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What are the types of traumatic dental injury and how can they be treated?

Treatment of the tooth depends on the type of trauma sustained. Your endodontist will discuss with you

1. Chipped or fractured tooth

Frequently, a chipped or fractured tooth can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown may be needed to restore the tooth.
If the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed.

Injuries in the back teeth often include fractured cusps, cracked teeth and the more serious split tooth. If the crack has extended into the pulp, the tooth may be treated with root canal treatment and crown to protect the tooth and prevent the crack from spreading. A split tooth, however, is often untreatable and an extraction is recommended.

2. Dislocated (luxated) tooth

During a luxation injury, a tooth may be pushed sideways, out of or into its socket. Your dentist or endodontist will reposition and stabilize your tooth with a splint. Endodontic treatment is usually needed for permanent teeth and should be started within a few days following the injury. Endodontic treatment for these teeth is done in 2 or more visits to allow for medication to be placed within the canal in between visits.

Children between 7-12 years old may not need root canal treatment since their teeth are still developing. For those patients, your endodontist will closely monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed.

3. Knocked-out (avulsed) tooth

Having a tooth that is completely knocked out of your mouth is a dental emergency. Take special precaution not to handle the root surface (hold the tooth at the crown part) and if the tooth appears dirty, gently rinse the tooth with water. Take care not to use soap, not to scrub and not to dry the tooth or wrap in tissue or cloth.

If possible, replant the tooth back into the socket using your fingers and biting down gently to hold it in place.

If you are unable to replant the tooth, try to put the tooth in an emergency tooth preservation kit (such as Save-a-Tooth® kit), in milk or at the cheek space in the mouth.

Head to your endodontist or dentist as soon as possible. The likelihood of saving your tooth is related to your management immediately after the injury (length of time the tooth was out of the mouth and the way it the tooth was stored before reaching the dentist) and timely treatment at the dental clinic.

Your endodontist or dentist will carefully evaluate the tooth, place it back in its socket (if not already done so) and examine you for any other dental and facial injuries. X-rays will be taken to check for any root or jaw bone fracture and other irregularities under the gums. A stabilizing splint will be placed for a few weeks. Root canal treatment may commence a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

Your endodontist or dentist will discuss with you the long term prospects of your replanted toot, taking all the factors into account.

4. Root fractures

The site of the horizontal fracture determines the long term health of the tooth. The closer the fracture is to the gums, the poorer the long-term success of the tooth. Your endodontist or dentist will discuss with you the treatment options and expected results based on the location of your fracture and whether it is coupled with a dislocation (luxation) injury.

A primary tooth (baby tooth) that is knocked-out should NOT be replanted as a replanted primary tooth may cause further and permanent damage to the developing permanent tooth that is growing inside the bone.

What are the possible consequences following trauma to the tooth?

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Some types of resorption are untreatable and may result in the loss of the tooth, localised infection and infraocclusion (the tooth appearing shorter than the neighbouring teeth). You should return to your dentist or endodontist to have the tooth examined at regular intervals for up to five years.

Root resorption progressed in spite of commencement of root canal treatment

The tooth may also undergo extensive calcification (pulp canal obliteration) over time as a response to the injury and it may remain symptomless for years.

The long-term management of teeth that sustained a traumatic injury is commonly multidisciplinary and your dentist will work together with an endodontist, periodontist, prosthodontist, orthodontist and even an oral surgeon to ensure the best possible care for your dental health, function and aesthetics.