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.
How will my injury be treated?
Chipped or Fractured Teeth
Enamel is the hardest substance in the human body, stronger even than our bones, and can withstand a lot of wear and tear. But as we live longer, and expose our teeth to stresses like clenching, grinding or chewing on hard objects, we can put our smiles at risk. If you think you have a cracked tooth, it’s important to seek treatment quickly, before the problem gets worse.
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/nerve 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.
Dislodged (Luxated) Teeth
A dislodged, or luxated, tooth is one that has been partially pushed into or out of its socket, or sideways, during an injury. Our endodontists 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. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection. An endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed.
Knocked-Out (Avulsed) Teeth
More than 5 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. It’s important to see a dentist or endodontist as soon as possible after the tooth is knocked out. Quick action will increase the likelihood of saving the tooth.
Saving a Knocked-Out Tooth
- Pick up tooth by the crown (the chewing surface) not the root.
Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully to minimize injury to the root.
- If dirty, gently rinse tooth with water.
Do not use soap or chemicals. Do not scrub the tooth. Do not dry the tooth. Do not wrap it in a tissue or cloth.
- Reposition tooth in 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 fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.
- Keep 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: 1) Emergency tooth preservation kit (such as Save-a-Tooth®), 2) Milk, or 3) 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 the nearest available dentist within 30 minutes.
Once you arrive at our office, our endodontists will carefully evaluate the tooth, place it back in its socket and examine for any other dental and facial injuries. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, root canal treatment may be initiated a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.
A traumatic injury to the tooth may also result in a horizontal 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. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.
Vertical root fractures, however, often require extraction of the tooth.