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Dental injuries

Published by BUPA's health information team, healthinfo@bupa.com, August 2007.

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

If you have a dental injury, you are likely to have received a blow to your face or mouth that resulted in one or more of your teeth being damaged or knocked out. This factsheet aims to explain how to prevent the most common dental injuries. It also provides information about the ways in which your dentist may be able to treat you.

What are dental injuries?
Causes
Treatment
Will I need further treatment?
Dental injuries in children
Prevention
Further information
Sources
Related topics

What are dental injuries?

Any number of things can cause damage to 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 lead to you breaking a tooth, particularly if it's already damaged by dental decay.

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

Causes

While most dental injuries are accidental, there are things that make these accidents more likely to happen. Some of the most common are:

playing contact sports, such as rugby or boxing, although any sport that involves physical contact, speed 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 - you may choose to have orthodontic treatment to make your front teeth less prominent
being unsteady on your feet - this includes young children who can trip over easily, or if you have a condition such as epilepsy, you may damage your teeth if you fall during a fit

Treatment

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 there is a lot of bleeding, then it's important that you call for emergency help.
Contact a dentist straight away. If it's outside normal opening hours, it's possible that there will be an answerphone message to give you information on where to go for emergency treatment. Alternatively, you can go straight to the accident and emergency department at the nearest hospital. The sooner you receive treatment the better chance you have of saving your tooth.
Even if you don't think your tooth is broken, it's still important that you go and see your dentist. There may be damage that you can't see and that may need treating.

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 (re-implant) in your mouth. 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 your 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 re-implant the tooth straight away, store it in saliva (of the person whose tooth it is), milk or salt water 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. If your tooth is only chipped, carefully handle and store the broken piece (as before in saliva, milk or salt water) as your dentist may be able to reattach it.

When you get to the dentist, he or she will have a look inside your mouth to see if your tooth has been re-implanted properly. Your dentist may do 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 may have swallowed or inhaled a piece of tooth, the 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 the tooth has chipped off but the pulp isn't damaged, the uneven edge may be smoothed and the corner replaced with a tooth-coloured filling. If the pulp has been damaged, you may need to have root canal therapy on your tooth and have a filling or crown fitted on top of your chipped tooth.

Root canal therapy removes damaged blood vessels and nerves from a tooth.

If a tooth has been loosened or knocked out

If your tooth has been knocked out completely but not yet successfully re-implanted, 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 may need to have your tooth splinted (joined to others) in order to hold it in place. Your dentist may do this by using a thin piece of wire to attach the loose tooth to those on either side of it, but there are other methods. If your tooth was re-implanted easily, 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 have it for up to three months.

If a tooth has broken roots

Your teeth have roots that are set in the jawbone. 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 further 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 broken teeth are unlikely to heal. In these cases, your dentist may advise you to have the tooth taken out.

Will I need further treatment?

It's possible that your tooth won't recover from the injury. Teeth depend on a good blood supply and if this is damaged, the pulp may die. You may then need to have root canal therapy to remove damaged blood vessels and nerves from the tooth. Alternatively, you may need to have the tooth taken out.

The pulp may die a long time after a dental injury, so it's important that you visit your dentist if you feel pain or notice any change in colour to the damaged tooth. If you do have your tooth re-implanted, 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, then the dentist is unlikely to try to re-implant it. This is because it could damage the permanent tooth when it develops. Occasionally, damage to a milk tooth can cause harm to the adult tooth. Your dentist will be able to watch out for this and advise on any treatment that may be needed.

Prevention

If you regularly play a sport that puts your mouth and teeth at risk of damage (eg rugby, boxing, cricket or hockey) you may wish to consider getting a mouthguard. This will offer some protection and can reduce the likelihood of you getting an injury.

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. This means that it will fit you properly and therefore give you more protection.

Mouthguards are usually made of rubber and form a cover that goes over your teeth and gums. 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.

If your mouthguard has been made properly, you should not have any problems talking or breathing normally while you are wearing it.

Further information

British Dental Health Foundation
0845 063 1188 (dental helpline)
www.dentalhealth.org.uk
British Dental Association
www.bdasmile.org

Sources

Dental, avulsed tooth. emedicine
www.emedicine.com
24 April 2007
Burden DJ. An investigation of the association between overjet size, lip coverage, and traumatic injury to maxillary incisors. Eur J Orthod 1995; 17(6):513-517
Wray D, Wray A. Understanding you teeth and mouth. Oxon: Family Doctor Series in association with the British Medical Association, 2000
Holt R, Roberts G, Scully C. ABC of oral health: dental damages, sequelae and prevention. Student BMJ, 2000 October (8):369-371
Knapik JJ et al. Mouthguards in sport activities: history, physical properties and injury prevention effectiveness. Sports Medicine 2007; 37(2):117-144
Common problems. British Dental Association
www.bdasmile.org
accessed 25 April 2007
Do you or a family member need emergency hospital treatment? NHS in England.
www.nhs.uk
accessed 25 April 2007
Mitchell DA, Mitchell L. Oxford Handbook of Clinical Dentistry. 4th ed. Oxford: Oxford University Press, 2005
Avulsed teeth. British Dental Health Foundation
www.dentalhealth.org.uk
accessed 25 April 2007
Caring for your mouth after a dental injury. British Association of Oral and Maxillofacial Surgeons
www.baoms.org.uk
accessed 25 April 2007
Andreasen JO, Andreasen FM. Textbook and colour atlas of traumatic injuries to the teeth. 3rd ed. Copenhagen: Munksgaard, 1994