While traumatic dental injuries occur most often in children, people of all ages can be affected. Whether the result of an automobile accident, a sports injury, an altercation or a bad fall, the severity of the injury will determine the necessary treatment.

Many common injuries affect the inner soft tissues of the tooth—known as the dental pulp. When this happens, a root canal treatment may be needed.

Most chipped teeth can be repaired with a simple filling. When the chip exposes the pulp, you may require a root canal treatment. Back teeth injuries often include fractured cusps, cracked teeth and the more serious split teeth. The crack may or may not extend into the root. If the root is affected, root canal treatment is usually necessary.

One of the more serious injuries dentists see is a tooth that is pushed into its socket. Your general dentist may reposition and stabilize the tooth, or he/she may refer you to an endodontist. Root canal treatment is usually started within a few weeks of this injury, with medication such as calcium hydroxide, may be put inside the tooth. A permanent root canal filling is usually placed at a later date. Periodic monitoring of the tooth is recommended.

When a tooth is pushed partially out of the socket, repositioning and stabilization is necessary. If the pulp remains healthy, the tooth may not require any additional treatment. However, if the pulp is injured, your dentist or endodontist will inform you if you should consider a root canal. Again, medication such as calcium hydroxide may be placed inside the tooth, followed by the root canal at a later date.

When a tooth is completely knocked out of your mouth, time is of the essence. Pick up your tooth by the crown (chewing portion)---try not to touch the root. If the tooth is dirty, you may rinse it gently in running water. Do NOT use soap or any other cleaning agent. Placing the tooth back in the socket is the best thing you can do---and go to your dentist IMMEDIATELY.

If you cannot replace the tooth in its socket, keep it moist. Saving the tooth is easier if it is kept moist. Solutions to keep your tooth moist are available at your local drug store. Alternatively, you may also put the tooth in milk or a glass of water with a pinch of salt. Or, you can put it in your mouth between your gum and cheek. Go immediately to your dentist.

A tooth that has been put back in its socket can be stabilized with a splint. Your dentist will also check for any other facial injuries.

A tooth that has not been put back in its socket will be examined by the dentist to determine if it is still intact. The tooth will be cleaned and carefully placed back in the socket. It may need to be stabilized with a splint for a period of time. Root canal treatment may be started, depending on the stage of root development. The length of time the tooth was out of the mouth and the way it was stored before reaching the dentist’s office, will influence the type of treatment. You may be asked to contact your physician to see if your tetanus booster is up to date.

Occasionally traumatic injury to the tooth will result in a horizontal root fracture. The long term health of the tooth will be determined by the actual location of the fracture. If close to the root tip, chances for success are greatly improved. If the fracture doesn’t result in the two pieces of the root being separated, there is always increased chance of success for saving the tooth. It is when the fracture is nearer to the chewing surface of the tooth that the long-term success rate suffers. This is regardless of separation of the pieces.

A splint to stabilize the tooth is required in a root fracture. If the inside of the tooth is damaged, it may need a root canal. Medication may be placed in the canal to prepare the fracture site for the root canal.

Permanent or adult teeth not fully developed may need special attention. An immature adult tooth has something called an apex—the tip of the root—which is open, leaving the root canal walls thin. As teeth develop fully, the apex closes and the canal walls thicken. Immature teeth that are injured may need one of the following procedures:

Apexogenesis: The injured soft tissue is covered with medication to encourage further root growth. The apex then continues to close and the walls of the root canal thicken. If the soft tissue heals properly, no additional endodontic treatment is necessary. Chances are the tooth can be saved with a more mature root. Apexogenesis is not always successful. In some cases, apexification may need to be performed.

Apexification: This requires the removal of unhealthy pulp. The endodontist places a medication at the root. This helps a hard tissue form near the apex. This hard tissue provides a barrier for the permanent root canal filling. In a tooth treated by apexification, the root canal walls will not continue to develop and thicken. This makes the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and offer maximum protection to your tooth.

An immature permanent tooth which has been dislodged can require minimal treatment or no treatment at all, other than follow-up visits until it matures. If it is severely dislodged, orthodontic or surgical repositioning and stabilization may be required.

If an immature tooth has been out of the mouth for less than one hour, it should be placed back in its socket and stabilized. Your dentist will want to watch it closely for three to four weeks. Important symptoms to notice are: changes in tooth color, pain, swelling or loosening of the tooth. Your dentist will follow the progress of the tooth closely and may recommend apexification followed by a permanent root canal filling, if any of those symptoms occur.

If the immature tooth has been out of the mouth for more than one hour, it may be replaced and filled with a medication. Re-evaluation will continue for six to eight weeks. In this instance, long-term health of the tooth is poor. Your endodontist will discuss other treatment options with you.

Long-term health of an injured tooth will be determined by several factors:

• Nature of the Injury

• Length of time from injury to treatment

• How the tooth was cared for

• Your body’s response to the injury and treatment

Timely treatment is of the utmost concern with dislodged or avulsed teeth. Resorption occurs when your body, through its own defenses, begins to reject your own hard tooth structure in response to the traumatic injury. This is why you must return to your dentist or endodontist for regular visits following any injury to your teeth. Neglecting to keep regular appointments for examination may result in the loss of the tooth.