What is it? Dental trauma is often the result of an accident. This could be a trip, fall, sporting accident or car accident- there are many possibilities. The damage caused can vary significantly; the tooth/teeth may have no symptoms, may feel bruised, the nerve in the tooth could die and form an abscess, the teeth could break or could even be knocked out completely. Whatever the circumstances, it’s always best to have your teeth checked by a dentist following a trauma.
Teeth can break for other reasons, not just trauma. A tooth can break if it bites something hard, if a large filling breaks or if it’s significantly decayed, among other reasons. It’s always best to see a dentist following a tooth has broken to allow them to offer treatment options and protect the tooth, if necessary, with a dressing.
How would I know I have it? Most people are aware there’s something wrong straight after a dental trauma, whether that’s a broken tooth, a tooth that’s come out, or pain.
However, occasionally it’s over a period of time symptoms may arise. This is usually the case when a tooth has had a knock and the nerve has died. Gradually the tooth will begin to cause pain, followed by hot and cold sensitivity, tenderness and normally the formation of an abscess. In this instance, a root canal treatment is required to clean out the infected nerve tissue causing the pain and abscess, thus making the tooth dead as it has no nerve supply. If a tooth breaks, pain and sharp edges are common symptoms.
Can it be treated? Most traumas and tooth breakage are repairable but how this is carried out depends on the circumstances. Repair can be immediate (such as a replacement filling) or may take months to give back function and aesthetics to a patient (such as implants and crowns following a car accident).
If a tooth breaks, how the tooth is repaired depends on how the tooth presents to the dentist. If the tooth can be filled with a filling, your dentist will discuss different material options with you.
This can include an amalgam (metal) filling. This type of filling needs a certain amount of tooth structure to be present to support the filling. A composite (white) filling may be an option, as a white filling chemically bonds to tooth structure; this can prove cost effective when there’s less tooth structure to hold a metal filling, and is cheaper than a crown.
A crown is often suggested when original tooth structure is lacking, therefore not providing a stable foundation or support for a filling. As a treatment option it’s advised to protect what tooth structure remains, as a crown covers a tooth, as a hat covers our head. The tooth in question will be drilled to minimize its shape and make it a smaller version of itself. Your dentist will take an impression of the tooth to be crowned. It’s common for the dentist to take impressions of all the teeth, upper and lower, which will be sent away to a laboratory where a crown will be made. The crown is completely bespoke and is manufactured to ensure a perfect fit. Once made, a crown is cemented in place.
It’s important to see a dentist as soon as possible to assess the situation, provide relief from pain and offer a treatment plan. If a trauma is serious and requires hospitalization (such as a road accident) the consultants from the oral department will be involved.
If a whole tooth is knocked out (roots as well), place the tooth in milk. If milk isn’t available, place it in the mouth; the best place is in the lower lip if this can be tolerated, however extreme care is needed to ensure tooth isn’t swallowed. This keeps the tooth in its natural environment. Try not to touch the root of the tooth and if the tooth is dirty, rinse with milk or tap water. Don’t scrub the tooth or use disinfectant.
If there’s bleeding from the area, don’t panic. Get a clean handkerchief or clean cotton material, fold it up to fit the area of the socket and bite down to apply pressure. Don’t use cotton wool or tissue. If painkillers are required, avoid medication containing aspirin; this thins the blood slightly which will make the area continue to bleed.
It’s possible to try to put the tooth back in yourself. Hold the tooth by the crown and put it back into the socket firmly, root first. Bite on a clean handkerchief for about 15-20 minutes. However, if it isn’t possible to do this, place in milk or the mouth as above.
Ideally a tooth needs to be reinserted within 24 hours of the accident for best results; the sooner the better for successful re-insertion, preferably within the first hour. Either a trip to a dentist or A&E will be required.
The tooth, if successfully reinserted will then need to be splinted to hold it in place while it heals and stabilizes in the jawbone. This is done by placing a piece of wire or fibreglass (which looks like a thin white strip of plastic) on to the teeth, which is long enough to reach the teeth either side of the loose tooth.
These teeth are now splinted together. The splint will need to stay on between 2 and 6 weeks, with the dentist checking the progress of the tooth regularly. Unfortunately this usually has to be done on the front surface of the teeth to hold it in place properly, so may be visible. Once the tooth is no longer loose, the dentist can remove the splint with the dental drill, leaving the teeth looking as they did before being splinted together.
Sometimes teeth that have been reinserted can die and need root canal treatment. This can normally be carried out by your dentist.
Where there’s a known risk of damage to your teeth, such as sports (rugby, hockey, boxing) it’s strongly advised an investment is made on a gum shield. Your dentist takes an impression of your upper teeth; this will only take 10 to 15 minutes. From this impression, a model of your teeth is made and a mouthguard is created on the model to ensure a snug, comfortable fit. Mouthguards range in price (£70 to £150 but call your dental practice for their fees) but are worth every penny as are certainly cheaper than a dental implant.