A tooth removed from its socket as a consequence of a trauma is called ‘tooth avulsion’. Tooth avulsion is one of the most seen cases of all traumatic injuries with 0.5% to 16% range in permanent dentition in conjunction with dental injuries can exist frequently at any time of life.
Esthetic appearance and chewing function of avulsed teeth can be restored by replantation. Immediate replantation of the avulsed tooth is the best management, but the replantation in 20-30 min after the injury or keeping the tooth in an appropriate storage media until the patient can be seen by a dentist is also feasible. The optimal replantation time for the best prognosis has been declared as 5 mins.
If a tooth is avulsed, make sure it is an adult (permanent) tooth (baby teeth should not be replanted).
- Keep the patient calm.
- Find the tooth and pick it up by the crown (the white part). Avoid touching the root. (b)
- If the tooth is dirty, wash it briefly (10 seconds) under cold running water and reposition it. Try to encourage the patient / parent to replant the tooth. Bite on a handkerchief to hold it in position.
- If this is not possible, place the tooth in a suitable storage medium, e.g. a glass of milk or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline). The tooth can also be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he/she could swallow the tooth- therefore it is advisable to get the patient to spit in a container and place the tooth in it. Avoid storage in water!
- Seek emergency dental treatment immediately by calling Health Precinct at 07 4788 0111.
Dentists at Health Precinct are trained to manage avulsed teeth and we prioritize your appointment as an immediate emergency. After the first aid is done, the dentist will have to splint the tooth to support the tissues and aid in healing.
- Avoid participation in contact sports.
- Eat only soft food for up to 2 weeks.
- Brush teeth with a soft toothbrush after each meal.
- Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week
- Patients have to be aware of the need for Root Canal treatment of the avulsed/ traumatized teeth.
- Root canal treatment 7-10 days after replantation.
- Splint removal and clinical and radiographic control after 4 weeks.
- Clinical and radiographic control after 4 weeks, 3 months, 6 months, 1 year and then yearly thereafter.
A tooth can get fused to the bone after a trauma. This is termed ‘Ankylosis’. Ankylosis is unavoidable after delayed replantation and must be taken into consideration. In children and adolescents ankylosis is frequently associated with a shorter tooth. Unwanted sequelae of trauma might demand additional treatments that will be discussed if needed.
A custom made sports mouth guard fits exactly to your teeth and protects teeth from trauma. Use of a custom made sports mouth guard is highly recommended by Health Precinct and the Australian Dental Association to avoid dental traumatic injuries.
BROKEN TOOTH / LOOSE FILLING
Though teeth are remarkably strong, they can chip, crack (fracture) or break. This can happen in several ways:
- Biting down on something hard
- Being hit in the face or mouth
- Having cavities that weaken the tooth
- Having large, old amalgam fillings that don’t support the remaining enamel of the tooth
Cracked teeth may not hurt always but your tongue usually feels the sharp area quite quickly. Minor tooth fractures are usually painless, while large fractures can hurt. The nerve inside the tooth may be damaged due to bacterial contamination from saliva. Extreme discomfort can also happen when nerve endings in the dentin are exposed. Pain from a broken or cracked tooth may be constant or may come and go. Many people feel pain when they chew because chewing puts pressure on the tooth
FIRST AID / THINGS YOU CAN DO:
Cracked (Fractured) Teeth
Unfortunately there is not much you can do at home. Cracked teeth are like cracks on your car windscreen. They only get worse over time. You need to see dentist at Health Precinct at the earliest as we prioritize emergency appointments. Sometimes the tooth looks fine, but it hurts only when you eat something hot or cold. If your tooth hurts all the time, it may have a damaged nerve or blood vessels. This is a serious warning sign. You will know if you have a cracked tooth if it does not hurt to bite on the tooth, but pain occurs when you release the bite.
If you have a broken tooth, see us at Health Precinct as soon as possible. We can figure out if the break was caused by a cavity, and if the tooth’s nerve is in danger. A damaged nerve will usually require root canal treatment.
As a first aid:
- Rinse your mouth well with warm water.
- Apply pressure with a piece of gauze on any bleeding areas for about 10 minutes or until the bleeding stops. If this doesn’t work, use a tea bag with pressure on the area to stop the bleeding.
- Apply a cold pack to the cheek or lips over the broken tooth. This will help reduce swelling and relieve pain.
- If you can’t get to see us right away, cover the part of the tooth that is in your mouth with temporary dental cement. You can find this at a drugstore.
- Take an over-the-counter pain reliever.
Treatment offered at Health Precinct:
There are several types of tooth fractures and breaks, each of which requires different treatments. These include:
- Minor cracks / Chips— Craze line affects only the enamel of the tooth and is painless. Minor cracks rarely need treatment. We may suggest repairing the damage with filling material to prevent it from getting worse or to make the tooth look and feel better. If the chip is very small, we may polish and smooth out the chipped area.
- Broken cusp— Cusps are the structural components of your tooth and have a pivotal role in grinding food. They usually do not affect the pulp and are unlikely to cause much pain. Your dentist may repair the damage to restore the tooth’s shape to avoid further structural damage to tooth, protect the nerve and improve your chewing effeciency. Frequently, an onlay or crown will be required.
- Cracked tooth — this type of fracture involves the whole tooth, from the chewing surface all the way down to the nerve. The pieces remain in place, but the crack gradually spreads. Serious cracks can involve the nerve and usually the broken part of the tooth will bleed. Treatment of a cracked tooth may be a mere filling to repair the crack. Cracked teeth often need a crown to prevent the crack from getting worse. If the pulp (nerve and other live tissues) is damaged, you may need a root canal as well. If the crack has gone down to the roots, the tooth might have to be extracted too.
- Split tooth— this means that the tooth has split vertically into two separate parts. Some teeth, such as your back teeth (molars), have more than one root. It may be possible to keep one of the roots, which will then be covered with a crown. First, you will need root canal treatment. Second, the dentist will remove any roots that cannot be kept. Third, you will need a crown to cover the root and replace the tooth. In some cases, when a root cannot be saved, the tooth will have to be removed.
- Decay-induced break— In this case, the tooth has broken or crumbled because a cavity weakened it from the inside out. Your dentist will evaluate the cavity and recommend the best way to restore the tooth. In some cases, if the decay is extensive and goes down to the bone, the tooth may have to be removed.
DENTAL ABSCESS / FACE SWELLING
A dental abscess is a collection of pus that forms in your teeth and spreads to the surrounding tissue. It forms as the result of a bacterial infection. The main symptom of a dental abscess is a severe, throbbing pain. Infection from the tooth/ gums starts spreading down the bones, cheeks, below the tongue and might cause swelling of the face too.
Usual signs are:
- Redness of the mouth/ face
- Difficulty in swallowing/ opening mouth/ breathing.
If someone is experiencing significant signs or symptoms, immediately call us on 4788 0111 and if unable to reach us, go to a physician or a hospital’s emergency department for evaluation, especially if feeling sick.
- People take nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen (Nurofen) or Paracetamol (Panadol), as needed for relief of pain and inflammation. These medications may help reduce pain, but they will not treat the infection. Call us on 4788 0111 for treatment of the dental abscess/
- If an abscess ruptures by itself, warm-water rinses will help cleanse the mouth and encourage drainage. Even then, a follow-up visit is important.
- Infectious swelling accompanying a dental abscess is different than inflammatory swelling, and application of ice or cold packs to the area is not recommended.
We prioritize dental emergencies and consider an abscess as acute emergency. Here at Health Precinct, care is taken to make an accurate diagnosis and locate the cause of the dental abscess. Usually, patients are put on appropriate antibiotics and the source of infection is addressed on the first appointment. Treatment might range from extraction to root canal treatment. However, if the infection if serious/ life threatening, we recommend you go to the emergency department at the earliest.