TOOTH FRACTURE OR TRAUMA

Tooth fracture or trauma is distressing and an alarming condition. Fracture of tooth can occur due to many causes. They may fracture while biting on a hard object, severe falls, accidents, sports injuries, decay induced fractures.

Children in the age group of 1 to 1 ½ years are prone to dental injuries most frequently. This is the age when they learn to toddle. Children in the age group of 8 – 11 years are prone are also prone to injuries in their permanent teeth.

Traumatic injuries of teeth may involve only the crown or both the crown and root. The severity of symptoms and treatment vary accordingly.

The symptoms depend on whether the pulp is exposed and the degree of damage to the pulp and the age of the patient.

Crown fractures:

If only a part of the enamel is chipped off it may be treated by smoothening any rough edges present and the chipped off part can be recontoured with tooth colored cements.

If a fragment of crown is broken then there is nothing to panic. If you find the fragment, get it to the dentist by storing it in milk or water to prevent dehydration. The fragment can be re attached if it fits well into the broken space. If not, that part can be replaced with tooth colored cements.

Sometimes crown fractures involve the inner most part of the tooth, the pulp. At this point one may experience a constant pain as the pulp contains nerves and blood vessels. In these conditions pulp therapy may be indicated.

Root fractures:

This type of fracture involves the roots only. The fracture can be at the crown region, middle of the root or the apical third of the root.

If the fracture is at the coronal third, the repair is less favorable because of the difficulty of immobilizing the tooth. Repair does not occur due to constant movement of tooth and exposure of pulp. In most of the cases the tooth need to be removed and later replaced with implants.

If the fracture is at the middle third, if the tooth can be successfully immobilized then it can be saved by root canal treatment.

If the fracture is at the apical third, the root needs to be stabilized with splints followed by root canal treatment.

Avulsed tooth or knocked out tooth:

 Avulsion occurs when the tooth is completely displaced out of the socket. This occurs frequently in children between the ages of 7 – 9. Replacement of primary tooth is generally not recommended due to the possibility of damage to the permanent tooth bud and it also may get ankylosed causing difficulty in normal exfoliation process. In these cases replacement with artificial prosthesis is recommended.

Avulsion in adults demands immediate replacement for tooth’s long term prognosis. When the tooth is avulsed the best way to preserve it is to place it immediately back to its socket. If immediate placement is not possible then place it into a protective solution like milk.

Care to be taken to the avulsed tooth:

Do not touch the root of the tooth, handle the tooth by its crown.
Do not scrub or scrape the tooth.
Do not allow the tooth to dry out.
Treatment should be done within 4 to 6 hours.

First Aid for a broken tooth:

Rinse your mouth gently with warm water.
Apply pressure with a piece of gauze until the bleeding stops, if there is any.
Apply cold pack to the injured cheek or lips. This will reduce the pain and inflammation.   
Take a pain reliever.