Traumatic Dental Injuries

Traumatic dental injuries never seem to happen at a convenient time, do they? Since the majority of after hours emergency calls involve some sort of traumatic event we thought we would compile a list of the most common dental injuries and how they are to be treated.

In the primary/baby teeth peak incidences of trauma are seen around the age of 2-3 years (when motor coordination is developing and children start moving around on their own). By the age of five approximately one third of children have suffered some form of dental injury, with boys being slightly more likely than girls to have had a traumatic event. In this age group the most common dental injury is tooth luxation.

In twelve year old, 20-30% will have suffered an injury with boys being approximately one third more frequently affected. The typical injury in this group is an uncomplicated crown fracture. Peak incidence for this injury is around 9-10 years when vigorous playing and sports activities become more frequent. Overall, in the permanent/adult dentition the most common injuries are due to falls, followed by traffic injuries, acts of violence and sports.

The following is a generalized list of the most common forms of dental trauma. This is in no way a complete list of dental injuries and all injuries must be handled on an individual basis. In all scenarios when we say you should seek treatment we mean either by our office or by a local Emergency Room (we would recommend Hartford Hospital’s ER since there is a dental and oral surgery resident available 24 hours a day there):

1. Tooth Avulsion- This is when an entire tooth is displaced completely out of it’s socket. Timing is critical in this scenario, as the tooth has its best prognosis if it’s reimplanted within thirty minutes of avulsion (the less time the tooth spends out of the socket the better). In fact, if the tooth is not dirty it is best to reimplant the tooth back into the socket and then hold the tooth in place while being transported to treatment. If you are not comfortable reimplanting the tooth yourself, it is best to put the tooth in your cheek so that your saliva coats the tooth while you are heading to either the office or the ER. Further treatment is of course necessary once you are in the hands of a dentist. Note: if the avulsed tooth is a baby tooth, reimplantation is not recommended but seek dental treatment as soon as possible.

2. Fracture of the Alveolar Process- This is when the jaw bone holding the teeth is fractured and it may or may not involve the tooth sockets. It will look like an entire segment of teeth is in the wrong position and the patient’s bite will be off. In this scenario it is important that the area not be touched in any way and you should be seen immediately.

3. Root Fracture- This type of injury is when the root is broken into two or more fragments. The tooth will appear longer and will be displaced towards the roof of the mouth. This type of injury can only be diagnosed with an x-ray and therefore you should seek treatment immediately.

4. Luxation Injuries- These injuries are to the teeth only (not the jaw bone) and are sub-classified into: concussion, subluxation, extrusion, lateral luxation and intrusion. Basically, this is when an injury occurs to the teeth resulting in them being abnormally loose, tender to touch, and they may or may not be in a different position.
a. A concussion injury occurs when a tooth is injured without injuring the jawbone. The tooth appears in the same position and is not abnormally loose but is tender to touch. In this case, it is best to be seen within 24 hours of the event.
b. A subluxation injury is when there’s an injury to the tooth supporting structures (mainly the ligament surrounding the tooth) resulting in an abnormally loose tooth, yet the tooth remains in its normal position. There may or may not be bleeding from the gums around the tooth and the bite may or may not feel off. In this scenario it’s best to have the tooth checked within 24 hours.
c. If the tooth appears longer (extrusion) or displaced sideways (lateral luxation) it is best to not touch the tooth and seek treatment immediately.
d. If the tooth appears shorter (intrusion) it is best to leave the tooth alone and seek treatment within 24 hours of the injury.

5. Fractured Front Teeth- This type of injury can be sub classified into complicated tooth fractures (involving the nerve of the tooth) and uncomplicated crown fractures (not involving the nerve of the tooth). In the case of nerve involvement the patient should be seen within 24 hours. Cases in which the nerve is not involved can wait longer than 24 hours for treatment.

As we already stated, this list is in no way comprehensive nor is it meant to serve as a means for you to diagnose and treat your own injuries. When an injury occurs it is best to call the office immediately. If the injury occurs outside of normal business hours and you do not hear back from us within 15 minutes we suggest seeking care at a local Emergency Room. Please save this article for future reference!
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