Tooth Cares for Traumatic Tooth Injuries

Traumatic injuries to the natural teeth represent a common incidence of emergency room visits, and a perplexing problem for physicians, often untrained in the proper management of immediate dental care. After-hours emergency dental personnel may not be readily available quickly enough to prevent the unnecessary loss of traumatized anterior teeth.

Completely Avulsed Teeth

Adult teeth that have been partially or fully avulsed (luxated) from the mouth require urgent attention. Successful treatment is contingent on the time frame that lapses from the moment of impact to the time of re-implantation of teeth that are completely removed from their sockets. Treatment must commence prior to a visit to the dentist. If you have an avulsed tooth:
- Gently rinse the tooth in tap water if grossly contaminated.
- Do not attempt debridement of the tooth surface.
- Replace the tooth within its socket with minimum pressure.
- Remember that precise alignment is not as crucial as a quick response.
- Obtain immediate dental care. If circumstances such as contaminated wounds, extensive injuries, or multiple tooth loss preclude re-implantation of the tooth, transport it the dental office in a container of milk, preferably cool temperature.

The patient’s own saliva or water are secondary choices. Remember: Time is of the essence. Teeth re-implanted within the first hour have a significantly better prognosis. Professional treatment usually consists of approximate alignment of the tooth and light stabilization. Further trauma to the tooth and socket should be minimal. Splints are generally maintained for 7-10 days, with no biting force and diet instructions to avoid further disturbance. Root canal treatment is customarily performed two weeks after the injury to reduce the chance of unfavorable pulpal (nerve chamber) responses at a future date. An assessment of other facial and neurological injuries must always be considered, even if other injuries are not apparent. Lacerations that require sutures must be treated within 24 hours for ideal healing and minimum scar formation. Tetanus updates are often advisable for contaminated oral wounds, especially if a tooth has been re-implanted. Appropriate documentation may be necessary for legal and insurance considerations.

Partially Avulsed Teeth

A partially avulsed (subluxated) tooth -- one that has been loosened but not removed from its socket -- requires immediate care, though time is not quite as critical as for the total avulsion. The mouth should remain open sufficiently to avoid further disturbance to the loose tooth and immediate dental attention must be arranged. Do not attempt to forcibly reposition the tooth. The dentist will usually attempt to properly position the partially avulsed tooth, using minimal pressure. If more than an hour has lapsed, there may be a bleeding impediment within the socket to regain ideal placement. The tooth should be stabilized and biting forces removed. A partially avulsed tooth, incompletely repositioned, may be moved at a later time using orthodontic treatment.

Fractures of Natural Teeth

Management of fractures depends on the portion of the damaged tooth structure and require professional expertise. While time factors are not as critical as in the treatment of avulsed teeth, dental fractures may necessitate high priority attention, depending on the level of discomfort and cosmetic concerns. Traumatized teeth that exhibit momentary sensitivity to hot and cold do not generally command as much immediate attention as loose teeth, or those causing persistent pain. Treatment of dental fractures is dependent on many factors and often palliative, even temporary management is preferred. Pulpal damage assessment is complex and often not easily discernable at the time of the injury.

Prevention

The most predictable occurrence of dental injuries is sports related. Participants in contact sports should have an appropriate athletic appliance fabricated to avoid unnecessary tooth loss. The design of the mouth guard depends on the nature of the sport. Eye protection is of even greater importance, particularly in sports involving fast moving objects (even tennis balls may cause substantial ophthalmic injuries).