Studies suggest that around a quarter of children and a third of adults experience some form of dental trauma during their lives. I am well versed in managing both children and adults who have sustained a dental injury, including patients who have already been treated elsewhere.
I assess and treat all types of dental trauma from immediately after an injury to managing long-term complications of (previously treated) cases. I work alongside in-house dental specialists which means that, when appropriate, I can take an efficient, multidisciplinary approach: for example, gently repositioning displaced teeth with orthodontic treatment, or deciding when a tooth is better replaced with a dental implant. This also keeps the number of appointments to a minimum.
My research on CBCT in dental trauma has shown it improves detection of traumatic injuries, increases diagnostic confidence, and supports more predictable treatment decisions compared with conventional radiography. Logically, this should improve the longevity of teeth.
What counts as dental trauma?
Dental trauma includes injuries to teeth, gums and/or the neighbouring jawbone, these types of injuries are commonly associated with sports accidents, a fall, or an assault. Increasingly, I am seeing more bicycle related accidents and patients slipping after coming out of the bath.
Dental trauma to teeth ranges from a small chip in the enamel, to a tooth that is loosened or pushed out of position, to a tooth that is completely knocked out (avulsed), as well as fractures of the root or the surrounding bone. The nerve (pulp) inside a tooth can be damaged even when the tooth looks intact, which is why an injured tooth needs proper assessment and follow-up.
My tooth has been completely knocked out (avulsed), what should I do?
Do not panic! The sooner the adult tooth is replanted back into its socket the better as this will improve its longevity. If possible, hold the tooth by the crown (top part), avoid touching the root and gently push the tooth back into the socket, then bite down gently on a folded-up napkin or tissue. Then seek urgent dental treatment.
If you cannot replant the tooth, then keep it moist by storing it in milk or your own saliva, as this helps to preserve the vitality of cells on the root surface. Do not use water or contact lens solution. Do not replant baby (deciduous) teeth.
My tooth/teeth have been moved and feel loose?
If your tooth feels loose (subluxation) or you feel it has moved out of its natural position (luxated) you should try and see an Endodontist as soon as possible. If this is not possible then you should:
- If your tooth feels slightly mobile and/or a little out of place, but you can bite normally then avoid any manipulation as this may damage the already traumatised blood and nerve supply.
- In cases where the tooth has been severely displaced (luxated) you can try and gently push it back to close to its natural position using your (clean) finger. Then gently bite down on a damp, folded up tissue or napkin for 20-30 mins. This will help to stabilise the tooth as well as reduce bleeding of the surrounding gum.
- If they do not slip into position, then leave them in their traumatised position. Do NOT force the tooth/teeth.
- Ice packs can be used to manage tenderness and/or facial bruising, use for 15-20 minutes at a time
- Take over the counter pain killers like Ibuprofen and/or Paracetamol to manage any tenderness.
- Do not avoid eating! It is really important to maintain your energy levels up. Just modify your diet and stick to soft food….yoghurt, soups are great, or smoothies but without a straw or seeds.
- Brush the healthy teeth as normal, but avoid brushing the traumatised area. Use warm saltwater rinses to clean away food debris from the injured teeth. Salt water rinses are anti-bacterial, reduces swelling as it draws out excess tissue fluid from the bruised area. Avoid mouthwashes as they may irritate the damaged gum.
- If the crown of the tooth fractures into pieces, then try and find them, keep them in a small bag and bring them to your appointment. In some cases we can reattach them.
Types of dental injury and how they are treated
Treatment depends entirely on the type and severity of the injury. I confirm the right approach for each tooth after a full assessment.
Why is CBCT useful after dental trauma?
A 3D CBCT scan will clearly reveal the nature of the dental injury as well as confirming if there are any tooth fragments in the lips. It also gives me an idea if root canal treatment is required or not, when possible I will try and avoid carrying out endodontic treatment, and either suggest reviewing the tooth on a periodic basis or carry out vital pulp therapy to preserve the tooth and the healthy nerve and blood supply for as long as possible.
How soon should I see an Endodontist?
If your tooth has been knocked out, displaced or part of the top of the tooth has been broken (fractured) off then you should seek an appointment as soon as practically possible.
Are there any long-term complications I should be aware of?
It is important to review traumatised teeth on a periodic basis as it is not uncommon for complications to occur weeks, months or even years after an initial dental traumatic injury. Typical complications include:
- Tooth discolouration: The top (crown) of the tooth may discolour to grey, yellow, or brown, this is typically due to the blood and nerve supply dying (pulp necrosis).
- Pain and/or an abscess: The core (root canal) can become infected with bacteria, this can result in toothache, gum boil and/or an abscess.
- Root resorption: Your body's own bone remodelling cells start nibbling away at the root, which can weaken the tooth and/or give rise to pain and/or an abscess.
- Ankylosis: The root may fuse directly to the neighbouring bone. This may result in the tooth looking shorter than the neighbouring teeth in the developing dentition (children/adolescence).
What treatment might be needed for an old dental injury?
Depending on your symptoms, and after assessing you and taking a 3D CBCT scan management typically involves one or more of the following:
- Root canal treatment: If the nerve within the root of the tooth has died or becomes irreversibly inflamed; then root canal will be indicated to preserve the health and function of the tooth.
- Bleaching: Discoloured teeth can be returned to their natural colour using a bleaching gel, which lightens the tooth from the inner and outer aspect of the affected tooth.
- Extraction and replacement: If there is extensive root resorption or bone the tooth may not be salvageable, in these cases a dental implant, bridge, or partial denture may be recommended.