Tooth Fractures (chipped or broken teeth):
These fractures can range from minor to severe. Minor
injuries involve chipping only the outer tooth layers while severe injuries
involve vertical, diagonal, and horizontal fractures of the tooth root. The
tooth is made up of three layers, the enamel, dentin, and the pulp. The
enamel and dentin are the two outer protective layers of the tooth. The
enamel is the white hard surface, and below that is the yellow layer of
dentin. The innermost living part of the tooth is called the pulp. Because
only 1/3 of the tooth is visible (known as the crown) in the mouth x-rays
are necessary to determine the extent of the tooth fractures.
Chipped Teeth:
These injuries
are minor and involve only the enamel layer of the tooth. In these
instances, the tooth is not out of place and the gums are not bleeding. The
tooth may not be sensitive to temperature or food, but rough edges on the
tooth may irritate the tongue and cheek. The pulp is not often at risk here
and treatment is not urgent. On the way to the dentist, sugarless gum or
orthopedic wax may be placed over the tooth to ease any discomfort. At the
dental office, the treatment is usually a filling or having a “cap” put over
the tooth to protect the pulp and restore normal tooth contour.
Fracture of Enamel and Dentin:
This fracture is deeper and like a chipped tooth, the gums
are not bleeding and tooth is still in place. However, these fractured
teeth may be sensitive to food and cold temperatures. Prolonged exposure of
this fracture could lead to bacteria attacking the dentin and eventually
result in pulp death. Death of these tissues can lead to infection and
abscess. Because of this, these injuries should be treated within days of
the injury. An anesthetizing cream will be placed over the dentin, followed
by a dental filling and cap will be placed over the tooth. A follow up
x-ray will be required 3-6 months later to ensure that the pulp has not
died.
If the fracture was deep enough to do actual damage to the pulp then either
the dying tooth will have to be removed or a root canal will have to be
performed. The root canal is designed to save the tooth from a) serious
infection and b) having to be removed. The root canal removes all the dying
pulp tissue and replaces it with inert material.
Serious Tooth Fracture:
A serious fracture is one that exposes both the dentin and the pulp. And
should be treated immediately. This tooth may be loose or out of place and
the gums may bleed. To prevent the tooth from falling out the dentist may
have to splint it by bonding it to the adjacent teeth while the bone and
gums around it heal. Because the pulp is exposed in this injury, there is a
high risk of pulp death; therefore, a root canal is often performed on the
first visit for the injury. However is the dentist decides to splint the
tooth then the tooth will need to be reevaluated in 2-4 weeks to see if a
root canal is needed. After the procedure, a filling or crown is added and
the splint is removed. The most severe tooth injuries are the ones that
fall vertically, horizontally, and diagonally on the tooth roots. In many
cases, this leaves the tooth very loose and extraction is needed. The hole
is then filled with a removable plate that contains a false tooth. On rare
occasions, teeth with horizontal fractures near the tip of the roots don’t
need to be extracted. However, the tooth is closely observed and x-rayed
periodically to watch for signs of infection and pulp death, in which a case
a root canal would be needed.
Teeth Knocked Out:
As many parents know, the upper two front teeth are the two most likely to
be knocked out. Those who play sports are at a great risk of this, as are
children who have protruding front teeth that have not yet been put into
correct alignment.
In most cases, if a
child’s baby teeth are knocked out nothing is done because the teeth will be
replaced with permanent teeth in time. Knocked out permanent teeth are
different stories. These teeth should be retrieved and kept moist and clean
(rinse in clean water or milk) and put back in their sockets as soon as
possible. Time is the most important factor here. The soon a tooth is
re-implanted the better chance it has to become reattached. Teeth
re-implanted within an hour frequently reattach themselves. This can
usually be done without the help of a dentist, but if you are at all unsure
store the tooth in milk or clean water and brought to the dentist as soon as
possible. Or if the victim is an adult or calm child, the tooth can be held
within the cheeks inside the mouth.
After the tooth has been
re-implanted, the dentist will splint the tooth for 2-8 weeks. This helps
stabilize the tooth while the bone heals. During this time, the patient
must take special care to eat mainly soft foods and brush all the other
teeth to keep the mouth as clean as impossible to ward off bacteria. In
adults, the re-implanted tooth should have a root canal performed in 1-4
weeks, but in children, however, this is often unnecessary because the roots
may not have fully developed. These teeth are observed for 5 years to make
sure the pulp is healthy and no root canal procedure will be needed.
For most re-implant
patients over the counter medications like acetaminophen (Tylenol) or
ibuprofen (Advil) are fine for pain relief. Chlorhexidine mouth rinse may
be prescribed to prevent gum disease and inflammation, since splinted teeth
cannot be brushed normally. The splint also usually collects added tartar
and debris. Oral antibiotics and tetanus toxoid injections are considered
for patients with lacerations on the gums and mouth.
Teeth Displaced:
Often instead of being knocked out of the mouth, teeth are displaced. This
gives the tooth the appearance of seeming longer, shorter, or “bent” to the
side, front, or back. Luckily this injury isn’t an emergency, but a trip to
the dentist is recommended as the sooner the tooth is realigned the better
(and faster) the tooth will become correctly realigned. Sometimes the
trauma can cause injury to the pulp so the tooth is monitored for several
months to determine if a root canal, or tooth extraction is required.
Prevention:
Prevention for dental injuries is fairly basic. Braces align teeth properly
and facemasks and mouth guards have been shown to reduce trauma to the
teeth, gums, jawbones, and joints. Mouth guards reduce the deformation of
the skull when a force is directed at the chin. Mouth guards have become
very important, almost eliminating the injuries that occurred to the face
and mouth. While mouth guards can be purchased in stores the best ones are
custom made by your dentist. The store bought mouth guards are less
expensive, but are not made for the athlete and may become loose,
uncomfortable, and make cause problems with speech or breathing. A well
fitting mouth guard should do none of the above. |
