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Dental Trauma or Injury
 

How will my injury be treated?

Chipped teeth account for the majority of all dental injuries. Avulsed or knocked-out teeth are examples of less frequent, but more severe injuries. Treatment depends on the type, location and severity of each injury and the development stage of the tooth. Any dental injury, even if apparently mild, requires examination by a dentist immediately. Sometimes, neighbouring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam or may only be detectable when problems arise much later.

Chipped or Fractured Teeth

traumaticinjuries01 Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-coloured filling. If a large portion of the tooth is broken off, more extensive work may be required on the tooth.

If the pulp tissue is exposed or damaged after a crown fracture, root canal treatment may be needed.

Dislogded (Luxated) Teeth

traumaticinjuries02 During an injury, a tooth may be pushed sideways, out of or into its socket. The tooth will need to be repositioned. The extent of the damage to the supporting tissues of the teeth will determine whether or not root canal treatment is required and we would take a conservative approach as oftentimes the tooth will heal without the need for root canal treatment. It is more damaging to the tooth when the tooth is pushed upwards into the socket as opposed to pulled slightly downwards as it causes a crushing injury to the supporting tissues. It is better for the supporting tissues to be stretched rather than crushed.

Children’s teeth are more likely to heal than adults teeth but when they don’t heal the damage is worse as the teeth are not fully developed. Careful monitoring is required. Again we would take a conservative approach. Multiple follow-up appointments are likely to be needed.

Knocked-Out (Avulsed) Teeth

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If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call your dentist immediately!

The golden time is 45 minutes, if you can reposition the tooth within 45 minutes, quicker if possible then your chances of saving the tooth are much higher.

If you cannot put the tooth back in its socket, it needs to be kept moist, ideally in saliva (between the gum and cheek) or milk. It is not advisable for a child to put the tooth between their gum and cheek as they could swallow the tooth. But an adult can safely keep the tooth there. Do not place the tooth in regular tap water because the root surface cells do not tolerate it.

Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, it will be cleaned and carefully replaced. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root 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. Taking all these factors into account, your dentist or endodontist may discuss other treatment options with you.

Root Fractures

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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?

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Chipped baby teeth can be 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, paediatric 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. We will do all that is possible to save the natural tooth.

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 defence 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. There are different types of resorption. It has to be noted that some types of resorption are untreatable. Digital radiographs are excellent for assessing for resorption.

 

 
 
 
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