Unfortunately traumatic dental injuries do occur, usually as a result of sports mishaps, automobile accidents, or bad falls. If your child has experienced a traumatic dental injury it is important to let us know in order to determine any necessary treatment. Any dental injury, even if apparently mild, requires examination by a dentist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.
Additionally, any baby tooth that sustains a traumatic dental injury may have adverse outcomes develop in the future. These include discoloration, nerve damage, root resorption, or abscess formation. If pain or an abscess develops, an extraction may be indicated.
Below is a list of common traumatic dental injuries:
Chipped or Fractured Teeth
Chipped teeth account for the majority of dental injuries. Depending on the severity of the tooth chip or fracture, sometimes simply smoothing a rough edge can do the trick. Other times, largely broken teeth may require a more extensive repair such as a crown placement or a bonded build-up to restore the tooth's normal form and contour. In severe cases, some fractured teeth may require nerve treatment (or root canal therapy) or ultimately extraction if the tooth in non-repairable or has a very poor prognosis.
Dislodged or Malpositioned Teeth
During an injury, a tooth may be pushed sideways, forward, or backward and out of alignment (or luxated). Other times a tooth may be pushed into the socket (intruded) or pulled slightly out of its socket (extruded).
Most adult teeth can be repositioned and stabilized for adequate healing. Root canal treatment is sometimes needed for adult teeth in these cases and should be started a few days following the injury if required.
Treatment of baby teeth that have sustained these types of injuries varies. Slight malpositioning of baby teeth may require no treatment, whereas more severe cases may require extraction. Other cases may warrant repositioning, but this may not always be favorable for baby teeth. Your dentist will assess the injury and let you know what's best.
Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, an adult or permanent tooth should be placed back into its socket as soon as possible. If putting it back into the socket is not feasible immediately, place it in a container of milk and contact your dentist right away. The less time the tooth is out of its socket, the better the chance for saving it.
Once an adult tooth has been put back in its socket, a stabilizing splint will be placed for a few weeks. Depending on the stage of root development, root canal therapy may be indicated.
Baby teeth that have been avulsed are typically not put back in place or replanted, as there is risk for potential damage to the underlying permanent tooth.
A traumatic injury to the tooth may also result in a horizontal or vertical root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. The closer the fracture is to the gum line, the poorer the long-term success rate. Stabilization with a splint is sometimes required for a period of time. Vertical root fractures are much more challenging and the prognosis of these injuries is typicallyl poor.
Traumatic Dental Injuries in Children
Chipped primary (baby) teeth can be aesthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.
Children's permanent teeth that are not fully developed at the time of the injury need special attention and careful follow-up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may allows for continued root growth. Your dentist may recommend evaluation by an endodontist for your follow-up care.
Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined or treated at regular intervals to ensure that root resorption is not occurring and that surrounding tissues continue to heal.
With any traumatic dental injury, time is of the essence. Contact your dentist immediately.