Tooth trauma is very common, occurring in as many as one in four of all school-going children, and in up to 33% of adults, usually occurring before the age of 19. The essential message is that if you sustain tooth trauma, it is imperative that you get to your dentist or endodontist as soon as possible, preferably within half an hour. The management of dental trauma varies between children with developing teeth (“baby” teeth, deciduous or primary teeth) and adults with permanent teeth. While all dentists are trained to take care of dental trauma, a specialist dentist, called an endodontist is further trained for an additional two years after dental school to take care of injuries inside the tooth.
What is endodontic treatment?
The tooth is composed of three layers. The hardest, outer (visible) part is called the enamel. The body of the tooth is called the dentin, and, within the dentin, lies the root, the softest tissue of the tooth, where the nerve and blood supply lies. The pulp runs from the crown (top) of the tooth down into the roots and is essential for growth and development of the new tooth. Once the tooth is fully formed, the tooth can survive and function without the pulp. The endodontist (from the Greek for “inside” and “tooth”) specializes in taking care of the inside of the tooth, or root cavity. Treatment of this area is sometimes called root canal therapy. Pediatric dentists are specially trained to take care of endodontic issues in developing teeth.
How will my injury be treated?
Since dental trauma is so common, all dentists are trained to take care of it. The management depends on many factors, including severity, location, and type of injury. Because of the forces at play causing trauma, it is essential that you consult with a dental professional after tooth trauma, since they will be best able to examine all the teeth and look for and diagnose other dental or bone damage – often this is only possible with x-rays.
With simple chips or fractures, the broken off piece (if available) may be simply re-attached to the tooth, or a tooth-colored filling may be placed to replace it. In more severe cases, where the pulp cavity is penetrated, root canal therapy may need to be done, and a crown or cap may need to be placed later to ensure the strength and integrity of the tooth.
Types of Teeth Damage
A tooth may be dislodged (luxated) with trauma, but not suffer other damage. This means that the tooth has moved with injury, in any direction. Depending on when you arrive for emergency treatment, your dentist may be able to reposition the tooth correctly in its socket and splint it in place so that the tooth may re-attach to the underlying bone and connective tissue. For permanent teeth, root canal treatment may need to be started and regular visits to the dentist following trauma may be required to monitor the state of health of the tooth and the pulp cavity.
Children with developing teeth (pre-pubertal, usually) usually do better than adults, since there is the potential for the cells in the pulp to grow further and heal what injury has occurred. Frequent follow-up visits are often required in children, so that the dentist can intervene if this does not occur.
Knocked Out Tooth (Avulsed Tooth)
A tooth completely knocked out of the mouth is known as an avulsed tooth. If there is any chance of re-attachment, the following should be done: Get to a dentist as soon as possible – preferably within half an hour. Handle the tooth as little as possible, holding it at the crown (top) end, rather than at the root end, where the nerve and blood supply lies. If possible, place the tooth immediately back in the socket, rinsing it with a little water if necessary. It is essential that the tooth not be exposed to unphysiological fluids if there is any chance for survival or re-attachment. Therefore, if its difficult to place it back in it’s socket, it would be better to hold it in the saliva of the mouth (between the check and gums) than suspending it in water. Failing that, the tooth may be placed in milk or normal saline (often found with contact lens solutions) and transported to the dentist. On no account should the tooth be cleaned with soap or any other agent, nor should the tooth be allowed to dry out, which will decrease its chance for survival.
Once at the dentist, s/he will examine your entire mouth looking for other injuries and see what can be done to save the tooth. Often, splinting the avulsed tooth back in its socket once cleaned and examined is all that is required. Root canal treatment may be required, but this usually occurs at a later date.
Tooth Root Fractures:
With trauma, the tooth may partially or completely split or fracture (cracked tooth). The location and direction of the fracture will decide the outcome of the tooth, so it’s important to consult with a dental professional after any trauma. Treatment may vary from simple splinting of the tooth, and, perhaps, a crown placement, to root canal therapy.
Do traumatic dental injuries differ in children?
Usually, chipped “baby” teeth can be restored quite easily. If a primary tooth is completely avulsed, it is not commonly reimplanted, since doing so may damage the development of the permanent tooth developing in the underlying bone. With teeth that are not fully developed at the time of the injury, special attention and follow-up will be required, since some teeth will still have a viable blood supply allowing for continued growth despite the injury. These damaged teeth will require frequent follow up appointments.
Will the tooth need any additional care or treatment?
The long-term outcome from dental trauma depends on many factors, including time to get therapy, how one’s body responds to the trauma, whether the tooth was fully developed or not, and many others. The most essential factor is probably the time taken to receive treatment, which is important to prevent root resorption, where the body treats the tooth as foreign and rejects the tooth, resulting in the root being eaten away over time. It will require regular visits to your dentist or endodontist to monitor for this condition, which may take up to 5 years to develop. Some, but not all forms of resorption are treatable.