Traumatic Injuries

Dislodged Teeth

Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be implanted.

Sometimes a tooth may be pushed partially out of the socket. The tooth is repositioned and stabilized. If the pulp remains healthy, then no other treatment is necessary. However, if the pulp becomes damaged or infected, root canal treatment will be required.

Avulsed Teeth
(Saving a Knocked-out Tooth)

Approximately one to three million permanent teeth are accidentally knocked out each year. Both adults and children are at risk.

With proper emergency action, a tooth that has been entirely knocked out of its socket often can be successfully replanted and last for years. Because of this, it is important to be prepared and know what to do if this happens to you or someone with you. The key is to act quickly, yet calmly, and follow these simple steps.

1. Pick up the tooth by the crown (the chewing surface) not the root.

The tooth should be handled carefully - touch only the crown - to minimize injury to the root.

2. Clean tooth with water.

If dirty, gently rinse the tooth with water, remembering not to handle the root surface.

Do not use soap or chemicals.

Do not scrub the tooth.

Do not dry the tooth.

Do not wrap it in a tissue or cloth.

3. Reposition tooth in socket immediately, if possible.

The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.

4. Keep tooth moist at all times.

The tooth must not be left outside the mouth to dry. If it cannot be replaced on the socket, put it in one of the following:

Emergency tooth preservation kit

Milk

Mouth (next to cheek)

If none of these is practical, use water (with pinch of salt if possible).

5. See a dentist as soon as possible.

Bring the tooth to a dentist or endodontist as soon as possible - ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.

Injuries in children

An injured, immature tooth may need one of the following procedures to improve the chances of saving the tooth:

Apexogenesis

This procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.

Apexification

In this case, the unhealthy pulp is removed. Medication is placed into the root canal to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.