The Truth About Traumatic Tooth Injuries

by Dr. Julie Melbinger-Wagner
ORIGINALLY PUBLISHED IN THE MEQUON BEACON

The last couple of months my children have been in the full swing of all their sports activities, and daily I am reminded of the possibility of tooth trauma, which was the impetus for this article.

In 1960, the Department of Oral Maxillofacial Surgery at the University Hospital of Copenhagen wrote a textbook on the treatment of traumatic dental injuries, “The Classification of the Treatment of Traumatic Dental Injuries”. Traumatic dental injuries were classified in this book as; Luxation, Avulsion, Tooth Fractures Without Pulpal Exposure, Crown-root Fractures, Root Fractures, Alveolar Fractures, Jaw Fractures with Tooth Involvement, and Primary Tooth Injuries. Obviously, this article will not allow me to cover any of these in detail but I will focus on the most common of these.

The most frequent of tooth trauma are crown fractures; something I have seen a lot of lately! This type of trauma could be as small as a piece of enamel fracturing (the hard outer shell of the tooth), or a fracture that involves both the enamel and dentin (the inner core beneath enamel). For dentists, this is a dream to treat because it only requires smoothing or bonding. A more difficult type of fracture involves the nerve, which unfortunately then requires that the tooth have a root canal.

Luxation is the disruption of a tooth’s nerve and blood supply from a trauma that damages the ligaments and bone around the tooth that holds it in place, causing the tooth to become angled, loose, or moved out of the socket. Treatment for this is as simple as the patient maintaining a soft food diet for a week, or as invasive as repositioning the tooth and fixating it to adjacent teeth to regain stability. Due to the disruption of blood supply from luxation, it is important to be aware of tooth color changes. When a tooth becomes pink, yellow, or grey, it is an indication of permanent damage to the tooth’s blood supply. If a tooth becomes pink, it is a sign of a recent trauma and a hyperexcited nerve that can only be treated with root canal treatment. If a tooth is grey, it is an indication that luxation caused permanent loss of blood supply, and the nerve is dead with a probable infection. If a tooth appears to be more yellow than adjacent teeth, it could be a sign of a past trauma that caused the pulp to recede or become calcified; our bodies natural way of preserving this tooth.

Avulsion is probably the scariest of tooth traumas. Tooth avulsion is when a tooth is completely displaced from the tooth socket, or in other words the tooth just falls out. Now I don’t have an official study to back this up, but from clinical experience and inherited, but practical clinical knowledge from my dad, this can be commonly seen with trauma from an elbow to the head during a basketball game. The key to the success if this trauma occurs, is transporting the tooth in Hank’s Balanced Salt Solution for no longer than 20 minutes. I’m not certain of many people or schools who would have this on hand, but simply storing the tooth in milk for 20 minutes will make your dentist feel more than comfortable reimplanting this tooth.

The fact of the matter is, no one is prepared to handle a dental trauma, but the key is prevention. Falling over or being hit in the face is one of the most common reasons for dental tooth trauma. The most obvious prevention here is this to avoid angering anyone enough to hit you or that obstacle in your house that may cause you to fall. Finally, if you or your child plays sports ALWAYS have them wear an athletic mouth guard, and if they are too uncomfortable to wear, please talk to you dentist about having a custom lab athletic guard made.