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Dental injuries

Published by Bupa's health information team, June 2009.

This factsheet is for people who have dental injuries, or who would like information about them.

A dental injury is usually caused by a blow to the face or mouth that results in one or more teeth being damaged or knocked out. This factsheet explains how to try and prevent the most common dental injuries. It also outlines the possible treatments for dental injuries.

About dental injuries

Any number of things can injure your teeth. Among the most common are falls, being hit in the face, accidents while playing contact sports and road traffic accidents. Sometimes even eating something very hard can break a tooth, particularly if that tooth is already weakened by tooth decay.

If you have received a blow to the face, you may also have cuts, swelling or broken bones that need medical attention.

Causes of dental injuries

While most dental injuries are accidental, there are risk factors that make these accidents more likely to happen. Some of the most common are listed below.

  • Playing contact sports such as rugby or boxing, or any sport that involves physical contact or moving objects such as bats and balls, can put you at risk of damaging your teeth.
  • Having upper front teeth that stick out has been shown to increase your risk of damaging them.
  • Being unsteady on your feet (toddlers for example), or having some medical conditions (such as epilepsy) can put you at greater risk of a dental injury.

First aid for dental injuries

If you have a dental injury, or witness one, there are some important things to bear in mind.

  • If the accident causes anyone to be knocked out (lose consciousness), or if there is a lot of bleeding, then it's important that you call for emergency help.
  • If it's not a medical emergency (as described above), but your tooth has been knocked out, contact a dentist straight away. If it's outside normal opening hours, there may be an answerphone message telling you where to go for emergency treatment. Alternatively, go straight to the accident and emergency department at the nearest hospital. The sooner you receive treatment the better chance that your tooth can be saved.
  • Even if you don't think your tooth is broken, it's still important that you go and see your dentist as soon as possible. There may be an injury below the gumline that you can't see.

If you or someone else has had a tooth knocked out, then it's worth remembering the following points.

  • Try not to touch the tooth's root - it's best if you only handle it by the crown (the white bit that you see in your mouth).
  • If possible, unless the tooth is a milk (baby) tooth, put it back into its socket in the mouth. This is called reimplanting the tooth. Try to put it in the right way round, but don't worry too much as your dentist can fix this. The important thing is to put it back in the mouth as quickly as possible.
  • When the tooth is back in its socket, keep it in place by biting down gently on a clean handkerchief or a piece of gauze.
  • If you can't reimplant the tooth straight away, store it in saliva (by spitting into a container) or milk until you can get to a dentist. One way to store your tooth in saliva is to place it inside your mouth between your cheek and gum. However, this isn't recommended with young children as they could swallow or inhale the tooth.
  • If you haven't got the whole tooth, it's better not to try to put a broken tooth back in your mouth. Handle and store the broken piece carefully (in a tub of saliva or milk) as your dentist may be able to reattach it.

Treatment of dental injuries

If a tooth has been loosened or knocked out

When you get to the dentist, he or she will have a look inside your mouth to see if your tooth has been reimplanted properly. If your tooth hasn't yet been successfully reimplanted, your dentist will attempt to do this as soon as possible. However, this may not always be appropriate - your dentist can tell you whether or not this is the case.

You will need to have your tooth splinted (joined to the neighbouring teeth) in order to hold it in place while it heals. Usually a splint is a thin piece of wire, which attaches the loose tooth to those on either side of it, but there are other types of splint. If your tooth was handled carefully and reimplanted quickly, you will need to keep this on for about a week. But if your injury was more severe and caused root damage, you may need to wear the splint for up to three months.

Your dentist may take some X-rays to get more information about how serious your injury is and to see if there are any pieces of broken tooth stuck in your lip, gum or tongue. If you think you have inhaled a piece of tooth, your dentist may refer you to hospital for a chest X-ray to confirm this.

If a tooth has been chipped

The treatment of a chipped tooth will depend on where your tooth has broken. Teeth have a core of blood vessels and nerves at their centre called the pulp. If your tooth is injured, the pulp can be damaged and the blood vessels may die.

If a piece of your tooth has chipped off but the pulp isn't damaged, your dentist will smooth the uneven edge and replace the corner with a tooth-coloured filling. If the pulp is damaged, your dentist may need to do root canal therapy to remove the damaged blood vessels and nerves from the tooth.

If a tooth has broken roots

Your teeth have roots that are set in your jawbones. If a root fractures (breaks), it's possible that your tooth won't look any different because the fracture is hidden by bone and gum. However, your dentist may be able to see a broken root on X-ray images.

If your tooth is quite firm, your dentist may simply ask you to come back for regular X-rays and tests to make sure that the pulp remains healthy. However, if your tooth is wobbly, it will need to be splinted for a few weeks to help the fracture heal.

During the weeks and months after the root fracture, if your dentist finds that the pulp has been damaged and isn't going to recover, he or she may recommend that you have root canal therapy to save the tooth.

Some fractures are unlikely to heal, particularly if they are near the gum or the tooth is broken lengthways. In these cases, your dentist may recommend that you have the tooth taken out.

After your treatment

If you feel pain or notice any change in colour to the damaged tooth at any stage after you've been treated, it's important that you visit your dentist, as the pulp may die a long time after a dental injury. If you have had your tooth reimplanted, you should continue to get it checked for at least two to three years afterwards.

Dental injuries in children

Young children who injure their milk teeth may receive different treatment to that given to adults or teenagers. If a milk tooth is knocked out, the dentist is unlikely to try to reimplant it. This is because it could damage the permanent tooth when it develops. Occasionally, an injury to a milk tooth can cause damage to the developing adult tooth. Your dentist will be able to watch out for this and advise on any treatment that may be needed.

Prevention of dental injuries

If you regularly play a sport that puts you at any risk (eg rugby, boxing, cricket, hockey) you may wish to consider getting a mouthguard. This will offer some protection and can reduce the likelihood of you getting an injury. Mouthguards are usually made of rubber and form a cover that goes over your teeth and gums.

You can buy mouthguards in some sports shops but it's better to ask your dentist to make one that is specially fitted for you. If your mouthguard has been made properly, you should not have any problems talking or breathing normally while you are wearing it. Your dentist will take a mould of your teeth using a putty-like material. This is then sent to a laboratory where your mouthguard is made. Children will need to have their mouthguards replaced as new teeth develop and their mouths grow.

Related topics

Further information

Sources

  • Dental, avulsed tooth. eMedicine. www.emedicine.com, accessed 30 January 2009
  • Chestnutt IG, Gibson J. Churchill's pocketbook of clinical dentistry. 3rd ed. Elsevier, 2007
  • Mitchell DA, Mitchell L. Oxford handbook of clinical dentistry. 4th ed. Oxford: Oxford University Press, 2007
  • Holt R, Roberts G, Scully C. ABC of oral health: dental damage, sequelae and prevention. BMJ 2000; 8: 369-71
  • When to call 999. London Ambulance Service NHS. www.londonambulance.nhs.uk, accessed 30 January 2009
  • British Association of Oral and Maxillofacial Surgeons. Caring for your mouth after a dental injury. www.baoms.org.uk, accessed 30 January 2009
  • Knapik JJ, Marshall SW, Lee RB, et al. Mouthguards in sport activities: history, physical properties and injury prevention effectiveness. Centre for Reviews and Dissemination DARE database. www.crd.york.ac.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2009

 

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