While most traumatic dental injuries occur in children and teenagers, people of all ages can sustain dental trauma, usually as a result of sports mishaps, automobile accidents, or bad falls. If you've experienced a traumatic dental injury, it is important to undergo thorough testing in order to determine whether root canal treatment may be necessary. A dental injury, even if apparently mild, requires examination by a dentist or an endodontist immediately. Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam.
Chipped or Fractured Teeth
Chipped teeth at the front of the mouth account for the majority of dental injuries. Most chipped or fractured teeth can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth is broken off, an artificial crown or "cap" may be needed to restore the tooth. In the event that the injury results in damage to the pulp of the tooth, root canal treatment is necessary prior to the restoration of the tooth.
Injuries in the back teeth can include fractured cusps, cracked teeth, or a more serious split tooth. If cracks extend into the pulp of the tooth, root canal treatment and a full coverage crown may be needed to try to preserve the tooth. Split teeth, or vertical cracks extending down the root surface, may require extraction.
Dislodged (Luxated) Teeth
During an injury, a tooth may be pushed sideways, out of, or into its socket. It is essential following a luxation injury that the tooth be properly repositioned and stabilzed. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury.
Children aged 7 to 12 may not require root canal treatment following a luxation injury, since the roots are still developing and can have a greater chance of recovering from the injury. For those patients, it is important to monitor the healing carefully and intervene immediately if any unfavorable changes appear.
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, and every effort should be made to avoid touching the root surface itself. If the tooth or root is dirty, quickly and gently rinse it in water. Do not use soap or any other cleaning agent, and never scrape or brush the tooth or root surface. 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.
Once the tooth has been put back in its socket, your endodontist will evaluate it and will check for any other dental or facial injuries. If the tooth has not yet been repositioned, your endodontist will clean it and carefully place it back in the socket. A stabilizing splint will be placed for a few weeks. Depending on the stage of root development, your endodontist may start root canal treatment a week or two later.
Root Fractures
A traumatic injury to a tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term prognosis for the tooth. If the fracture is close to the root tip, the chances for success are greater. The closer the fracture is to the gum line, the poorer the long-term success rate. Stabilization with a splint is often required for a period of time.
Traumatic Dental Injuries in Children
Chipped primary (baby) teeth can be aesthetically restored. Primary teeth that have been knocked out typically should not be reimplanted since it can result in damage to the underlying permanent tooth that is growing inside the bone.
Children's permanent teeth that are not fully developed at the time of the injury need special attention and careful follow-up, but not all of them will require root canal treatment. In an immature permanent tooth, the blood supply to the root and the presence of stem cells in the region may allow pulp vitality to be maintained and therefore allow for continued root development. Therefore, careful clinical and radiogrpahic monitoring is essential.
Root Resorption
Root resorption occurs when your body's immune system attacks your tooth or root in response to the traumatic injury. If resorption occurs subsequent to an injury, you may require specialized treatment over multiple appointments in order to try to minimize the amount of damage to the root surface and to provide your tooth with the best possible prognosis.
Root resorption can be internal (within the pulp of your tooth) or external (on the outer root surface) in nature, which can affect both the proposed treatment and the prognosis. A CBCT scan may be recommended to more accurately evaluate the size and location of the resorptive defect and to help to determine the prognosis for the tooth. In some cases, root canal treatment as well as surgery can be necessary to manage resorption. If the resorption is severe or in an unfavourable location, extraction of the tooth may be the only option.
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