Traumatic Dental Injuries
Traumatic dental injuries often occur in accidents or sports-related injuries. Chipped teeth account for the majority of all dental injuries. Dislodged or 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 examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam. Endodontists are dentists who specialize in treating traumatic dental injuries. With their advanced skills, techniques and technologies they can often save injured teeth.
Are you worried that you suffer from a cracked tooth? Do you know that endodontic treatment could save your cracked tooth? Before your symptoms worsen, visit an endodontist to see if your tooth can be saved. Endodontists are specialists at diagnosing your symptoms and saving your teeth.
Our smiles are built to last. In fact, tooth enamel — the outer surface of our teeth — is the hardest substance in the human body, stronger even than our bones. That tooth enamel can withstand a lot of wear and tear. But as we live longer, and expose our teeth to stresses like clenching, grinding or chewing on hard objects, we can put our smiles at risk. If you think you have a cracked tooth, it's important to seek treatment quickly, before the problem gets worse.
How do I know if my tooth is cracked?
Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with
release of biting pressure, or pain when your tooth is exposed to temperature extremes.
In many cases, the pain may come and go, and your dentist may have difficulty locating
which tooth is causing the discomfort.
Why does a cracked tooth hurt?
To understand why a cracked tooth hurts, 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 the inner
soft tissue called the pulp. The pulp contains the tooth's nerves and blood vessels.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces,
and the pulp can become irritated. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the tooth
What if my tooth is chipped?
Chipped teeth account for the majority of all dental injuries. Most chipped teeth can be repaired either by reattaching the broken piece of tooth enamel or by placing a tooth-colored filling. See your dentist as soon as possible after the injury to treat your chipped tooth and keep it from worsening.
After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.
The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations.
What can I do to prevent my teeth from cracking?
Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
Don't clench or grind your teeth.
If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.
Wear a mouthguard or protective mask when playing contact sports.
How will my cracked tooth be treated?
There are many different types of cracked teeth. The treatment and outcome for youtooth depends on the type, location and extent of the crack.
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth.
Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.
When a piece of a tooth’s chewing surface breaks off, often around a filling, it’s called a fractured cusp. A fractured cusp
rarely damages the pulp, and usually doesn’t cause much pain. Your dentist can place a crown over the damaged
tooth to protect it. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or
cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medications
(such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.
A cracked tooth means a crack extends from the chewing surface of your tooth vertically toward the root. The tooth is not yet separated into pieces, though the crack may gradually spread. Early diagnosis is important in order to save the tooth. If the crack has extended into the pulp, the tooth can be treated with a root canal procedure.
However, if the crack extends below the gum line, it is no longer treatable, and the tooth cannot be saved and will need to be extracted. That’s why early treatment is so important. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack
with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the
crack, however, will determine whether any portion of the tooth can be saved. In some cases, endodontic treatment
may be performed to save a portion of the tooth.
Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the
chewing surface. They often show minimal signs and symptoms and may therefore go
unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.
A dislodged, or luxated, tooth is one that has been partially pushed into or out of its socket, or sideways, during an injury. If this happens to you, see a dentist or endodontist as soon as possible. He or she 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 such as calcium hydroxide may be put inside the tooth as part of the root canal treatment.
Children between seven and 12 years old may not need root canal treatment 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. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.
More than 5 million teeth are knocked out every year in children and adults. With proper emergency action, a tooth that has been knocked out of its socket can be successfully replanted and last for years. It's important to see a dentist or endodontist as soon as possible after the tooth is knocked out. Quick action will increase the likelihood of saving the tooth.
Saving a Knocked-Out Tooth
1. Pick up tooth by the crown (the chewing surface) not the root.
Locate the tooth immediately; do not leave it at the site of the accident. The tooth should
be handled carefully -- touch only the crown -- to minimize injury to the root.
2. If dirty, gently rinse tooth with water.
Do not use soap or chemicals.
Do not scrub the tooth.
Do not dry the tooth.
Do not wrap it in a tissue or cloth.
3. Reposition tooth in socket immediately, if possible.
The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.
4. Keep tooth moist at all times.
The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following:
Emergency tooth preservation kit (such as Save-a-Tooth®)
Mouth (next to 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.
Bring the tooth to a dentist or endodontist as soon as possible -- ideally, within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.
Treatment for a knocked-out tooth.
Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket and
examine you for any other dental and facial injuries. A stabilizing splint will be placed for a
few weeks. Depending on the stage of root development, your dentist or endodontist may
startroot canal treatment a week or two later. A medication may be placed inside the tooth
followed by a permanent root canal filling at a later date.
The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential.
A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate. Sometimes, stabilization with a splint is required for a period of time.
Do traumatic dental injuries differ in children?
Chipped primary (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 all that is possible to save the natural tooth. These specialists are the logical source of information and expertise for children who are victims of dental trauma.
Will the tooth need any special care or additional treatment?
The nature of the injury, the length of time from injury 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. It has to be noted that some types of resorption are untreatable.