Tooth Injuries

The 3 most common tooth injuries are 1) fracture, 2) luxation (dislocated), and 3) avulsion (entire tooth comes out).

Fracture. A fracture usually splits the tooth into 2 or more parts. Part of the tooth stays attached to the socket and 1 or more pieces of the tooth break free.

When the flesh inside the tooth (pulp) is injured, it can be identified by bleeding at the site or a pink or red dot in the dentin. Dentin is the yellowish second layer usually covered by enamel. Problems involving the dentin may be painful because the junction of the enamel and dentin is very sensitive. Limiting exposure of air, fluid in the mouth (saliva), temperature changes, and the tongue to tooth pulp will decrease the pain.

Fractures may be classified as:

  • Crown fractures. A crown fracture may involve the enamel only or the enamel and dentin. Sometimes crown fractures are broken down as simple (no pulp involvement) or complex (pulp involvement).

  • Root fractures. Root fractures almost always involve the pulp.

  • A combination of both.

Luxation. Luxation means the tooth becomes dislocated within the socket but maintains some attachment. There are different types of luxations. They be identified by teeth that appear:

  • Longer than the surrounding teeth (extruded).

  • Positioned ahead of or behind the normal tooth row (laterally displaced).

With either injury, the tooth should be firmly grasped with a gloved hand and moved into its normal position. If the procedure is too difficult or too painful, the tooth should be left where it is for a dentist to reposition.

  • Pushed into the gum and appears shorter than the surrounding teeth (intruded). Do not attempt to reposition an intruded tooth.

With all luxated teeth, get to a dentist as soon as possible.

Avulsion. Avulsion means the entire tooth is removed from its socket. The best outcomes require putting the tooth back in place within 60 minutes. After 2 hours, the chances of saving the tooth are small but getting to a dentist right away can be beneficial. Locate and protect the lost tooth. The tooth will often still be in the mouth, but if it cannot be located, check clothing, and the surrounding area. If dirty, the tooth should be gently cleaned with water or salty water (saline). To make saline combine ¼ teaspoon of table salt in a cup of warm water. The tooth should be handled only on its enamel surface. The root should be protected from further injury. If the tooth cannot be repositioned into the socket after cleaning, transport the tooth in saliva, distilled water, or milk to the dentist. Avulsed baby (primary) teeth should not be reimplanted.

TREATMENT

  • Gently biting into gauze or a towel will help control the bleeding. An exposed nerve requires dental exam and care.

  • Tooth fragments should be handled on their enamel surfaces, saved, and sent to the dental office with the injured person.

  • Minor fractures, involving only the enamel, usually do not require immediate dental treatment. A tooth can also be loosened by injury with no visible fracture or displacement. A person with this injury should be referred to a dentist for an X-ray exam to look for tooth fractures below the gum line.

  • Root fractures require joining the fractured tooth to a healthy tooth (splinting) by a dentist as soon as possible. If splinting is not possible, extraction of the remaining tooth may be necessary.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • If you are given antibiotics, finish all of them as directed.

RISKS AND COMPLICATIONS

Complications from tooth injuries can include:

  • Tooth death.

  • Tooth loss.

  • Cosmetic deformity.

  • Infection.

PREVENTION

Mouth guards should be worn in all contact sports.

SEEK DENTAL CARE IF:

  • Pain becomes worse rather than better, or if pain is uncontrolled with medications.

  • You have increased swelling or redness in your face near the injured tooth.

  • You have an oral temperature above 102° F (38.9° C) not controlled by medicine.

  • You cannot open your mouth.