooth’s ligaments or the follicle guiding its development.