Traumatic Dental Injuries

While traumatic dental injuries occur most often in children, people of all ages can be affected. Whether the result of an automobile accident, a sports injury, an altercation, or a bad fall, the severity of the injury will determine the necessary treatment.

Many common injuries affect the inner soft tissues of the tooth (known as the dental pulp). When this happens, a root canal treatment may be needed.

The long-term health of an injured tooth will be determined by several factors:

  • The nature of the injury,
  • The length of time between injury and treatment,
  • How the tooth was cared for, and
  • Your body's response to the injury and treatment.

Jump to children's injuries

Types of Injuries

Chipped teeth (the most common form of injury)

Illustration of chipped tooth

Most chipped teeth can be repaired with a simple filling. When the chip exposes the pulp, root canal treatment may be necessary. Injuries to the back teeth often include fractured cusps (the chewing surface of the crown), cracked teeth, or (more serious) split teeth. The crack may extend into the root. If so, root canal treatment is usually required.

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Dislodged Teeth

Illustration of dislodged tooth

One of the more serious injuries dentists see is a tooth that is pushed into its socket. Your general dentist may reposition and stablize the tooth or refer you to us. Root canal treatment is usually started within a few weeks of the injury; medication (such as calcium hydroxide) may be placed inside the tooth. A permanent root canal filling is usually placed at a later date. During that time, periodic monitoring of the tooth is recommended.

When a tooth is pushed partially out of its socket, repositioning and stabilization of the tooth is necessary. If the pulp remains healthy, additional treatment may not be necessary. However, if the pulp is injured, your dentist will work with us to determine if root canal treatment is required. Again, medication (calcium hydroxide) may be placed inside the tooth; root canal treatment would occur at a later date.

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Avulsed (knocked out) Teeth

Illustration of evulsed tooth

When a tooth is completely knocked out of your mouth, time is of the essence. Carefully pick up the tooth by the crown (the chewing portion). Try not to touch the root. If the tooth is dirty, rinse it gently in running water; do not touch the root while doing so. Do NOT use soap or any other cleaning agent when rinsing the tooth. The best thing you can do, if possible, is to place the tooth back in its socket, then see your dentist IMMEDIATELY!

A tooth that has been put back into its socket can be stabilized with a splint. Your dentist will also check for any other facial or dental injuries.

If you cannot return the tooth to its socket, you must keep it moist. Saving the tooth is easier if the tooth is kept moist until you see your dentist. There are commercial solutions you can use available at your local drug store. Alternatively, you can do one of the following:

  • Place the tooth in a glass of milk,
  • Place the tooth in a glass of water with a pinch of salt, or
  • Keep the tooth in your mouth between your gum and your cheek.
Again, you should see your dentist immediately!

Illustration of splinted teeth

A tooth that was not returned to its socket will be examined by the dentist to determine if it is intact. The tooth will be cleaned and placed back into the socket. It may need to be stabilized with a splint for some period of time. Depending on the stage of root development, root canal treatment may be started.

The length of time the tooth was out of the mouth and the way it was stored before reaching the dentist's office will impact the type of treatment. You may also be asked to check with your physician to determine if your Tetanus booster is up-to-date.

Timely treatment is extremely important with dislodged or avulsed teeth. Resorption occurs when your body, through its own defenses, begins to reject your own hard tooth structure in response to the traumatic injury. This is why you must return to your dentist (or us) for regular visits following any injury to your teeth. Failure to keep regular follow-up appointments for examination may result in the loss of the tooth.
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Root Fractures

Illustration of tooth with a root fracture

Occasionally, traumatic injury to the tooth will result in a horizontal root fracture. The long-term health of the tooth is dependent on the location of the fracture. If the fracture is close to the root tip and the root pieces have not separated, the chances for success are greatly improved. If the fracture is closer to the chewing surface of the tooth, the long-term success rate suffers.

A splint to stabilize the tooth is required when treating a root fracture. If the inside of the tooth is damaged as well, root canal treatment may be necessary. Medication may be placed in the canal to prepare the fracture site for the root canal.

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Do traumatic dental injuries differ in children?

Illustration of an immature tooth with an open apex

Permanent or adult teeth that are not yet fully developed may require special attention. An immature adult tooth has something called an apex—the tip of the root—leaving the walls of the root canal thin. As teeth develop fully, the apex closes and the canal walls thicken. Immature teeth that are injured may need one of the following procedures:

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Illustration of an immature tooth as the canal walls thicken and the apex closes

The injured soft tisue is covered with medication to encourage further root growth. The apex then continues to close and the root canal walls thicken. If the soft tissue heals properly, no additional endodontic treatment is necessary. Chances are the tooth can be saved with a more mature root. Apexogenesis is not always successful. In some cases, apexification may need to be performed.

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Illustration of an immature tooth treated with apexification

In this procedure, unhealthy pulp is removed. We would then place medication at the root of the tooth to close the apex. This provides a barrier for the permanent root canal filling. In a tooth treated with apexification, the root canal walls will not continue to develop and thicken. This makes the tooth susceptible to crown or root fractures. Proper restoration will help minimize this possibility and will offer maximum protection to your tooth.

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Other Injuries

An immature permanent tooth which has been dislodged can require minimal treatment (or no treatment at all) other than follow-up visits until the tooth matures. If it is severely dislodged, orthodontic or surgical repositioning and stabilization may be required.

If an immature tooth has been out of the mouth for less than one hour, it should be placed back in its socket and stabilized. Your dentist will want to watch it closely for three to four weeks. Important symptoms to watch for are:

  • Changes in tooth color,
  • Pain,
  • Swelling, or
  • Loosening of the tooth.
If any of these symptoms occur, your dentist may recommend apexification, followed by a permanent root canal filling.

If the immature tooth has been out of the mouth for more than one hour, it may be replaced and filled with a medication. Re-evaluation will continue for six to eight weeks. In this case, long-term health of the tooth is poor. If so, we will discuss other treatment options with you.

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