Dental trauma is injury to the mouth, including teeth, lips, gums, tongue, and jawbones. The most common dental trauma is a broken or lost tooth.
Dental trauma may be inflicted in a number of ways: contact sports, motor vehicle accidents, fights, falls, eating hard foods, drinking hot liquids, and other such mishaps. As oral tissues are highly sensitive, injuries to the mouth are typically very painful. Dental trauma should receive prompt treatment from a dentist.
Causes and symptoms
Soft tissue injuries, such as a "fat lip," a burned tongue, or a cut inside the cheek, are characterized by pain, redness, and swelling with or without bleeding. A broken tooth often has a sharp edge that may cut the tongue and cheek. Depending on the position of the fracture, the tooth may or may not cause toothache pain. When a tooth is knocked out (evulsed), the socket is swollen, painful, and bloody. A jawbone may be broken if the upper and lower teeth no longer fit together properly (malocclusion), or if the jaws have pain with limited ability to open and close (mobility), especially around the temporomandibular joint (TMJ).
Dental trauma is readily apparent upon examination. Dental x rays may be taken to determine the extent of the damage to broken teeth. More comprehensive x rays are needed to diagnose a broken jaw.
Soft tissue injuries may require only cold compresses to reduce swelling. Bleeding may be controlled with direct pressure applied with clean gauze. Deep lacerations and punctures may require stitches. Pain may be managed with aspirin or acetaminophen (Tylenol, Aspirin Free Excedrin) or ibuprofen (Motrin, Advil).
Treatment of a broken tooth will vary depending on the severity of the fracture. For immediate first aid, the injured tooth and surrounding area should be rinsed gently with warm water to remove dirt, then covered with a cold compress to reduce swelling and ease pain. A dentist should examine the injury as soon as possible. Any pieces from the broken tooth should be saved and brought along.
If a piece of the outer tooth has chipped off, but the inner core (pulp) is undisturbed, the dentist may simply smooth the rough edges or replace the missing section with a small composite filling. In some cases, a fragment of broken tooth may be bonded back into place. If enough tooth is missing to compromise the entire tooth structure, but the pulp is not permanently damaged, the tooth will require a protective coverage with a gold or porcelain crown. If the pulp has been seriously damaged, the tooth will require root canal treatment before it receives a crown. A tooth, that is vertically fractured or fractured below the gumline will require root canal treatment and protective restoration. A tooth that no longer has enough remaining structure to retain a crown may have to be extracted (surgically removed).
When a permanent tooth has been knocked out, it may be saved with prompt action. The tooth must be found immediately after it has been lost. It should be picked up by the natural crown (the top part covered by hard enamel). It must not be handled by the root. If the tooth is dirty, it may be gently rinsed under running water. It should never be scrubbed, and it should never be washed with soap, toothpaste, mouthwash, or other chemicals. The tooth should not be dried or wrapped in a tissue or cloth. It must be kept moist at all times.
The tooth may be placed in a clean container of milk, cool water with or without a pinch of salt, or in saliva. If possible, the patient and the tooth should be brought to the dentist within 30 minutes of the tooth loss. Rapid action improves the chances of successful re-implantation; however, it is possible to save a tooth after 30 minutes, if the tooth has been kept moist and handled properly.
The body usually rejects re-implantation of a primary (baby) tooth. In this case, the empty socket is treated as a soft tissue injury and monitored until the permanent tooth erupts.
A broken jaw must be set back into its proper position and stabilized with wires while it heals. Healing may take six weeks or longer, depending on the patient's age and the severity of the fracture.
There is no substitute for treatment by a dentist or other medical professional. There are, however, homeopathic remedies and herbs that can be used simultaneously with dental care and throughout the healing process. Homeopathic arnica (Arnica montana) should be taken as soon as possible after the injury to help the body deal with the trauma. Repeating a dose several times daily for the duration of healing is also useful. Homeopathic hypericum (Hypericum perforatum) can be taken if nerve pain is involved, especially with a tooth extraction or root canal. Homeopathic comfrey (officinale) Symphytum may be helpful in treating pain due to broken jaw bones, but should only be used after the bones have been reset. Calendula (Calendula officinalis) and plantain (Plantago major) can be used as a mouth rinse to enhance tissue healing. These herbs should not be used with deep lacerations that need to heal from the inside first.
When dental trauma receives timely attention and proper treatment, the prognosis for healing is good. As with other types of trauma, infection may be a complication, but a course of antibiotics is generally effective.
Most dental trauma is preventable. Car seat belts should always be worn, and young children should be secured in appropriate car seats. Homes should be monitored for potential tripping and slipping hazards. Child-proofing measures should be taken, especially for toddlers. In addition to placing gates across stairs and padding sharp table edges, electrical cords should be tucked away. Young children may receive severe oral burns from gnawing on live power cords.
Everyone who participates in contact sports should wear a mouthguard to avoid dental trauma. Athletes in football, ice hockey, wrestling, and boxing commonly wear mouthguards. The mandatory use of mouthguards in football prevents about 200,000 oral injuries annually. Mouthguards should also be worn along with helmets in noncontact sports such as skate-boarding, in-line skating, and bicycling. An athlete who does not wear a mouthguard is 60 times more likely to sustain dental trauma than one who does. Any activity involving speed, an increased chance of falling, and potential contact with a hard piece of equipment has the likelihood of dental trauma that may be prevented or substantially reduced in severity with the use of mouthguards.
American Academy of Pediatric Dentistry. 211 East Chicago Ave., Ste. 700, Chicago, IL 60611-2616. (312) 337-2169. http://www.aapd.org.
American Association of Endodontists. 211 East Chicago Ave., Ste. 1100, Chicago, IL 60611-2691. (800) 872-3636. http://www.aae.org.
American Association of Oral and Maxillofacial Surgeons. 9700 West Bryn Mawr Ave., Rosemont, IL 60018-5701. (847) 678-6200. http://www.aaoms.org.
American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. http://www.ada.org.
Crown — The natural part of the tooth covered by enamel. A restorative crown is a protective shell that fits over a tooth.
Eruption — The process of a tooth breaking through the gum tissue to grow into place in the mouth.
Evulsion — The forceful, and usually accidental, removal of a tooth from its socket in the bone.
Extraction — The surgical removal of a tooth from its socket in the bone.
Malocclusion — A problem in the way the upper and lower teeth fit together in biting or chewing.
Pulp — The soft innermost layer of a tooth containing blood vessels and nerves.
Root canal treatment — The process of removing diseased or damaged pulp from a tooth, then filling and sealing the pulp chamber and root canals.
Temporomandibular joint (TMJ) — The jaw joint formed by the mandible (lower jaw bone) moving against the temporal (temple and side) bone of the skull.