Traumatic Injuries

Chipped or Fractured Teeth

Chipped teeth account for the majority of all dental traumas. The remaining conditions represent more serious problems, including dislodged and knocked-out teeth. Treatment depends on the type, location and severity of each injury. When any dental injury occurs, the most important thing is to see your dentist or endodontist immediately. The outcome or prognosis for your specific injury often depends on how quickly you see your dentist.

Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth, when this occurs, root canal therapy is indicated. Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.

 

During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries.

Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury, and a medication, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed over the infection at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.

Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp is injured, your dentist or endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.

Avulsed Teeth

If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent.

Do traumatic injuries differ in children?

Apexogenesis

One procedure, called apexogenesis, encourages the root to continue developing as it helps heal the pulp. The injured soft tissue is covered with a medication to encourage further root growth. The apex continues to close, and the walls of the root canal thicken. If the pulp heals, no additional endodontic treatment may be necessary. The more mature the root becomes, the better the chance the tooth can be saved. However, apexogenesis is not always successful. Sometimes, a different procedure called apexification is required.

Apexification

During apexification, the unhealthy pulp tissue is removed. The endodontist places a medication into the root to help a hard tissue form near the apex, or root tip. This hard tissue provides a barrier for the permanent root canal filling. In spite of appropriate treatment, the root canal walls of a tooth treated by apexification will not continue to develop and thicken, making the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and maximize protection of your tooth.

Other Injuries

An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.

If an immature permanent tooth has been out of the mouth for less than one hour, the tooth should be placed back into its socket, stabilized and watched closely by the endodontist for 3-6 weeks. During this time, your endodontist will look for changes in tooth color, pain, swelling and loosening of the tooth. If any of these problems arise, an apexification procedure may be needed. If the immature tooth has been out of the mouth and dry for more than one hour, the tooth may be put back into the socket, filled with a medication and re-evaluated for several weeks to months. The long-term health of this tooth is generally poor, so your endodontist may discuss other treatment options.

What is resorption?

Resorption is a process by which the body’s own defensive mechanism begins to reject your tooth. Resorption is the body’s response to traumatic injury. Your endodontist can evaluate your tooth for resorption and discuss appropriate treatment options.