Chipped teeth account for the majority of all dental trauma. The remaining conditions represent more serious problems, including dislodged and knocked-out teeth. Treatment depends on the type, location and severity of each injury. When any dental injury occurs, the most important thing is to see your dentist or endodontist immediately. The outcome or prognosis for your specific injury often depends on how quickly you see your dentist.
Most chipped teeth can be repaired with a simple filling. Sometimes a chip will expose the pulp of the tooth, when this occurs, root canal therapy is indicated. Injuries in the back teeth often include fractured cusps, cracked teeth, and the more serious split teeth. Cracks may or may not extend into the root. If the crack does not extend into the root, the tooth can usually be restored by your dentist with a full crown. If the crack does extend into the root and affects the pulp, root canal treatment is usually necessary in an attempt to save all or a portion of your tooth.
Children's permanent or adult teeth that are not fully developed at the time of the injury may need special attention. In an immature adult tooth, the tip of the root, called the apex, is open, and the root canal walls are thin. As the tooth develops, the apex closes and the canal walls thicken. An injured immature tooth may need one of the following two procedures to improve the chances of saving the tooth:
Resorption is a process, in which the body’s own defensive mechanism begins to reject your tooth. Resorption is the body’s response to traumatic injury. Your endodontist can evaluate your tooth for resorption and discuss appropriate treatment options.
An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.
If an immature permanent tooth has been out of the mouth for less than one hour, the tooth should be placed back into its socket, stabilized and watched closely by the endodontist for 3-6 weeks. During this time, your endodontist will look for changes in tooth color, pain, swelling and loosening of the tooth. If any of these problems arise, an apexification procedure may be needed. If the immature tooth has been out of the mouth and dry for more than one hour, the tooth may be put back into the socket, filled with a medication and re-evaluated for several weeks to months. The long term health of this tooth is generally poor, so your endodontist may discuss other treatment options.
During an injury, a tooth may be pushed into its socket. This can be one of the more serious injuries. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury, and a medication, such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling will be placed over the infection at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.
Sometimes a tooth is pushed partially out of the socket. Repositioning and stabilization of the tooth are usually necessary. If the pulp remains healthy, no additional treatment may be needed If the pulp is injured, your dentist or endodontist may need to start root canal treatment. Medication, such as calcium hydroxide, may be placed inside the tooth and should be followed by a permanent root canal filling at a later date.
If a tooth is completely knocked out of your mouth, time is of the essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place the tooth back into its socket. Go to the dentist immediately.
If you cannot put the tooth back in its socket, be sure to keep it moist, milk is an excellent storage medium. The less time the tooth spends drying out, the better the chance for saving the tooth. Solutions to keep your tooth moist are available at local drug stores. You can also put the tooth in milk or a glass of water with only a pinch of salt, or you can simply put it in your mouth between your gum and cheek. Bring your tooth to the dentist immediately. If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and may check for any other facial injuries.
If the tooth has not been put back in its socket, your dentist will examine the tooth to determine if it is still intact and check for other facial injuries. Your dentist will then clean the tooth carefully and place it gently back into the socket. Your tooth may need to be stabilized with a splint for a period of time. Depending on the stage of root development, your dentist or endodontist may start root canal treatment immediately. A medication may be placed in the tooth followed by a permanent root canal filling at a later date. The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist may influence the type of treatment you receive. You should contact your physician to see if a tetanus booster is necessary.
A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are better. If the fracture does not result in the two pieces of the root being separated, there is also a better chance for success. However, the nearer the fracture is to the chewing surface of the tooth, the poorer the long-term success rate, regardless of whether the pieces are separated.
One procedure, called apexogenesis, encourages the root to continue developing as it helps heal the pulp. The injured soft tissue is covered with a medication to encourage further root growth. The apex continues to close, and the walls of the root canal thicken. If the pulp heals, no additional endodontic treatment may be necessary. The more mature the root becomes, the better the chance the tooth can be saved. However, apexogenesis is not always successful. Sometimes, a different procedure called apexification is required.
During apexification, the unhealthy pulp tissue is removed. The endodontist places a medication into the root to help a hard tissue form near the apex, or root tip. This hard tissue provides a barrier for the permanent root canal filling. In spite of appropriate treatment, the root canal walls of a tooth treated by apexification will not continue to develop and thicken, making the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and maximize protection of your tooth.