After Dental Trauma; There Are Certain Things To Do - - Right Away
from the Valley News, Friday May31st, 2002


As the summer months approach we dentists find an increase in the number of traumatic injuries that we treat in the office.  Baseballs, the side of the pool, elbows, prybars, asphalt and sidewalks all can have quite a deleterious effect on the teeth when they meet.  Actually it doesn't take much to cause a tooth fracture or avulsion (being knocked out either partially or completely) if the blow has enough energy behind it.  Two heads colliding in a soccer match or even just a tap on the elbow while someone is drinking from a bottle can cause quite a serious and permanent injury.  One of the most common causes of sports related tooth avulsion injuries today is from informal basketball play.   In the pursuit of the perfect 'slam-dunk' the face can get caught in the net on the way down; gravity does the rest.  

What people may not know is that when a tooth is actually knocked out it can be saved and replanted in its socket.  The guidelines for the treatment of an avulsed tooth are as follows:

I.  Management at Site of Injury
A.  Replant immediately in the tooth socket, if possible.  If contaminated, rinse with water before replanting
B.  When immediate replantation is not possible, place tooth in the best transport medium available.

II. Transport Media
A.  Hanks' Balanced Salt Solution (H.B.S.S.) This may be available from a school nurse's office or other first aid response centers.
B.  Milk
C.  Saline
D.  Saliva (between the cheek and gum)
E.  If none of the above is available, use water.

The patient should see a dentist as soon as possible after the injury to assess damage and treat the patient with both immediate and long term therapy.  The teeth most commonly need to be splinted together for a period of one to eight weeks depending on the injury. This is accomplished by using a passive orthodontic arch wire with brackets and/or some tooth colored bonding material.  Root canal treatment will ultimately be necessary; this is not an uncomfortable procedure, sometimes even local anesthetic is not required.  Often a post and a crown will be recommended as well for the long term stability of the tooth.  Careful re-evaluation for an extended period will reassess that the treatment was in fact a success.   Failures can pop up even years down the road but if care was taken to handle the situation promptly and carefully at the time of the injury then there is a good chance that a costly artificial tooth replacement can be avoided.

Prevention of sports-related dental injuries is simple; a mouth guard is available from your local pharmacy or dental office and should be worn for all sports or activities where this type injury is likely. The over-the-counter 'boil and bite' variety is sufficient for most needs but can be uncomfortable and impossible to speak with.  A custom made guard from a dental office is more expensive but while made specifically for the individual who wears it, it is more comfortable (and thus more likely to be in the mouth when necessary) but also allows for speaking without removal.

If the injury cannot be prevented it is at least nice to know that the tooth may be preserved--even if its been knocked out.   Public information and quick treatment is the key.