Managing Dental Injuries Part 1: Periodontal Injuries

Dental trauma to adult teeth is often painful and distressing for the injured child. The most accident prone times in a child's life in regards to damaging permanent teeth are between 7-10 years of age. Most injuries result from falls and collisions while playing, running, or bicycling. Research suggests that one in three children have experienced dental injury to permanent teeth, with a statistically greater percentage in boys. The premise of this blog will be to review common periodontal injuries (injuries to the tooth root and surrounding ligaments) in adult teeth teeth and proper emergency care.


2 major types of periodontal injuries and their treatments

1. Luxation: the tooth is out of position, but it is still in the mouth.

A luxated tooth has been moved out of the [tooth] socket. The impact may have displaced the tooth upward (very common), downward (Figure 1 below), backwards, forwards or less commonly to the side.

After a luxation injury, it is important to see your orthodontist as quickly as possible. Every hour counts! Luxation injuries have a favorable prognosis with early treatment. Your orthodontist can reset the tooth with a combination digital manipulation and braces on the anterior teeth. The braces function to move the tooth into the proper position and also work as a non-rigid functional splint. Many orthodontists will choose to keep the braces in place for 3 weeks. A soft-food diet (eggs, milk-proteins, pasta, oatmeal, soups) should be kept for 3 weeks.

Luxation injuries often involve damage to tooth pulp and nerves, as well as the ligaments and bone plates (dentoalveolus) around the tooth root. After the tooth has been splinted for 3 weeks, your orthodontist will refer your child to your pediatric or family dentist to further evaluate the health of the tooth. While younger teeth (children 7-9 years of age) typically retain vitality, more mature teeth (children 10+ years of age) are a high risk for inflammatory injuries that may require root canal treatment or less commonly extraction if the tooth fuses to the bone (known as ankylosis).


2. Avulsion: the tooth is completely out of the mouth.

Avulsion is the most severe periodontal injury in which the tooth has been completely knocked-out of the mouth (Figure 2 below). Avulsion injuries commonly occur after a forceful fall to the ground during play, rather than organized sports. Similar to luxation injuries, avulsion is associated with fractures to the dentoalveolus, as well as damage to the nerves, blood vessels and supporting tissues. However, if you act quickly, there is a good chance that the tooth can be saved.

Home-care instructions for an avulsed tooth:
Pick the tooth up by the crown (this is the part of the tooth that see you in the mouth). Avoid touching the root of the tooth. If the tooth is dirty do not attempt to disinfect or scrape the tooth root. Attached to the root are vital periodontal ligaments cells which are crucial to allowing the tooth to re-adhere to the bone. Simply, wash gently under cold tap water (10 seconds). The tooth has a better chance of surviving if it is kept its natural environment. If you feel comfortable doing so, attempt to replace the tooth into its socket. Alternatively, you may transport the tooth in a zip-lock bag filled with milk or the child's saliva to the orthodontist. It is important to keep the tooth moist.

At the surgical appointment, your orthodontist will administer local anesthetic, digitally reinsert the tooth, and place a non-rigid functional splint. The child will likely be given an antibiotic cover, an antibacterial rinse (chlorhexidine mouthwash), and placed on a soft-diet for 3 weeks. It is critical that the tooth be reinserted within 30-60 minutes after trauma so it may undergo pulp revascularization. The longer an avulsed tooth remains out of the tooth socket, the greater the likelihood of ankylosis.


A Quick Summary of Luxation and Avulsion:
1. Visit your orthodontist immediately.
2. After digital manipulation, the tooth will be splinted for 3 weeks or more.
3. Luxation injury (particularly intrusive luxation) have a high risk for root canal treatment. Avulsion injuries have a high risk for both root canal treatment treatment and future ankylosis.
4. Avulsed teeth should be placed in a zip-lock bag with milk. The tooth should be reinserted within 30-60 minutes for best prognosis.

I hope this has provided some useful information of dental trauma. I encourage all dentists to visit the website: http://www.dentaltraumaguide.org for review of traumatic injuries and instructional videos. Please feel free to respond with any questions or comments.

Respectfully,

Neal Kravitz
South Riding, Virginia
www.KravitzOrthodontics.com
Emergency Cell: 703-638-2467