Dental injuries

Dental injuries can occur to all teeth, most commonly the teeth in the front of the mouth. Teeth can be cracked, displaced from their sockets or completely knocked out. Dentists are concerned about trauma to primary teeth and even more so about damage to permanent teeth, which may have important lifelong consequences. Parents should always consult their child's dentist after tooth trauma. Some injuries are not easily observable. A dentist is trained to make a complete diagnosis and perform the proper treatment.

Cracked teeth. A tooth is composed of three layers: the outer protective enamel; the internal supportive structure, called dentin; and the soft tissue centre of the tooth containing the nerves, called the dental pulp. A crack (fracture) in a tooth can affect any or all of these layers. A small fracture may require only smoothing by the dentist using a sandpaperlike instrument. A more extensive rack may require a dental restoration to reestablish the form, function and appearance of the tooth. If a dental fracture affects the hollow portion in the centre of the tooth and exposes the dental pulp (there is usually bleeding from the exposed region), a dentist should be seen as soon as possible so he can repair the damage and prevent loss of the pulp. If a part of the pulp does die, the tooth can still be saved with endodontic (root canal) therapy: removing the dead pulp tissue and filling the root canal space with a sterile filling material. The tooth can then be repaired in the usual manner.

Loosened teeth. Most times slightly loosened teeth will reattach themselves and become stable after a few days'rest. Sometimes, however, teeth are so loose that the dentist needs to splint them together to stabilize them while healing occurs. Antibiotics are sometimes beneficial, to prevent infection of the dental pulp and attachment tissues. Dentists will advise a soft diet for a time to help the healing process.

Avulsed teeth. Sometimes, a tooth may be completely knocked out of the mouth (an avulsed tooth). If a baby tooth is avulsed, dentists usually recommend not to reimplant it. Underlying permanent teeth may suffer developmental damage when a traumatized primary tooth is reimplanted. A permanent tooth should be reimplanted as quickly as possible, however, usually within thirty minutes, to maximize the chance of keeping the pulp alive. First, make sure that the tooth is indeed permanent and is intact. Gently hold it by the crown (the part that shows in the mouth), not by the pointed roots. Rinse it very gently under tap water. Do not scrub or rup the root in any way; that will damage the attached tissue, which is required for reattachment. Insert the tooth back into its normal position. If you can not reimplant the tooth, place it in a glass of milk or commerially available tooth rescue container. Then take the child to a dentist or seek dental emergency servise at a hospital A&E department. Time is important with permanet tooth avulsions. After a tooth has been out of the mouth for thirty minutes, the chances for succesful reimplantation drop fast.