Tooth Trauma

     Teeth can be traumatized in many different ways.  No one plans on having an accidental fall, a car accident, or a sports injury but accidents happen.  Any blow to the mouth can damage a tooth.  Most of these tooth injuries are merely cosmetic but some are true dental emergencies.  Tooth trauma can vary from minor chips to a knocked out tooth.  Here’s what you need to know about caring for your traumatized tooth. 

     Every tooth has three layers:  enamel, the hard outer coating; dentin, the main part of the tooth; and pulp, the fleshy nerve center.  Many people who “chip” their teeth simply knock out a piece of enamel.  They may have a gap in their smile, but they aren’t likely to feel much pain.  If enough enamel breaks off, though, the dentin can be exposed.  The tooth still shouldn’t hurt too much, but it may be sensitive to cold.  The worst breaks go all the way to the pulp.  This can cause extreme pain as well as bleeding from the tooth. 

Broken Teeth 

     There are many possible treatments for broken and fractured teeth, depending on the size of the break. 

     If there is only a minor chip on the outer part of the tooth (the enamel), we may be able to repair the damage with a filling. Minor chips don’t always need treatment. Adding filling material may prevent it from getting worse or may make the tooth look better.  If the chip is small, the area can be lightly sanded to smooth out any rough edges. 

      A more serious break can involve the enamel as well as the inner layer of the tooth (dentin).  Sometimes the damage can be repaired with a filling, but most often the tooth will need a crown. 

     The most serious break or fracture is deep enough to expose the nerve tissue.  These teeth will almost always hurt and be sensitive.  The broken part of the tooth will bleed.  Serious fractures often require root canal treatment to remove the exposed nerve.  A crown will be needed to protect the tooth.    

     A cracked tooth fracture involves the whole tooth, from chewing surface to the nerve chamber.  In this type of fracture, the two pieces of tooth have not come apart.  The pieces remain in place, but the crack gradually spreads.  Pain from this type of fracture may be constant or may come and go.  Many people feel pain when they chew because as food is chewed pressure is applied to the tooth.  When the fractured tooth bites down on food, the crack in the tooth gets wider, but once the pressure is released, the crack closes again.  Treatment for a cracked tooth usually involves a crown.  If the fracture is severe,

root canal therapy may be indicated, or the tooth may even be non-restorable.

A tooth that is sensitive to changes in temperature or hurts while you are eating,

is a warning sign that something is wrong and should be evaluated as soon as possible.

Displaced Tooth

     If the injured tooth has been pushed out of its’ normal position (displaced) the tooth will need to be evaluated as soon as possible, but are usually not true emergencies.  Call our office to schedule an appointment.   Displaced teeth that interfere with biting, chewing or closing of the mouth need to be repositioned quickly.  These are more emergent.  Call our office at any time (the phones are always answered.)  Some displaced teeth may have to be repositioned in the socket.  Displaced teeth often need to be splinted for a period of time. 

     Splinting involves binding a group of teeth together so that the biting forces are shared by a large number of teeth instead of being born by the affected tooth.  The affected tooth may also require root canal therapy. 

“Knocked Out” Tooth 

     A “knocked out” tooth, also know as an avulsed tooth, is possibly the most traumatic of any single tooth injury. The tooth is forced from its normal position. Even worse, the tooth is completely out of the socket. After an accident, the knocked out tooth has to be placed back into the socket with an hour. If the tooth can be re-implanted within 15-30 minutes, there is a 90% chance of keeping that tooth for the rest of your life. Here are some first aid techniques to consider:

·        Handle the tooth by the chewing edge only.

·        The tooth has to be rinsed off only using water or saliva.  Do not scrub the tooth.

·        Making sure the tooth is facing the correct way; place the tooth back into the socket. 

·        In order for the tooth to be level with the adjacent teeth, use your thumb to gently press the tooth up into the socket until it is in the right position. 

·        Bite down on gauze or a wet tea bag to stabilize the tooth.

·        Call us right away (the phones are always answered).

     If you are unable to place the tooth back into the socket, call us right away or go to an emergency room.  Transporting the knocked out tooth is very important.  Here are a few simple instructions:

·        The tooth has to be moist.  Do not let it dry out.

·        Place the tooth in a container with a small amount of whole milk or saliva.

·        If you do not have a container, you can carry the tooth between your lower lip and gum, or under your tongue.

     For knocked out primary (baby) teeth, there are usually no long term problems unless the unerupted  permanent teeth are damaged.  Baby teeth usually cannot be put back in.  If you are not sure if it’s a baby or permanent tooth, use the guidelines listed above and call for an appointment as soon as possible. 

     We may be able to prevent a possible emergency by catching dental problems before they begin- saving you a lot of discomfort and a potential emergency visit later. 

  by Bernadette and Jill, Chairside Assistants

 August 25, 2009

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