Dental trauma most often occurs to upper incisors, usually between 8-12 years of age, and is more common in boys. These injuries are most commonly related to falls, fights, sporting injuries and road traffic accidents.

At this age, the root development of the incisors is not yet complete, and prompt referral to a Paediatric Dentist is essential for immediate assessment and care. This is to optimise the survival of the nerves of teeth and therefore their continued development. If there has been damage to the nerve or blood supply of the tooth, long-term follow-up with possible treatment may be necessary.

AVULSED PERMANENT INCISORS

This is when the tooth is completely displaced from the socket. It is important to replace the tooth in its socket as soon as possible  (unless this is contraindicated due to a compromising medical condition which would require antibiotic cover prior to any dental treatment).

The survival of avulsed teeth depends very strongly on the length of time the tooth is out of the mouth and how it is stored. The best survival outcome is for teeth that are replanted immediately. If the tooth is out of the mouth for more than 5 minutes, it must be kept moist to prevent further damage to the dental cells covering the root of the tooth. The tooth may be stored in fresh cold milk, in the mouth, or in physiologic saline.

The tooth must not be handled by the root and should not be scrubbed to remove dirt. Holding the tooth by the crown, it can be gently washed with saline or sterile water followed by re-implantation. It should then be held in place by biting on a clean handkerchief and the patient taken to a dentist immediately. If it cannot be replanted then store the tooth as described above and see a dentist immediately.

This tooth will then be splinted for 7-10 days and the patient should be given appropriate antibiotics, a mouthwash and referred to his/her doctor for a tetanus injection if required.

The follow-up treatment depends on the stage of root development of the tooth.

DISPLACED PERMANENT INCISORS

This displacement of the tooth may be seen as one of the following;

  1. Partial displacement of tooth out of bony socket (the tooth looks longer).
  2. Partial displacement of tooth into the bone socket (the tooth looks shorter).
  3. Displacement of the tooth sideways.

The main objectives of treatment are to re-position these teeth into the correct position and stabilise them to prevent further damage to the supporting structures, nerve and blood supply of the tooth/teeth.

The timing of the re-positioning may be immediate or delayed and is dependent upon a number of factors. The displaced teeth will require long-term follow-up with X-rays and may require root canal treatment if there has been irreversible damage to the nerve and blood supply of the teeth.

FRACTURED PERMANENT INCISORS:

The fracture may involve one or all of the following dental tissues: enamel, dentine, pulp (nerve) of the tooth.

Fracture of enamel and dentine, or enamel, dentine and pulp is usually associated with sensitivity to cold air and pain.

The main objective following this type of injury is to maintain the vitality of the pulp and prevent pain.
If the nerve of the tooth is not involved, then the tooth can be built-up with a tooth-coloured filling material. If the nerve is exposed, depending on the size of exposure and time since it occurred, the nerve will need to be treated.

In most cases, even if the nerve is removed, the tooth can be restored to almost the original shape. The aesthetics of these teeth are usually slightly compromised until the mid-teens when advanced restorative work can be carried out.

In the meantime, all efforts should be concentrated on saving the traumatised tooth and monitoring the root development using X-rays.

PERMANENT TOOTH/ROOT FRACTURE:

The traumatised tooth may look normal, have increased mobility or the tooth may look displaced.

For diagnostic reasons, multiple dental X-rays are necessary to assess the level and extent of the fracture.
Some root fractures require immobilisation, and prompt treatment of such fractures increases the chance of healing and hence tooth survival.


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