TRAUMA

If you have just been involved in a facial trauma involving your teeth, you should see someone immediately. Please call your dentist, oral surgeon, or endodontist for immediate emergency assistance.

If you have sustained obvious damage to the face, or have signs of injury to any additional areas of your body, we recommend beginning in the emergency room (i.e. Harborview).

There are several types of dental trauma worth noting:

  1. Tooth fracture
    A break/crack of the anatomic crown. This type of fracture would be sustained above the bone level and would be visible to you in the mirror.
  2. Root fracture
    A break of the tooth deep below the bone level. This type of fracture would not be visible without an xray or CBCT scan.
  3. Tooth concussion/luxation/intrusion
    Tooth has absorbed force and may have moved within the bone socket. Your dental provider will monitor your case to determine if intervention is necessary. Certain movements within the bone socket are more likely to need treatment immediately while some require no intervention.
  4. Avulsion
    A tooth and root comes out of the mouth. Tooth should be repositioned as immediately as possible (by a physician or dentist). Timing is critical for success - it is preferred that the tooth is repositioned within 30 minutes of the traumatic event. After 60 minutes, we see major compromises in outcome. If you are unable to see a physician or dentist immediately, limit dry time out of the mouth! Keep the root surface hydrated and cold. Cold sports drinks and milk are the most commonly studied, and available, liquids to place a tooth until reimplantation. Touch the root surface as little as possible and do not attempt to clean the surface yourself. If you do not have access to the list of recommended liquids, pouch the tooth in your cheek.
  5. Alveolar fracture or condylar fracture
    A break to the facial bones or jaw bones. This type of fracture is usually diagnosed with a CBCT scan. Depending on location and severity of the fracture, this may require intervention such as repositioning, splinting, or surgery.

There are numerous trauma cases seen by the endodontic specialty. Traumas need to be followed closely for special monitoring following an event. There is a recommended schedule for monitoring cases as the risk levels change following trauma. In general, the risks for consequence decrease over time. Unfortunately, we now know that risks reach an asymptote. Following one year, risk will stabilize but never become zero. For example, it is common for a tooth involved in a childhood injury to need sudden intervention 30 years later. This is not a reflection on patient hygiene or neglect.

The following is a list of major consequences that could occur at any point following a trauma:

  1. Infarction/Necrosis
    Blood supply to a tooth is interrupted causing the interior pulp tissue to die and become a source of infection. As the tissue changes, it can stain the tooth internally. Tooth can appear discolored. Necrosis can usually be treated with root canal therapy. The staining can usually be treated with internal bleaching.
  2. Resorption
    Spontaneous eating away of root structure. This event can occur from the outside-in, but can also be from the inside-out. In most cases, patients have no symptoms and may be unaware that this is happening. Discovery and diagnosis of resorption may often be through an incidental finding on an x-ray by a general dentist. Resorption is sometimes treatable with root canal therapy and surgery. In other cases, prognosis is poor and the most reasonable next step is extraction and implant.
  3. Calcification
    Not pathology. Pulp tissue can react by laying down disorganized secondary dentin. This may have the effect of making a tooth appear more yellow. Sometimes the calcification can form imperfectly and interrupt blood supply. Interruption of blood supply requires treatment. However, calcification can complicate treatment options if a root canal therapy is needed.

For more information or to schedule an appointment, call our office at 206-633-3636 today!