There are many causes of trauma or injuries to teeth that range from accidents and falls to injuries during sports activities. Children with chronic seizures or children who experience child abuse are also at risk of getting their teeth injured. Dental injury management is also a helpful part of preventing teeth from getting injured if we know the common causes and situations in that damages occur.
First, dentists’ examination?
A complete history of the patient’s injury is necessary to make suitable treatment and diagnosis. The dentist should know how the injury has occurred in order to refer the patient to the specialists, for example, in case of brain injury.
Radiograph imaging is an important examination strategy to check for root fractures, pulp damage, and other possible dangerous changes in the soft tissues around the teeth.
Dentists should examine these:
- Jaw bones and other facial bones
- The broken tooth in all aspects
- Mobility of the tooth
- The condition of the dental pulp
- Alveolar bone
- Periodontium
- Soft tissues
Children and dental injuries
Children are at greater risk of dental trauma or injuries because of their playful nature. Toddlers of 2 and 3 years because of their newly achieved walking abilities are at risk of hurting their primary teeth. Also, children 9 and 10 years old may harm their permanent teeth since they are at the peak of their activities. Children may experience falling and other accidents when playing outside or doing sports activities.
Since bone in primary teeth is immature, teeth especially in the anterior part of the mouth are at greater risk of being displaced or luxated.
What are the different types of dental injuries?
Although traumas to teeth can involve the fracture of both enamel and dentin in the crown of a tooth, a fracture of the root can happen along with the injury to the crown of the tooth. But challenges start when tooth injuries involve the pulp, which needs much care and management. These are common dental injuries:
- Luxation
- A fracture of the tooth
- Avulsion
- Intruded and extruded teeth
Luxation means the displacement of the injured teeth. The dislocated tooth can be in a different direction from the socket of the tooth. When the injured tooth is inward, it is intruded. If the tooth is pushed toward the outer direction, it is extruded. Luxation also includes subluxation and concussion. In these mild traumas, the injury is not severe and periodontium is mildly injured. There is no displacement of the tooth and the treatment may need splints for 1 or 2 weeks.
Avulsion happens when the tooth is out of its socket. Patients must visit the dentist within half an hour after the injury to have their tooth replanted and followed by root canal treatment.
How to restore broken teeth?
If there is a small injury to the enamel of the tooth, dentists use fine disks to smooth the broken part. In extensive injuries and large broken parts of a tooth, composite resin with acid-etch restoration is a popular option. A broken tooth with just small enamel and dentin loss requires reattachment and etching with dental bonding and materials.
When the dental damage is so severe that exposes dentin, pulps are in danger of irritation from bacteria. Therefore, glass ionomer cements with the dentin-bonding agent can protect the pulp. In the next step, composite resin can restore the broken part of the tooth in the most ethical way.
There are some ways to treat a broken tooth that has resulted in pulp exposure in order to save the vitality of the pulp.
- Direct pulp cap
- Pulpotomy
- Pulpectomy
Direct pulp cap is the method of immediate treatment right after the dental injury (within 2 hours after the incident). In a direct pulp cap, capping materials cover temporarily the pulp to protect it from any fluids or bacteria. There should be enough crown to support the restorative materials. Mineral trioxide aggregate (MTA) is the common capping material in this restoration.
Pulpotomy is done when the crown remaining of the injured tooth is not enough to hold the temporary materials for restoration to protect the exposed pulp. After cleaning and preparation of the pulp, the filling materials are seated to seal all the margins in the tooth. A crown restoration with dental bonding procedures is the next restorative step. Root canal therapy is not necessary if pulpotomy is done well.
Pulpectomy is the procedure of saving the tooth with necrosis or nonvital pulp. The pulpectomy along with root canal treatment are methods to try to restore the tooth with mentioned conditions. It is the method to try instead of extraction of the tooth which challenges treatment procedures in the future.
Serious outcomes of dental injury
Pulp hyperemia is one of those consequences of trauma to teeth. Reddish and darker colors of injured teeth are signs you may find in pulpal hyperemia. The worst scenario is the bad changes in the pulp ending in pulp necrosis. If there is damage to the blood flow to the pulp, it leads to pulpal necrosis. How do we know that pulpal necrosis has occurred? Dentists use thermal tests or heat to know if the tooth responds to the heat or not. If the tooth fails, it is a sign of pulpal necrosis. Dentists may use more such tests as an electric test, cold responses, or more thermal tests in the next visits to check the pulp vitality in the tooth.
How to prevent injuries to teeth
Although the list for tips preventing traumas or injuries to teeth can include many daily caring tips. The two most noticeable tips are mouth protectors and wearing seatbelts. Using mouthguards during sports activities can protect your children’s teeth from any injuries. Mouth protectors are made of polymers and are effective in protecting any blows to facial bones and teeth.
Since car accidents account for most unexpected dental injuries, wearing a seatbelt can prevent upcoming injuries. Parents should know not wearing seatbelts can lead to serious injuries whether to teeth or other parts of the body in car accidents.
