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Trauma & Nerve Damage to Teeth

The proper evaluation can make all the difference!

By Dr. Asgeir Sigurdsson

(Continued)

Dislodged teeth.

Dislodged (Luxated) Teeth: During an injury, a tooth may be pushed sideways, out of, or into its socket. Your endodontist, pediatric dentist or general dentist will reposition and possibly stabilize your tooth with a splint for few weeks. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication such as calcium hydroxide may be put inside the tooth as part of the root canal treatment. A permanent root canal filling will be placed at a later date.

Children between 7 and 12 years old may not need root canal treatment since their teeth are still developing. For these injuries, a dentist, pediatric dentist or endodontist will monitor the healing carefully with clinical and radiographic (x-ray) examination and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people's teeth can be stimulated to complete root growth and heal the pulp following injuries or infection.

Knocked-Out (Avulsed) Teeth: If a tooth is completely knocked out of your mouth, time is of the essence. The tooth should be handled very gently, avoiding touching the root surface itself. If it is dirty, quickly and gently rinse it in cold water (either tap or clean bottled water). Do not use soap or any other cleaning agent, and never scrape or brush the tooth. If possible, the tooth should be placed back into its socket as soon as possible. The less time the tooth is out of its socket, the better the chance for saving it. Call a dentist immediately!

Avulsed tooth.

If you cannot put the tooth back in its socket, it is best to keep it in milk to prevent the root surface from drying out. Doing this will keep the living cells moist and alive for a few hours. Another option is to simply put the tooth in the patient's mouth between the gum and cheek or, collect the patient's own saliva in a cup and to keep the tooth in it temporarily until getting to the dentist. Do not store or transport the tooth in regular tap water or in a dry cloth/kitchen paper towel because the root surface cells will not tolerate it and will die, greatly diminishing the long-term prospects for the tooth.

Splint.

Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries. If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later. A medication may be placed inside the tooth followed by a permanent root canal filling at a later date.

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist very much influences the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your dentist, pediatric dentist or endodontist may discuss other treatment options with you.



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