If you have just been involved in a facial trauma involving teeth, you should see someone immediately. Please call your dentist, local oral surgeon, local endodontist for IMMEDIATE and EMERGENCY assistance.
If obvious and significant damage to the face (or if you have sustained additional areas of injury), we will recommend beginning in the Emergency Room, e.g. Harborview.
TYPES OF TRAUMAS:
- Tooth Fracture: patients could have a break/crack of the anatomic crown (visible/above the bone level). Root fracture: a break of the portion of the tooth deep/below the bone level (not visible without an xray or CBCT). Based on the type of fracture, your doctor will walk you through the prognosis or success of treatment options available.
- Tooth concussion/luxation/intrusion: tooth root has absorbed force and can have moved within the bone socket. Your dentist/specialist will monitor your case for the possibility intervention is necessary. Certain movements within the bone socket are more likely to need treatment immediately. Some require no intervention.
- Avulsion: a tooth and root comes out of the socket/mouth. Tooth should be repositioned as immediately as possible (by a physician or dentist). Timing is critical for success. Within 30mins is preferred, after 60mins we see major compromises in outcome. The earlier the tooth is reimplanted, the better. Limit dry time out of the mouth! Keep the root surface hydrated and ideally cold; GET MOVING to see someone right away!! Cold Gatorade/sports drink and cold milk are the most commonly studied and available liquids to place a tooth until reimplantation (Our goal is an isotonic solution that is cold to delay cell death). Do Not attempt to clean the root surface yourself. Touch the root surface as little as possible. Worst case scenario if you have no access to ideal or recommended cold liquids, pouch the tooth in your cheek.
- Alveolar fracture or condylar fracture: this can be a break to the facial bones or jaw bones. Usually this is diagnosed with a CBCT. Depending on location and severity this may require intervention such as repositioning, splinting, or surgery.
There are numerous trauma cases seen by the Endodontic Specialty. Typically traumas need to be followed closely for special monitoring following a traumatic event. There is typically a schedule for monitoring cases as the risk levels change following a trauma. In general the risks for consequence decrease following trauma. 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.
Major consequences of a trauma could occur:
- Infarction/Necrosis: blood supply to a tooth can be interrupted causing the interior pulp tissue to die and become a source of infection. As the tissue changes it can stain a tooth internally. Tooth can appear browner or grayer. Usually can be treated with Root Canal Therapy. Staining can usually be treated with internal bleaching.
- Resorption: spontaneous eating away of root structure. Usually can be from the outside-in, can be from the inside-out. Typically a patient has no symptoms and may be unaware this is happening; many times this may be an incidental finding on an xray by their general dentist. Sometimes this is treatable with root canal therapy and surgery. Sometimes prognosis is poor and next steps should be an extraction/implant.
- Calcification: not pathology, but 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 imperfectly form and interrupt blood supply requiring treatment, and sometimes calcification can complicate treatment options if a future root canal therapy is needed.
For more information or to schedule an appointment, call our office at 206-633-3636 today!