Dental Trauma Health Article

Definition

Dental trauma is injury to the teeth, gums, and jawbones. The most common dental trauma is a broken or displaced tooth.

Description

Dental trauma may be inflicted in a number of ways: contact sports, motor vehicle accidents, fights, falls, eating hard foods, drinking hot liquids, and other such mishaps. Dental trauma includes teeth that are knocked out (dental avulsion), cracked (fractured), forced out of position (dental luxation, lateral displacement, or extrusion), pushed up into the jawbone (dental intrusion), or loosened by impact (subluxation or dental concussion). Oral tissues are sensitive, and injuries to the mouth are typically very painful. Dental trauma should receive prompt treatment from a dentist and in some cases is considered a dental emergency.

Demographics

Children between the ages of 1.5 and 3.5 years are most likely to experience dental trauma to their primary (baby) teeth, because this is the age at which they are learning to run. According to the International Association of Dental Traumatology, half of children experience dental injury, with injury occurring most often in children ages eight to 12. Fracture of the tooth crown (the part that is above the gum line) is the most common injury. School-age boys are twice as likely to experience dental trauma as girls.

Causes and symptoms

The cause of dental trauma varies depending on the age of the child. Toddlers are more likely to injure a tooth by falling, while older children are more likely to suffer dental trauma from a sports injury. Teenagers often present with dental trauma as the result of fights. The incisors in the upper jaw are the most commonly injured teeth.

Pain characterizes all dental trauma. The tooth may be knocked out and the socket bleeding, or it may be loose. There may be additional damage to the bones of the jaw and to the soft tissues of the mouth.

When to call the dentist

A permanent tooth that has been knocked out is a dental emergency. The dentist should also be called whenever dental trauma results in pain, dislocation of the tooth, or tooth sensitivity to hot or cold.

Diagnosis

Dental trauma is readily apparent upon examination. Dental x rays may be taken to determine the extent of the damage to fractured teeth. More comprehensive x rays are needed to diagnose a broken jaw.

Treatment

There is a possibility that a permanent tooth that has been knocked out can be re-implanted if handled promptly and correctly. If possible, the tooth should be reinserted in the socket and held there until the child sees a dentist or visits the emergency room. If it is not possible to replace the tooth in the socket, the tooth should immediately be placed in milk, saliva, or cool water with a pinch of saline solution (not contact lens solution or plain water). The tooth should be handled only by the crown and never be allowed to dry out. If a dentist can see the child within half an hour and the tooth has been preserved correctly, there is a possibility that it may be successfully re-implanted. Primary teeth are usually not re-implanted.

For lesser dental trauma, soft tissue injuries may require only cold compresses or ice to reduce swelling. Bleeding may be controlled with direct pressure applied with clean gauze. Deep lacerations and punctures may require stitches. Pain may be managed with aspirin or acetaminophen (Tylenol, Aspirin Free Excedrin), or ibuprofen (Motrin, Advil).

Treatment of a broken tooth will vary depending on the severity of the fracture. For immediate first aid, the injured tooth and surrounding area should be rinsed gently with warm water to remove dirt, then covered with a cold compress to reduce swelling and ease pain. A dentist should examine the injury as soon as possible. Any pieces from the broken tooth should be saved and taken to the dentist with the child.

If a piece of the outer tooth has chipped off, but the inner core (pulp) is undisturbed, the dentist may simply smooth the rough edges or replace the missing section with a small composite filling. In some cases, a fragment of broken tooth may be bonded back into place. If enough tooth is missing to compromise the entire tooth structure, but the pulp is not permanently damaged, the tooth will require a protective coverage with a gold or porcelain crown. If the pulp has been seriously damaged, the tooth will require root canal treatment before it receives a crown. A tooth that is vertically fractured or fractured below the gum line will require root canal treatment and protective restoration. A tooth that no longer has enough remaining structure to retain a crown may have to be extracted (surgically removed).

A broken jaw must be set back into its proper position and stabilized with wires while it heals. This is usually done by an oral surgeon. Healing may take six weeks or longer, depending on the patient's age and the severity of the fracture.