Traumatic injuries can happen to both children and adults. These may be the result of playing a sport, an automobile accident, a fight or fall. Thankfully handling these in a child or adult is very similar except in some very special circumstances.
First thing you must determine is what type of damage was done to the tooth.
Is the tooth chipped or fractured? A chipped tooth most of the time simply requires a filling. If the pulp is exposed these too may only require a filling. This usually depends on how large the exposure is. Large exposures usually require root canal treatment. You should see your restorative dentist or endodontist as soon as possible.
Injuries to the back teeth may include fractured cusps, fractured teeth or even teeth that have completely split. These teeth may require crowns and root canals to restore. Sometimes they even have to be extracted.
Teeth may have intruded (pushed into) the socket. Your restorative dentist or your endodontist needs to reposition and stabilize the tooth. Your endodontist will start root canal therapy on the tooth shortly after this. He may even use calcium hydroxide inside the tooth. These teeth should be looked at periodically by your dentist or endodontist to monitor healing.
The tooth maybe partially avulsed (partially out of the socket). If you are comfortable to do so, push the tooth back into the socket. You should get the patient to their restorative dentist to stabilize it as soon as possible. If you are not comfortable doing this, get the patient to their restorative dentist as soon as possible to stabilize the tooth.
These teeth may or may not require root canal treatment. Time, periodic observation, and periodic testing by your restorative dentist or endodontist will help determine this.
With avulsed teeth (completely knocked out of the mouth) time is extremely important.
First, find the tooth and pick it up by the crown (this is the part of the tooth that was sticking out of the gum). Do not touch the root at all. Rinse off any debris from the root. Place the tooth back into the socket. Be sure to orient the tooth the proper way. Get the patient to their dentist or an endodontist as soon as possible.
If you cannot place the tooth back into the socket, you must keep it moist. This can be done by placing the tooth into a “save-a –tooth” kit. Most sports places have these or one can be obtained from a drug store. If this is not available, place it in milk, in the mouth, between the cheek and gum, or under the tongue (make sure not to swallow it!). The last resort would be to place the tooth in water with a pinch of salt.
You must get the person to the restorative dentist or endodontist as soon as possible. The best result is obtained if the tooth is placed back in the socket in less than an hour. The longer the tooth is out of the mouth, the poorer the prognosis becomes. The tooth will then be stabilized with a splint by the doctor. Root canal therapy must be done on this tooth. This is usually started within seven days after the trauma. The endodontist may use calcium hydroxide as a medication in the tooth before completing treatment. Because of the trauma, the tooth or teeth should be observed with x-rays for several years. This is done at no charge at our office.
Root fractures usually occur in a horizontal direction when teeth receive trauma and do not move. The long term prognosis depends on where the fracture is. The closer the fracture is to the end of the root, the better the prognosis will be. Sometimes these teeth do require a splint to stabilize them.
There are times when traumatic injuring occurs in children and adults when the roots have not finished forming. Situations such as these are called open apex or immature teeth. These teeth have very thin walls and there are several procedures that can be done to help close the apex.
If the immature tooth is completely avulsed, time is extremely important. If the tooth is placed back in the socket within an hour, the chances the blood supply will reform is very good. The tooth needs to be stabilized and evaluated for three to four weeks. A change in the tooth color, pain, swelling or loosening of the tooth indicates pulpal death. If this happens, apexification will be required.
If it has been out for longer than an hour, the prognosis is very poor. It is usually not recommended to be placed back in the socket. If it is it should be stabilized and the pulp tissue removed. A medication is placed in the tooth and re-evaluated in six to eight weeks. With the poor prognosis other treatment options may be discussed.
As with all trauma cases the teeth should be followed longer than standard root canal treatments. At our office these teeth are followed for an additional three to five years at no charge.