Dental Trauma/Accidents: Tips for Success

dental injuriesDental Trauma hits home, because I am an orthodontist that suffered a serious accident as a child during my routine bus ride to school.  It created a career passion and something that I am considered to be an expert in my profession, based on my specialized training to manage accidents.

Dental Injuries – Epidemiology

  • An average of 22,000 accidents occur annually among children, less than 18 years of age
  • Over 80% of all dental injuries involve the upper teeth
  • 30% of Pre-school age children have a dental injury of some kind
  • The most common sports injuries are in baseball, basketball,  fights, vehicular & women’s volleyball reporting high numbers
  • Children with primary teeth, less than 7 years of age, sustained over half of the injuries in activities associated with home furniture
  • Outdoor recreational products and activities with related dental injuries are among children ages 7-12 years of age (ie. trampolines)

 

Trauma (Tooth CPR) Immediate Response

A Quick 5 Step Guide to help you determine what to do:

  1. If there are any concerns for medical attention- Always seek first by calling 911 or visiting your closest trauma center/emergency facility. Never dismiss a head injury, even if there is blood involved.
  2. Partially Avulsed teeth/fractured teeth- call your orthodontist or dentist immediately.  If the trauma involves the loss of tooth -determine if it is a baby tooth or permanent. Baby teeth should never be reimplanted, but consult immediately with your general dentist or call your orthodontist that specializes in trauma.  If a tooth cannot be located, mandate a chest x-ray to rule out aspiration(inhaling tooth) at your local ER center.
  3. The key factor to dental trauma success is minimizing the amount of time that the permanent tooth is outside of the mouth(avulsion). Success rate is directly related to re-implantation within 5-30 minutes.  Rule of thumb- 1% of successful reimplantation lost for every 1 minute out of socket (dry). NEVER dry /clean tooth or clean(even if dirty). Immediately submerge tooth in any isotonic solution which could include: milk, contact solution,  or breast milk, or room temperature water(poorer result) to name a few. Storage of tooth in a liquid medium will buy you time. Regular milk has been seen in cases to be almost as good as an immediate re- implantation. Do not handle root surface- only touch clinical crown if possible.  If tooth is outside of mouth, call your oral surgeon or periodontist for reimplantation.
  4. If tooth is partially avulsed(not out of mouth) -Call your dental specialist and inquire if they technology to take a 3D radiographs orCBCT(Cone Beam) to determine if tooth is fractured and if splinting is necessary.  Splinting is stabilizing the tooth for 2-3 week period with a semi-rigid medium/wire. Orthodontic braces count as stabilization, if seen by a trained specialist in the recommended time above. There are a high number of false negatives reported with traditional dental x-rays
  5. Root resorption(deterioration) is directly associated with the amount of time the tooth is outside of the mouth or untreated(storage medium dependent) For example:  Shorter time = Better Prognosis. Root resorption should be monitored by your dental specialist. NO activities are suggested during splinting of teeth.

Tips for success:

  • A mouthguard must be worn immediately following injury
  • Root Canal Therapy is a high possibility and your dental specialist should guide you when to seek a consult.  The endodontist will traditional follow guidelines/protocols associates with the AAE(American Association of Endodontists)
  • Remember that a hopeless tooth is not a Worthless tooth, because children typically cannot have dental implants placed until after the cessation of the individual’s craniofacial growth around the age of 19-22
  • Locate a Board Certified Specialist by researching online

 

Thanks to Dr. Joseph K. Vargo, a Board Certified Orthodontic Specialist from Vargo Orthodontics, for his insight into dental injuries.

 

 

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