Injured or Traumatized Teeth - What To Do?

Injured Teeth

Injured Teeth

In general you should differentiate between children’s teeth-traumas and adult dental accidents.

"Child had a tooth knocked out" this search enquiry is seen all the time on the internet. Independent of age, when it comes to casualties the most important thing is their general condition. Are the pupils the same size? Is the casualty lucid and generally space and time aware and oriented? If in doubt call a doctor immediately.

Children's Dental Accidents

We differentiate between injuries to teeth and to the mouth and combined injuries.

In layman’s terms, teeth injuries can be sub-divided into three areas too. There’s a difference between an enamel fracture and a dentine fracture with or without exposure of the dental nerve.

A complete break of the enamel and/or isolated enamel fractures do not normally require immediate treatment. Treatment is indicated for isolated enamel fractures mainly on aesthetic and subjective feelings of disturbance. The fractured tooth often lies in the aesthetic zone and/or the breakage grates against the lips, tongue or cheeks with a sharp edge. Treatment takes place by means of, for example, special plastics with the help of which the fractured portion of the tooth can be rebuilt.

A dentine fracture without exposure of the nerve requires prompt dental treatment. The exposed dentine may be sensitive to cold or heat. The more the dentine is harmed, i.e. the more dentine (the yellowish inner tooth material) is exposed, the sooner the treatment the better. Since dentine is connected with the dental nerve, irritation may occur. Depending on the size of the fracture reconstruction is carried out with, amongst others, plastics, veneers, part-crowns and crowns.

Injuries to dentine are frequently treated by dentists with special medication and/or chemical preparations. After such treatment the tooth may remain sensitive for some days. After an enamel and dentine fracture a regular half-yearly check should be done at the dentist for at least 3 years, even if there are no further problems. The dentist will carry out a cold test and check if there is any further damage to the tooth.

An enamel and dentine fracture with nerve exposure requires immediate dental attention. Depending on the size, duration and contamination of the opening of the wound, the nerve tissues may, for example, be sheathed with medicaments and the tooth reconstructed or an immediate root treatment may be done and subsequent tooth reconstruction.

Depending on the age of the child the treatment to save a milk tooth will be more or less aggressive. Whilst older children will have their teeth pulled, younger ones’ teeth, on the other hand will be tried to be saved – by a root treatment, for example.

With root treatments for milk teeth no permanent root-filling material is used since the roots of milk teeth are re-absorbed by the body when teeth are changed. Therefore with root treatments for milk teeth a re-absorbable antiseptic material is used. Depending on the seriousness of the injuries this treatment may be carried out under full anesthetic.

Facial injuries can basically be classified in two groups: separate soft tissue injuries and hard tissue injuries.

Deep and/or large-area soft tissue injuries should always be examined and treated by a doctor. Facial wounds may bleed profusely. If nothing else is available simply press a hand to the bleeding wound. The surface of what you press with should be clean – a clean hand or a clean hanky but in an emergency an unwashed hand will do.

In the case of hard tissue injuries, i.e. to bones, there are very often other problems along with the bleeding. Patients with broken jaws are frequently disturbed by teeth no longer fitting together as they once did. Patients with injuries to the orbits (eye-sockets) often complain of double vision, sometimes in the case of particular eye-movements. People with cheekbone fractures often suffer from problems with opening and closing of their mouths whilst problems when breathing through the nose can be a sign of fractures of the nasal bones.

The most important thing in such situations and in accidents in general is to be careful that no further injuries occur to you or the victim of the accident and that you should get help as soon as possible. Heroic actions can easily cause more damage, for example attempts to put back broken teeth are useless and merely painful.

Children’s teeth usually show better regeneration capability than those of older men. Teeth dislocated by the accident and repositioned by the dentist can heal in the case of children. When examining injuries of the lower jaw and/or chin of children, not only are the teeth examined but also the ends of the joints of the lower jaw. This can be seen through 3 things, two of which can be done by yourself.

First of all, ask your child if his teeth fit together properly. If your child finds that they don’t or feels something wrong with his teeth then this could be – along with the chin injury – an indication of a fracture in the joint of the jaw. In such cases stick your two (washed) little fingers in his ears and tell him to open and close his mouth. You can feel the way the ends of the lower jaw cause movement in the ear canal with every opening and closing of the mouth.

If you or the doctor don’t feel such a movement then an X-ray should be done.

It’s important that as an adult you keep calm. Your child should not have to experience further trauma under any circumstances – the accident was enough! It’s important that your child understands that he is being helped and that as parents you shouldn’t be afraid or show exaggerated sympathy for your child. Don’t transfer your fears to the child, give him security. This can be achieved through calmness, comforting words and clear explanations.

Adult Dental Accidents

The assessment of findings, diagnosis and treatment are very similar in the case of adults as of children though of course differences do exist. Use is made of more complex (and costly) materials which usually also last longer. The disadvantage of these materials is that, in order to obtain good results, they must be used very carefully and precisely – and this takes time, which you wouldn’t want to take with a child.

Children, as often as not, do not understand the treatment. With milk tooth treatments duration is not the most important factor. Simple and efficient application, painless and quick treatments are more important in the treatment of children and of milk teeth.

Therefore in the case of an adult an enamel and dentine fracture, for example, would rather be treated with a ceramic veneer than with plastic. However, we’d like to show here dental accidents which mainly concern adults.

Ceramic Fracture of a Dental Crown

Most patients complain about a sharp edge and/or particles of food getting caught. In the worst case the crown will have to be replaced by the dentist. If several crowns have been damaged, for example by a blow then a check by a dentist is definitely required.

Dental Pin Fracture

If you can remove the crown and its pin from your mouth with your fingers then you go go to your dentist with it. Either the pin is incorrectly constructed, or the tooth has caries, or the root is broken. Combinations of these are also possible. The dental treatment depends on the cause. If the tooth is usable the root-pin must definitely be re-done.

Loss of Dental Crown

If the tooth has had a root treatment and you can remove the crown then do this. If the tooth has not had a root treatment, then it’s better to leave the crown. In both cases dental treatment is needed.

Broken Prosthesis

Apart from the prosthesis not being able to be used any more, not a lot can happen. Attempting to re-glue it with superglue is useless and when it’s done in the mouth it’s also dangerous. A dental technician can repair the prosthesis if necessary.

Broken Prosthetic Brace

If the prosthesis still holds despite a broken brace then it can still be used for a short time. Soft foods are recommended until such time as the visit to the dentist takes place.

Broken Prosthetic Tooth

Apart from aesthetic degradation the breakage of a prosthetic tooth has no effects on health.

Loosening of a Dental Implant

Sometimes the abutment of a dental implant can be loosened as a result of a blow or trauma to the dentition. One can notice that the implanted tooth moves slightly. You shouldn’t chew on that tooth and you should go to your dentist as soon as possible, so that the abutment can be re-tightened. Your dentist can also rule out a broken abutment or implant.

Broken Bridge with a Prosthetic Part

The prosthetic part shouldn’t be stuck back onto the bridge. If the prosthesis is still on the bridge then it should be left in the mouth and a dentist consulted.

Acute Contusion of the Jaw Joint

You often notice that your teeth do not fit together well and that the joint of the jaw hurts with particular movements. The causes of a contusion of the jaw joint are: overstretching, for example at the dentist’s or hard to chew food. The jaw joint usually recovers within three days.

This post is also available in: German

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