The Challenge of Traumatic Injuries to the Mouth
Traumatic injuries occur in children and teens due to sports injuries or accidents near home or school, and serious accidents such as injurious falls or automobile crashes can affect any age range.
Many types of injuries can occur:
- Chipped or Fractured Teeth. A corner of a tooth is traumatically fractured and needs to be restored due to esthetic and functional concerns. A crown fracture can be uncomplicated (no dental pulp exposure) or complicated (pulp exposed).
- Dislodged (Luxated) Teeth. Teeth can be pushed towards or away from the dental arch; into or out of the tooth socket; requiring repositioning and stabilizing before evaluating for treatment options.
- Knocked-Out (Avulsed) Teeth. Because normally protected tissues are fully exposed, the tooth should be placed back into its socket as soon as possible. Gently rinse, but do not scrub debris from an exposed root and handle by the crown. If repositioning is not possible, store in Save-A-Tooth Solution (available at many local pharmacies), or milk, until your dentist is able to reposition it.
- Root Fractures. Horizontally oriented fractures of teeth result in a mobile crown that will have varying degrees of looseness, which may require repositioning and stabilizing before evaluating for treatment options.
The International Association for Dental Traumatology has provided a free dental trauma first aid app entitled IADT ToothSOS Mobile App which can be downloaded for Apple and Android devices.
Many factors influence the type of treatment indicated and the prognosis:
- Stage of Development of the Tooth. Treatments for immature teeth will always favor efforts to keep the tooth vital until the end of the root has narrowed and the roots have thickened during the maturation process.
- Primary (Baby) Teeth vs Permanent Teeth. Knocked out baby teeth should never be replanted, to protect from inadvertently damaging the underlying, developing permanent tooth.
- Time Between Trauma and Treatment. With any type of dental traumatic injury, time is of the essence in administering First Aid, and in seeking professional evaluation and treatment.
- Injury Extent Beyond the Obvious. Adjacent teeth need to be evaluated and re-evaluated long term to ascertain their status.
- Extent of Damage to surrounding gum, ligament and bone tissues. The nutritional and immunologic lifelines for dental tissues become disrupted after trauma, which affect healing.
Complex and uncertain distinctions between a favorable and unfavorable healing response from traumatized pulps and supporting tissues exist, and may not be clearly evident until months after injury. Dr. Odum and Dr. O’Connor will consider the factors above to estimate tooth prognosis using a clinical exam, 2-D images, and 3-D CBCT images. Specialized techniques will be required to save traumatized teeth, which may include multiple stage root canal therapy and monitoring.