Traumatic Dental Injury
Traumatic dental injuries often occur in accidents or sports-related injuries. Chipped teeth account for the majority of all dental injuries. Dislodged or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury. Any dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately.
Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam. Endodontists are dentists who specialize in treating traumatic dental injuries. With their advanced skills, techniques and technologies they can often save injured teeth.
Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.
If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.
Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth. Split teeth may require extraction.
During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.
Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear.
If a tooth is completely knocked out of your mouth, time is of the essence. See an endodontist or dentist immediately! Handled the knocked-out tooth very gently, avoiding touching the root surface and follow these steps to protect the tooth:
More than five million teeth are knocked out every year in children and adults. With proper emergency action, a tooth that has been knocked out of its socket can be successfully replanted and last for years. Review, remember and share these steps to saving a knocked-out tooth. Your knowledge and quick action will likely increase the likelihood of saving the tooth! If this has happened to you, see an endodontist or nearest available dentist within 30 minutes of the injury!
Steps to saving a knocked-out tooth:
- Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully. Touch only the crown to minimize injury to the root. Pick up the tooth by the crown (the chewing surface) NOT the root.
- If dirty, gently rinse the tooth with water.
- Do not use soap or chemicals.
- Do not scrub the tooth.
- Do not dry the tooth.
- Do not wrap the tooth in a tissue or cloth.
- Reposition the tooth in the socket immediately, if possible.
The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with your fingers, or position above the socket and close your mouth slowly. Hold the tooth in place with your fingers or by gently biting down on it.
- Keep the tooth moist at all times.
The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following:
- Emergency tooth preservation kit (such as Save-a-Tooth®)
- Mouth (next to cheek)
- Regular tap water is not recommended for long-term storage because the root surface cells do not tolerate water for long periods of time.
- See an endodontist or nearest available dentist within 30 minutes of the injury.
Bring the tooth with you to your emergency appointment ideally, within 30 minutes. However, it is possible to save a tooth even if it has been outside the mouth for an hour or more.
Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.
The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.