Tooth Injuries

Tooth Injuries

Summary

Tooth injuries may include damage to teeth as a result of falls, accidents and other mishaps. These injuries can cause teeth to become chipped, cracked, partially displaced or completely dislodged from the socket in the mouth.

In most cases, a tooth injury requires the care of a dentist or other medical professional. The severity of injury depends on which portions of the tooth have been damaged. The tooth is composed of the crown, root, dentin, enamel and pulp.

Patients are urged to seek emergency help whenever a permanent tooth is knocked out, jaw swelling indicates a potential fracture or bleeding of the gums does not stop despite firm pressure.

Tooth injuries may be described as uncomplicated or complicated. Uncomplicated injuries do not expose the pulp, which reduces the chance of infection and loss of the tooth. On the other hand, complicated injuries do expose the pulp to potential infection, which can lead to the death of the pulp. If the pulp dies, pus may begin to build up near the root tip in the jawbone. This is called an abscess, and it can damage the bone around the teeth.

When a permanent tooth is completely knocked out, it can still be saved. Teeth have the best chance of being saved if they are replaced within 30 minutes of falling out. After two hours, the tooth has a low probability of surviving. Primary teeth that are completely knocked out of the socket cannot be reimplanted.

A dentist can stabilize teeth that are loose but still intact. Teeth that are chipped or cracked can have the jagged edges smoothed during dental procedures.

People can help reduce their risk of tooth injuries by taking simple precautions, such as wearing a mouth guard and proper headgear when participating in contact sports, wearing a helmet during sports and using a seatbelt when traveling in a car.

About tooth injuries

Tooth injuries can result in teeth that are chipped, cracked, partially displaced or completely dislodged from the socket in the mouth. These injuries often occur as the result of falls or accidents during athletics.

A tooth injury usually requires a visit to a healthcare professional. In many cases, consulting the dentist is the best option. However, a visit to a hospital emergency room may be necessary if the patient has suffered a blow to the head – which can be life-threatening – or an injury to another body part.

Patients who suffer a tooth injury often have symptoms such as bleeding in the area, pain or increased sensitivity in the tooth. Patients are urged to seek emergency help in cases of dental emergencies, such as when a permanent tooth is knocked out, jaw swelling indicates a potential fracture or bleeding of the gums does not stop despite firm pressure. Appointments with a dentist can be scheduled for less serious injuries, such as a minor chip in a tooth (e.g., cracked teeth).

The severity of injury depends on what portions of the tooth have been damaged. The tooth is composed of several parts:

  • Crown. Part of the tooth that is visible above the gum line.

  • Enamel. The hard, translucent outer shell that covers the crown. The enamel is hard enough to handle the strain of a lifetime of biting, chewing and grinding. It also protects the tooth from bacteria and changes in temperature when eating hot or cold foods. Nonetheless, it is very brittle and may crack or chip.

  • Root. Part of the tooth that pushes into the upper (maxilla) or lower (mandible) jawbone. A hard shell called cementum covers the root and attaches to fibers that fasten the root to the jawbone.

  • Dentin. Layer of the tooth found beneath the enamel (protective covering over the crown) and beneath the cementum (protective covering over the root). It makes up most of the tooth’s structure and is responsible for the tooth’s color.

  • Pulp. Located beneath the dentin at the core of the tooth and made up of blood vessels, nerves and connective tissue. The blood supply of the pulp provides the nutrients that keep the tooth alive.

The tooth is also supported by the gums, the pink flesh below the teeth that combine with other features of the mouth to surround and hold teeth in place. Bundles of connective tissue fibers make up the periodontal ligament. These fibers anchor the teeth to the jaws, with one end of each fiber connected to the cementum and the other embedded in the alveolar socket.

Tooth injuries may be described as uncomplicated and complicated. Uncomplicated injuries do not expose the pulp, which reduces the chance of infection and loss of the tooth.

On the other hand, complicated injuries do expose the pulp to potential infection, which can lead to the death of the pulp. If the pulp dies, pus may begin to build up near the root tip in the jawbone. This is called an abscess, and it can damage the bone around the teeth. For this reason, an infected tooth is usually treated with a procedure called a root canal that removes the infected pulp and saves the tooth.

If a permanent tooth is knocked out, rapid action is required to save it. More than 2 million teeth are knocked out each year in mishaps, but 90 percent of them can be saved with proper treatment, according to the National Safety Council. Teeth have the best chance of being saved if they are replaced within 30 minutes of falling out. After two hours, the tooth has a low probability of surviving. For more information, see the section Saving a Tooth.

Primary teeth that are knocked out do not require special care after they come loose, as they cannot be reimplanted.

Types and differences

In addition to complicated and uncomplicated tooth injuries, there are specific types of injuries classified by the damage caused by trauma. They include:

  • Concussion. Minor injury to the periodontal ligament, which is a bundle of connective tissue fibers that anchors the teeth to the jaws. Typically, such injuries do not cause the tooth to be knocked out of alignment.
  • Subluxation. Injury that causes a tooth to become loose in the socket but is not knocked out of position.
  • Intrusive luxation. Injury that causes the tooth to be pushed deep into the socket, sometimes to the point that the tooth is no longer visible. The tooth may appear knocked out.
  • Extrusive luxation. Injury that displaces the tooth from its position. These teeth require immediate treatment to keep them from becoming permanently fixed in this position.
  • Avulsion. An injury that completely knocks a tooth out of place. Immediate replantation of the tooth is necessary to save it.

Signs and symptoms

Although in most cases the signs of tooth injury are obvious, other signs and symptoms may occur that can indicate the severity of the injury. For example, patients who experience concussions may feel dental pain when the tooth is tapped with a dental instrument. Some teeth – such as primary incisors – may change color after a concussion.

Symptoms of subluxation (when a tooth is loosened but not knocked out of place) may include bleeding around the neck of the tooth. In many cases, a splint needs to be placed around the subluxated tooth to help repair the periodontal ligament.

Teeth that are fractured cause various symptoms depending on the extent of the fracture. For example, fractures of the enamel and dentin may lead to increased sensitivity of tooth to cold foods or drinks, or to air. Fractures that go beyond the enamel and dentin and reach the pulp may cause bleeding around the tooth or formation of a small red spot. For more information on the different types of fractures, see Types of fractures.

Types of fractures

There are various types of fractures that may occur as part of a dental emergency. Fractures may involve the tooth’s crown, root or both. In some cases, the pulp may be damaged. This type of damage is most likely to cause pain.

Each type of fracture requires a slightly different form of treatment. Patients who experience a fracture can rinse their mouths with warm water and to apply an ice pack to the outside of the mouth in the area of damage to reduce any swelling. Patients should see a dentist as soon as possible.

Treatment by a dentist will vary depending on the type of fracture that occurs. Fracture types include:

  • Minor crack. Also known as a “craze line,” this type of damage affects only the outer layer of the tooth (enamel) and causes no pain. In most cases, no treatment is required. However, light polishing can smooth out rough spots.
  • Chip. A chipped tooth usually does not require extensive treatment. A dentist may suggest using filling material to repair the tooth. This helps to keep the chip from getting worse and improves the tooth’s cosmetic appearance. Very small chips may merely need to be sanded to smooth away any rough edges.
  • Cusp fracture. Damage that affects the pointed chewing surfaces of a tooth can adversely affect a patient’s ability to chew. Such damage usually is fixed by rebuilding the damaged area to restore the tooth’s shape. Onlays and crowns are often used to repair a cusp fracture.
  • Serious fracture. This damage typically exposes nerve tissue, causing bleeding and pain. A root canal treatment is usually necessary to remove the nerve in the tooth. Once this procedure is complete, a crown will be used to cover the tooth.
  • Cracked tooth. Damage that begins on the chewing surface and extends all the way down to the nerve. The tooth does not break in two, but the crack itself remains in danger of spreading. Filling material can be used to repair some cracks. However, in many cases a crown or root canal treatment is required.
  • Split tooth. Occurs when a cracked tooth actually splits into two separate parts. In most cases, the tooth must be extracted. Sometimes, a split tooth may be treated with a root canal treatment (if the pulp is damaged) and a crown used to cover and protect the tooth.
  • Vertical tooth fractures (split root). Damage that begins in the tooth root and spreads upward to the chewing surface. This type of fracture is often very painful due to inflammation or infection of the tissues surrounding the root. In most cases, the tooth must be extracted.
  • Decay-induced fracture. Fracture of the tooth resulting from a cavity that weakens the tooth from the inside out. Treatment for a decay-induced fracture varies on a case-by-case basis and can best be determined by a dentist who examines the damage.

Diagnosis and treatment of tooth injuries

Patients who visit a dentist after a tooth injury will have their lips, tongue and gums examined for all tooth fragments that may have broken loose during the injury. A dentist often can determine the severity of the injury based on whether or not the tooth is loose and whether or not the tooth is tender to the touch.

In some – but not all – cases, x-rays may be helpful in determining the extent of the injury. If the injured tooth is still in the mouth, the dentist will determine whether the tooth needs to be realigned or removed.

In some cases, the tooth can be pushed into place or reimplanted without having to perform major restoration work. However, some injuries may be severe enough to put the tooth’s pulp at risk of infection or death. In such instances, the main purpose of treatment is to keep the pulp of the tooth intact. If the pulp cannot be saved, it may need to be removed.

Treatments that may be performed when the pulp is compromised include:

  • Direct pulp capping. Placement of a cement base under a deep filling to protect the pulp from infection.

  • Pulpotomy. Removal of the top part of the pulp, which results in partial removal of the nerve. It most often is used on primary teeth.

  • Pulpectomy. Complete removal of the pulp. This is usually the start of root canal therapy. After the pulp is removed, the hollow area within the tooth is usually filled and sealed.

  • Extraction. Removal of the entire tooth from its socket in the jaw. Extraction may be used when the tooth is too damaged or diseased to be saved.

Dental restoration procedures, including cosmetic dentistry, may be recommended to improve the appearance of cracked or chipped permanent teeth.

Pain reliever medications can help reduce any lingering discomfort that remains while the patient recovers following a tooth injury. However, these drugs should only be used if approved by a physician. Aspirin should not be used to treat the pain of children younger than 18, as this medication has been linked to a potentially fatal condition called Reye syndrome.

Saving a Tooth

The steps used to save a tooth differ depending on the nature of the injury. Injuries to permanent teeth require quick action to try to save the tooth. If the tooth is chipped or broken, the patient should collect all the pieces and make sure no part of the tooth is embedded in the lips, tongue or gums. Rinse the mouth with warm water and hold a cold compress to the injured area for 10 minutes. Call a dentist right away and proceed as suggested.

If a permanent tooth is partially knocked out, try to gently but firmly push it back into place. If the tooth is completely knocked out, pick up the tooth by the crown at the top, not by the root of the tooth. The tooth should be rinsed (but not scrubbed) in saline (water and salt) solution or milk, which is chemically similar to a tooth. The tooth can also be soaked in a cup with the solution. 

If the tooth is rinsed over a sink, make sure to plug up the drain of the sink to prevent the tooth from being lost. Water can be used, but only as a last resort as it contains chlorine that can damage the root of the tooth.

If possible, gently replace the tooth in the socket in order to preserve it during the trip to the dentist. Then, bite down on a gauze pad until reaching the dentist. If the tooth cannot be replaced in this way, place it in a glass of milk. Patients also can properly preserve the tooth by placing the tooth inside their mouths between the cheek and gum. As a last resort, the tooth can be placed in a mild saltwater solution (1/4 teaspoon of salt to 1 quart of water) or wrapped in tissue.

Prevention methods for tooth injuries

Patients can reduce the risk of tooth injury by taking simple steps to protect themselves during certain activities. Patients are urged to wear protective head gear with mouth protection, and a mouth guard when playing contact sports such as baseball, soccer, football and hockey. People should also wear helmets when bicycling, rollerblading and skateboarding. People are also urged to wear a seatbelt at all times when traveling in a car. Such protection greatly reduces the risk of injury to the teeth. In some patients, especially young children, an overbite should be orthodontically corrected to minimize the risk to damage to the top front teeth.

Finally, regular dental visits allow a dentist to track potential weaknesses and other problems that could result in a tooth injury down the line. Dentists also can provide preventative care and recommend preventive methods to keep teeth strong, healthy and less susceptible to injury.

Questions for your doctor about tooth injuries

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their treatment options. The following questions related to tooth injuries may be helpful:

  1. How can I lower my risk of tooth injury?
  2. If I injure a tooth, should I call a dentist or my physician?
  3. What are the odds that a tooth can be saved after being knocked out for more than 30 minutes?
  4. Is my tooth injury complicated or uncomplicated?
  5. Is there a chance that my mouth will reject a reimplanted tooth?
  6. Will I have to see the dentist more regularly after having a tooth reimplanted?
  7. Will I require cosmetic surgery to enhance the appearance of the tooth.
  8. What are my options if a permanent tooth cannot be saved?
  9. Can I take pain reliever medications to reduce soreness?
  10. Which sports require the use of a mouth guard, or a helmet with mouth protection?
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