Management of Traumatic Injuries to Teeth

By Penny Creek Family & Implant Dentistry
March 10, 2010
Category: Dental Trauma
Tags: Tooth Trauma  

Summer has finally arrived in Seattle, and with this warm weather we see many of our children riding their bikes and playing sports in and around our neighborhoods.   

Over the weekend my 5 year old son took quite a spill off his bike when one of the training wheels fell off while he was riding down a small hill by our house.  Fortunately, he managed to steer the bike into the grass before flipping over the handle bars.  Wow, what a sight for a parent! My son walked away a bit shaken up by the experience, and with only minor abrasions to his knee.  Of course, as a dentist, I immediately imagined broken teeth and lacerations to the lips. 

Many children and adults are often not so lucky.  They often chip, fracture, displace or completely avulse (knock out) one or more teeth as a result of similar accidents. Dental injuries can also result from auto accidents, assaults, falls, and a variety of sporting activities. 

Dental injuries can happen at anytime, but I tend to see an increased number of injured children and young adults in the summer and fall.

Studies have found that boys injure their teeth more often than girls, and that upper front teeth are more likely than the lower ones to be traumatized. 

Minor tooth fractures involve chipping of the outer tooth layers called enamel and dentin.  Enamel is the outermost white hard surface, and the dentin is the yellow layer lying just beneath the enamel.  Enamel and dentin serve to protect the inner living tooth tissue called the pulp.

Minor chips and fractures are often accompanied by temperature sensitivity and sharp edges that tend to irritate the lips, cheeks and tongue.  It is recommended to save the broken piece and bring this to your dentist.  Cover the fracture with wax or sugarless gum and contact your dentist for immediate evaluation.  Definitive treatment usually involves a composite resin filling on front teeth to protect the pulp and restore the tooth to natural contour.

Severe fractures expose the dentin and pulp, and often have vertical, horizontal or diagonal fractures extending into the root of the tooth.  We also may see bleeding gums, tooth displacement and laceration of the surrounding soft tissues.  These fractures are very serious and need immediate attention. 

The best way to manage these injuries is to gently clean the dirt or debris from the injured area with warm water, and place a  cold compress on the child’s face in the area of the injury to minimize pain and swelling.  Try to locate and recover the broken tooth fragments to bring to the dentist.  Call Penny Creek Family and Implant Dentistry for immediate evaluation.

Definitive treatment for these injuries usually requires root canal therapy to treat the damaged pulp tissue followed by a large composite resin filling or porcelain crown. Splinting may be necessary if the tooth was displaced.

Appropriate management of completely avulsed (knocked out) teeth is very critical to the long term prognosis.  The most important variable affecting the success of re-implantation is the amount of time that the tooth is out of the socket. Teeth re-implanted within 1 hour of the accident frequently reattach to their sockets.  Teeth that remain out of the mouth for periods longer than one hour are more prone to root resorption and short term failure leading to extraction.

Following the accident recover the tooth and rinse it gently under running water if the tooth is dirty.  Do not scrub it.  Try to handle the tooth only by the crown and not the root, and place the tooth back into the socket from which it came.  If the patient or parent is unsure about reimplanting the tooth, then the tooth should be placed in the following media (in order of preference): Hanks solution, milk, saline, saliva, and water.  If none of these are available the tooth can be held in the mouth within the cheeks or under the tongue.  Call Dr. Chad G. Slocum immediately for evaluation and treatment. 

Definitive treatment will include a splint to stabilize the tooth for 4-6 weeks followed by root canal therapy.  The patient will want to maintain routine follow-up care with their dentist to monitor for possible complications. 

Unfortunately our warm sunny wonderful summer weather also brings increased traumatic injuries to the teeth and mouth.  With proper education and preventative measures these injuries can often be avoided.