Cracked & Broken Tooth Treatment
Teeth breaking, broken teeth or Fracturing after the Trauma of an accident can be dealt with to lessen dental complications later. Read below what can be done if a blow to the face or an impact fractures and breaks teeth, with other injuries too. ACTING QUICKLY and correctly is vital if a tooth is to be saved!
In short, keep any knocked-out teeth in milk (not broken bits, just whole teeth with roots attached) and see a Dentist within 30 mins - if a person lost consciousness even briefly, just go STRAIGHT to A+E Hospital, in case any bleeding occurred in the brain - Teeth come second to Major Medical complications!
Acutely fractured and damaged teeth often happen without warning and is often a distressing incident such as an accident or an assault,
involving damage to the mouth solved by emergency dentistry treatment.The information published below is just for general guidance only and does not substitute for you seeking professional advice.
In the UK, telephone advice can be obtained from NHS Direct on 111 or 0845 46 47 for Dental or Medical problems, as well as from your own Dentist or Doctor. If in any doubt seek Medical/Dental attention immediately. TELL THEM IT IS URGENT AS A WHOLE TOOTH HAS BEEN KNOCKED OUT AND NEEDS RE-IMPLANTATION IMMEDIATELY !!!
Immediate Action usually necessary after severe Dental Trauma:
If there was a loss of consciousness, no matter how brief, you must get that person to hospital as quickly and safely as possible, or call the Emergency services for help (999, 112, 911 etc.) Any consciousness, however brief, indicates possible Brain damage or damaged bleeding vessels internally, which are a far greater emergency than teeth!
If there was no loss of consciousness, find or confirm the location of any tooth fragments. Keep any pieces you find, they may be useful later. If the whole tooth has been knocked out (Root and Crown intact) then it may be possible to "re-implant" this if done by a Dentist, ideally within the hour! After 24 hours a whole tooth is very unlikely to "take" even if implantation is attempted correctly. The best chances are within the hour or better 30mins = a very short time!
Re-implantation does not apply to "first" baby teeth, just second "adult" teeth. If the soft tissues don't stop bleeding quickly, applying gentle but constant pressure with a clean, rolled-up cotton handkerchief will help greatly. Don't dab on and off, but keep pressing for about 5 mins constantly, as pressure helps stop bleeding.If you can't confirm that the tooth fragments actually left the body, further investigations will be needed to confirm they are not embedded in soft tissues (e.g.: lips) or swallowed or worst of all, inhaled into the lungs.
Naturally, seek Professional help and advice immediately. Initial damage assessment/action: Put any whole teeth in milk and DO NOT scrub off any dirt, just gently rinse in milk. There may be other damage done apart from teeth, such as fractured cheek or facial bones. If the white part of the eye has blood in it, this could damage the eyesight if not treated. If you are suspicious of ANY other damage/problems apart from teeth, seek medical attention immediately.
Lips often swell and bleed profusely, but usually, stop bleeding quickly if the lips are not disturbed too much. Ask the injured not to talk too much and reassure them. Jaw bones can be fractured, but this is less common in children as their bones are more "rubbery", but fractures are more common in the elderly, as bones get more brittle. If there is any outside dirt or soil in the wounds, try to gently wipe or dab these away, so they do not leave a "DIRT" tattoo in the face later. Remember to update their TETANUS status too, perhaps needing a booster later! If there is any difficulty talking or pain on opening the mouth, get the injured to keep their mouth closed, but make sure they can breathe through their nose without distress and lean their head forwards. Get help urgently! (eg: phone 999 UK, 112 Europe, 911 USA etc.).
At the Dentist:
Assuming any urgent medical problems have been dealt with first, the Dentist can assess any damage. Teeth may be loose but undamaged or pieces may be fractured away. The Dentist will check any damage and do initial repairs to allow lips etc. to heal before re-assessing treatment needs. Small fractures can be fixed to look good. Slightly mobile teeth usually firm up by themselves. Teeth that move a lot (>2mm) will often be splinted to stabilise them. Larger fractures may have exposed the nerve of the tooth and require a root canal treatment to remove the exposed nerve comfortably.
Some teeth go darker 2 weeks to several months after the injuries. These have had a nerve die from the trauma shock. They usually require root canal treatment too and often internal bleaching to reduce the darkness. Despite this, they may still need a further Cosmetic solution later (e.g.: Veneer or Crown). Some fractured fragments fit together exactly, allowing them to be glued together. Otherwise, tooth-coloured fillings and bonding are used initially, with other treatment often needed later.
Physiological Splinting of losing Teeth:
When Teeth are largely intact, but mobile, then in the majority of cases they need splinting, but NOT RIGIDLY, so that the Periodontal ligament can re-establish it's blood supply/heal properly, without bonding hard to the bone, which we call "Ankylosis" - this can cause problems later, especially in Children where other teeth may continue to erupt and the gums and bone (alveolus) ridge continue to grow vertically, leaving the "ankylosed" tooth behind. Obviously, this may still be better than having no tooth at all, so a rigid splint is better than NO splint, but it should be removed/replaced ASAP, which could be painful/traumatic at the time.
So better to use a Physiological Splint, such as Ortho or Stainless-Steel wire (even a metal paperclip reshaped) glued onto each tooth separately with tooth -coloured filling - this gives enough support but also isn't TOO rigid, like using a cement joining the teeth together would be and thus cause a bony union with the root, rather than healing of the periodontal ligament that was once there. It may be though the urgent nature of such a situation means you have to compromise this initially, then correct later when you can.
Accidents can happen anywhere, but GumShields are particularly useful for contact sports and racket sports, both to prevent tooth injuries AND protect any corrective or Cosmetic work done in your mouth. Diseased or heavily filled teeth (past-disease) are obviously more vulnerable to breaking than intact, healthy teeth. Also, bad habits, such as clenching and grinding (stress?), can weaken teeth and create growing fractures - these may need reinforcing with Crowns to prevent serious fractures/tooth-loss etc.
So general prevention and regular visits to your Dentist can help improve health and reduce problems.
If any accidents happened outside and dirt got into any wounds, remember to update your Tetanus status.
In Summary - don't delay getting urgent Medical attention if patient lost consciousness or has other injuries apart from teeth. If a tooth has been knocked out whole, you basically have 30-60 mins max. to get it back in again with a reasonable chance (50/50) of success.
We hope the above information increases your awareness and urgency for action in such matters.
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Wishing you good Dental Health AND a Smile to be proud of, from all at the SmileSpecialist® Team.
*Dr.Kilcoyne is a UK registered Specialist in Prosthodontics (GDC No.58373) which includes The Functional and Cosmetic Dentistry aspects of Crowns, Dental Implants, Bridges, Veneers, Fillings, Dentures, Bonding etc. Please go to our MAKE an APPOINTMENT page if you'd like to access his Expertise.