Statistics show that one-third of all 5-year-olds have sustained injury to their primary teeth, and one-quarter of all 12-year-olds have sustained injury to their permanent teeth. Dental trauma can happen through sporting events, a fall, a car accident or other impacts.
Dentists and physicians classify dental injuries into four main categories:
1) fractures - either a part of the tooth comes off or a root is fractured
2) lateral or extrusive luxation - loosening or displacement of the tooth from its normal position
3) intrusion - displacement of the tooth into the alveolar bone
4) avulsion - complete loss of tooth from its socket
If any of these things happen, get to a dentist as soon as possible. Don't wait! The longer you wait to seek appropriate dental treatment, the greater the possibility that the tooth, gum tissue or alveolar bone will suffer permanent damage. If there is a chance of salvaging the tooth treatment needs to begin right away. Many dentists reserve spots in their schedule for walk-ins and emergencies.
Examination of Dental Trauma
On visiting a dentist, examination will surround:
- determining the extent of damage to the tooth, gum, and alveolar bone
- determining the extent of tooth mobility/loosening/displacement and alteration of bite (occlusion)
Expect at least one radiograph to be taken, likely a panorex (wide/all the way around the mouth). This radiograph will allow the dentist to see all mouth structures from one TMJ to the other. X-rays of individual teeth may also be warranted, such as bite-wings or periapical films, to evaluate the tissues and structures immediately affected by the traumatized tooth.
Treatment for Dental Trauma
Fracture
X-rays will be taken to determine the extent of the damage to the tooth, particularly if the fracture is suspected to be or is confirmed to run below the gum line. If part of the tooth is broken off, the tooth fragment(s) should be kept hydrated in milk, as there is the possibility that the fragment can be reattached. If there is damage to the pulp chamber, a root canal may be necessary. Other treatments include splinting to help the broken/re-attached tooth heal and settle back into its proper occlusal space, or extraction if the tooth is unable to be salvaged.
Lateral or Extrusive Luxation
Primary teeth will likely be extracted if there is a risk that the tooth may be swallowed if it were to come completely loose.
Permanent teeth will require splinting, repositioning, possibly root canal therapy and long-term follow-up.
Intrusive Luxation
Primary teeth will be monitored for damage to any unerupted permanent teeth and whether the tooth will re-erupt.
Permanent teeth will be monitored or treated to promote re-eruption, either surgically or through orthodontics, often in conjunction with root canal therapy because of trauma to the root.
Avulsion
Avulsed primary teeth will likely not be reinserted. However, it may be recommended that the space be maintained with a crown or partial denture until such time as the permanent teeth erupt.
The preferred method of treatment--if at all possible--is re-implantation. This can be done on-site, before heading to the dentist for evaluation. Simply rinse the tooth in cold tap water and re-implant it into the socket immediately. Be careful not to touch, rinse or bump the root because you could further damage the root and compromise successful re-implantation.
If the tooth cannot be re-implanted immediately, keep it hydrated in milk until you can get to a dentist. Once in the dental office, the dentist will rinse the tooth and socket (to flush out any clots) and attempt to re-implant the tooth. The patient will then be prescribed antibiotics--usually penicillin--and recommended they have a tetanus shot if they haven't had one in the previous five years.
If the tooth can not be salvaged or the re-implantation fails, the area will be monitored for healing of the socket and underlying alveolar bone and treatment may be considered for implant placement, possibly with bone grafting. A conventional fixed bridge or partial denture may be other treatment alternatives, though implant placement is the preferred tooth replacement method.
Sources: www.aafp.org (American Academy of Family Physicians)