Front teeth are very susceptible to injuries from traffic accidents or impacts with hard objects (such as biting a pen or opening a bottle cap…). Given their significant aesthetic role in the face, dentists often strive to preserve these teeth when they are injured.
In young individuals, the tooth pulp can recover after trauma; therefore, dentists do not rush to perform root canal treatment and typically recommend minimizing impact on the injured tooth. To aid in pulp recovery, it is advisable to eat soft foods and avoid consuming very hot or very cold drinks. However, there are many cases where symptoms of swelling or discoloration may appear 5-8 years after the injury. At that point, root canal treatment and attention to any lesions at the tooth apex are necessary.
Teeth Displaced but Not Fractured
Partially displaced teeth: It is crucial to visit a dentist immediately for adjustment and stabilization with a splint for a few weeks. Root canal treatment is only performed if there are symptoms of swelling or pain.
Teeth pushed out: Right after the injury, apply firm pressure to push the tooth back into its original position. If there is pain or difficulty, see a dentist immediately for adjustment and monitoring to ensure timely root canal treatment if necessary.
Teeth intruded into the bone socket: The dentist will reposition the tooth to align it with adjacent teeth and then stabilize it with composite resin for three weeks. Root canal treatment is only performed if the tooth is swollen or painful…
Teeth completely avulsed from the bone socket: Rinse off any dirt from the tooth with saline, hold the tooth with a saline-soaked gauze, or place it in your mouth to keep it moist before seeing a dentist. The longer the tooth remains outside the bone socket, the harder recovery becomes. Hence, it is essential to visit the dental clinic promptly to have the tooth replanted into the socket, facilitating the re-establishment of pulp and blood vessels. Root canal treatment is only performed if the tooth exhibits swelling or pain.
Teeth Impacted but Not Fractured and Not Displaced
The tooth pulp may recover; thus, it’s important to minimize impact on the tooth and avoid very hot or cold foods. Stabilize the tooth to adjacent teeth if there is any looseness and maintain good oral hygiene, avoiding excessively hot or cold foods. The dentist will not perform adjustments or aesthetic fillings as this may affect the tooth pulp. Aesthetic restoration should begin a few months later when the pulp has temporarily recovered.
Injured teeth can “live” for a long time. After 5-10 years, they may die and require root canal treatment to preserve the tooth. Additionally, teeth may also experience resorption or looseness without any symptoms of swelling or pain. Depending on individual aesthetic requirements or discomfort, extraction may be necessary.
Fractured Crown Without Pulp Exposure
It is advisable to minimize strong impacts on the tooth, monitor the tooth pulp, and only perform root canal treatment if there is swelling or pain. Typically, after three weeks of trauma, the dentist will perform restorative filling of the tooth crown.
Fractured Crown With Pulp Exposure but No Bleeding
The tooth may only hurt when stimulated, so it is important to see a dentist promptly for pulp capping and preservation filling. Root canal treatment is only performed when there are symptoms of swelling or persistent spontaneous pain.
In cases of pulp exposure with bleeding from the fracture and the tooth has not fully matured, it is essential to visit the dentist for pulp treatment and temporary sealing of the root canal for 3-9 months or 1-3 years until the tooth matures, at which point a complete sealing of the tooth pulp can be done. Note that teeth that have undergone root canal treatment are very susceptible to fracture if impacted by hard objects.
Fractured Crown
Horizontal root fracture: Fracture involving 1/3 or 1/2 of the root has a good prognosis for retention. In some cases, two pieces may fracture, but the pulp remains vital. The tooth will be stabilized to adjacent teeth using composite resin and thoroughly cleaned.
Longitudinal fracture along the tooth axis: A fracture along the length of the tooth axis is challenging to bond with cement, and typically extraction is required.
Fractured Crown Near the Gum Line
The fractured portion of the crown should be extracted, the pulp from the root portion treated, and a post created to support a crown restoration over the root.
To prevent dental injuries, it is essential to wear protective mouthgear during sports, wear helmets while riding motorcycles, and fasten seat belts when in a car. Orthodontic treatment for children with cavities or protruding teeth should be considered to prevent injuries to the front teeth from falls. If there is any dental injury, seek treatment at a dental center promptly.
