While most traumatic dental injuries occur in children and teenagers, people of all ages can be affected. Usually, such injuries are the result of sports mishaps, automobile accidents or bad falls. No matter what the cause, the type and severity of the injury will determine the treatment necessary. Dental injuries may affect the inner soft tissue of the tooth, known as the dental pulp.
When the injured pulp becomes inflamed or infected, endodontic treatment may be needed. Proper initial care significantly reduces the risk of tooth loss later.
What is endodontic treatment?
“Endo” is the Greek word for “inside” and “odont” is greek for “tooth.” Endodontic treatment treats the inside of the tooth. To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves and connective tissues. The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp because the tooth continues to be nourished by the tissues surrounding it. Today it is possible to treat an immature tooth in a young person when the pulp becomes diseased after decay or trauma and expect to keep such a tooth for a long time.
What are the most common types of dental trauma?
Chipped teeth account for the majority of all dental injuries. Dislodged and 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 immediate examination by a dentist or an endodontist. Sometimes, neighboring teeth suffer additional, unnoticed injuries that may not be apparent until weeks, months or even years after the initial dental injury.
Chipped or Fractured Teeth
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 is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention and it is important to seek professional help as soon as possible after the injury. 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 split teeth. 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
During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist 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 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 under the age of 15 may not need root canal treatment for traumatized teeth since their teeth are still developing. For those patients, 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. A viable treatment alternative for immature teeth is a process called regenerative endodontics. This treatment uses stems cells from young pulp to promote healing, repair and continued root development. Ask your endodontist if your child’s tooth is a good candidate for this procedure.
Knocked-Out (Avulsed) Teeth
If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into the socket in the mouth as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call a dentist immediately!
If you cannot put the tooth back in its socket, it needs to be kept moist in special solutions that are available at many local drugstores (such as Save-A-Tooth). If those solutions are unavailable, you should put the tooth in milk. Doing this will keep the root cells on your tooth surface moist and alive for a few hours. Another option is to simply put the tooth in your mouth between your gum and 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.
Once the tooth has been put back in its socket, your dentist or endodontist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, your dentist or endodontist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. It is very important that root canal treatment start within a couple of weeks after replantation, with the exception of a tooth in a very young child. Your endodontist or dentist can make that determination.
The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the likelihood of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.
A traumatic injury to the tooth may result in a horizontal root fracture. After the diagnosis has been made, the tooth may need to be repositioned if it is out of place. This will likely be followed by placing a splint for a few weeks. Properly treated, teeth with horizontal root fractures usually have a good prognosis.
Do traumatic dental injuries differ in children?
Chipped primary (or “baby”) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted. This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.
Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow-up, but not all of them will need root canal treatment. In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist or endodontist to stimulate continued root growth. Endodontists have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Endodontists will do everything possible to save the natural tooth. These specialists are the best source of information and expertise for children who experience dental trauma.
Will the tooth need any special care or additional treatment?
The nature of the injury, the length of time frominjury to treatment, how your tooth was cared for after the injury and your body’s response all affect the long-term health of the tooth. Timely treatment is particularly important with dislodged or knocked-out teeth in order to prevent root resorption. Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following the injury, you should return to your dentist or endodontist to have the tooth examined and/or treated at regular intervals for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. Some types of resorption are untreatable.