Trauma Management with Unexpected Accident?

Trauma Management

Trauma to the teeth can be a devastating and costly affair. Poor management of dental trauma can result in several poor outcomes including loss of teeth and supporting bone, resulting in aesthetic and functional comprimises. Traumatic dental injuries (TDIs) occur frequently in children and young adults, comprising 5% of all injuries. Twenty‐five percent of all school children experience dental trauma and 33% of adults have experienced trauma to the permanent dentition, with the majority of the injuries occurring before age 19. (International Association of Dental Traumatology).

What do I do in case of dental trauma?

If the trauma happens to a baby tooth or teeth?
  • A young child is often difficult to examine and treat due to lack of cooperation and because of fear. The situation is distressing for both the child and the parents. A calm and gentle dentist is required.

  • If the child has lost consciousness, then they should be seen by the emergency department.

  • If a baby tooth is knocked out, it should not be put back in.

  • If a baby tooth is broken or knocked, an x ray and examination will be provided, and advice regarding further treatment can be given.

  • The baby teeth roots are often close to the developing adult tooth, which can mean that trauma to baby teeth can have a permanent effect on the developing adult teeth.

  • Repeated trauma episodes are frequent in children, especially those with a large overjet.

I’ve knocked my front tooth and it is chipped, what happens now?

Diagnosis determines the treatment. These are the possible outcomes:

1. Enamel only chip. Usually fixed by rebonding the missing bit of tooth, or with a ‘cap’, or simply by smoothing the rough edge out. Review at 6 weeks is recommended.

2. Enamel and dentine fracture. The tooth may be very sensitive and may require an insulating layer over the sensitive part of the tooth before a full repair can be made. Review at 6 weeks is recommended.

3. Nerve exposure. In an immature adult tooth, the nerve may be capped or cleaned by a ‘pulpotomy’ before a cap can be placed. In mature adult teeth a root canal therapy and more involved restorative treatment may be required. Review at 6 weeks is recommended following treatment.

4. Crown-root fracture. This may need immediate stabilising by gluing the fragments back together. Definitive treatment depends on the severity but may require root canal, crown lengthening or orthodontic movement, or extraction and implant treatment.

5. Horizontal root fracture. This would require stabilising using a flexible splint for 4 weeks, followed by review. If the tooth dies, the fragment closest to the crown of the tooth may need root therapy. Even with the best treatment, sometimes extraction is unavoidable

6. Fracture of the jawbone holding the teeth. This requires splinting ad repositioning of the broken segment and regular review. Many outcomes are possible following this type of trauma including loss of teeth vitality, root therapy and tooth loss.

What to do if I have knocked my tooth out?

  • Keep calm.

  • Find the tooth and pick it up by the crown (the white part). Avoid touching the root.

  • If the tooth is dirty, wash it briefly (max 10 seconds) under cold running water and reposition it.

  • Try to put the tooth back into its socket (the hole where it came from).

  • Once the tooth is back in place, bite on a handkerchief to hold it in position.

  • If this is not possible, place the tooth in a glass of milk or sterile saline if available.

  • The tooth can also be transported in the mouth, keeping it inside the lip or cheek if the patient is conscious.

  • Avoid storage in water!

  • Seek emergency dental treatment immediately by calling (02)94887676