Dental injuries

About dental injuries

There are a number of ways in which your teeth can be damaged, such as chipping or breaking (fracturing) a tooth. A dental injury can also cause your tooth to come out of its socket (dental avulsion).

Any number of things can cause a dental injury. For example, you may have a fall, get hit in the face or be in a road traffic accident. Sometimes even eating something very hard can break your tooth, particularly if it’s been weakened by tooth decay. Most dental injuries occur as a result of a fall, and many young children damage their milk (baby) teeth while they are still unsteady walking and running.

Most dental injuries are accidental but there are some factors that make these accidents more likely to happen. Some of the most common are listed below.

  • Playing contact sports, such as rugby or boxing, or any sport that involves physical contact or moving objects such as bats and balls.
  • Having prominent upper front teeth.
  • Being unsteady on your feet, for example, if you’re elderly and have a lot of falls, or having a medical condition, such as epilepsy.

First aid for dental injuries

If you or someone you’re with has a dental injury, it's important to get the right help.

If the accident causes you or someone you know to be knocked out (lose consciousness) or if there is a lot of bleeding, it's important to call for emergency help. Otherwise, contact a dentist straight away. If it's outside usual opening hours, contact an out-of-hours dentist or go to the accident and emergency department at the nearest hospital.

Try to do the following if your tooth has been knocked out.

  • Try not to touch the tooth's root – it's best if you handle it by the crown (the white bit at the top).
  • If possible, put the tooth back into its socket in your mouth. This is called reimplanting. If the tooth is dirty, gently rinse it with milk or saline solution (for example contact lens solution) for a few seconds, but don't scrub the tooth. Try to put it in the right way round, but don't worry too much as your dentist can fix this. The important thing is to put it back in as quickly as possible. Don't put children’s milk teeth back in the socket as this can damage the developing adult teeth.
  • Bite down gently on a clean handkerchief or a piece of gauze to keep your tooth back in place in its socket.
  • If you can't reimplant your tooth, store it in milk or saliva (by spitting into a container) or place it inside your mouth between your cheek and gum until you can get to a dentist. However, this isn't recommended for young children as they could swallow or inhale the tooth.
  • If you haven't got the whole tooth, don't try to put a broken tooth back in your mouth. Store it in a pot of saliva or milk as your dentist may be able to reattach it.

Even if you don't think your tooth is broken, it's important to see your dentist as soon as possible. There may be an injury below the gumline that you can't see.

Treatment of dental injuries

If your tooth has been loosened or knocked out

Your dentist will look inside your mouth to see if your tooth has been reimplanted properly. If not, and depending on your injury, he or she may try to reimplant it as soon as possible. However, this may not always be appropriate or possible.

You may need to have your tooth splinted (joined to your neighbouring teeth) to hold it in place as it heals. There are different types of splint – the most common is made of clear plastic. Another type is a thin piece of wire that attaches your loose tooth to those on either side of it. How long you need to keep the splint on will depend on how severe your injury was.

Your dentist may take some X-rays to see how serious your injury is and if there are any pieces of broken tooth stuck in your lip, gum or tongue. It’s rare, but if there is a possibility that you have inhaled a piece of tooth and it’s stuck in your airway, your dentist may refer you to hospital for a chest X-ray.

If your tooth has been chipped

Treatment for a chipped tooth will depend on where your tooth has broken. Teeth have a core of blood vessels and nerves at their centre called the pulp. If your tooth is injured, the pulp can be damaged and the blood vessels may die.

If a piece of your tooth has chipped off but the pulp isn't damaged, your dentist will smooth the uneven edge and replace the corner with a tooth-coloured filling. If the pulp is damaged, you may need to have root canal treatment to remove the damaged blood vessels and nerves from your tooth.

Your dentist may also check whether the chipped tooth has caused any further damage to your mouth. For example you may need to have an X-ray to check that a piece of your tooth isn’t stuck in your lip.

If your tooth has broken roots

Your teeth have roots that are set in your jawbones. If a root fractures, it's possible that your tooth won't look any different because the fracture is hidden by bone and gum. However, your dentist may be able to see a fractured root on X-rays.

If your tooth is quite firm, you may only need to go back for regular X-rays and tests to make sure that the pulp stays healthy. However, if your tooth is loose, it will need to be splinted for a few weeks to help the fracture heal.

If your dentist finds that the pulp has been damaged and isn't likely to recover in the weeks and months after the root fracture, he or she may recommend that you have root canal treatment to save your tooth.

Some fractures are unlikely to heal, particularly if they are near your gum or the tooth has broken lengthways. Your dentist may recommend that you have your tooth taken out.

After your treatment

If at any stage you feel pain or notice any change in colour to your damaged tooth, it's important to see your dentist. This is because the tooth pulp can die a long time after a dental injury. If you have had your tooth reimplanted, continue to get it checked as you may need treatment in the future.

Dental injuries in children

Young children who injure their milk teeth may need different treatment to adults or teenagers. For example, if a milk tooth gets knocked out, the dentist is unlikely to try to reimplant it. This is because it could damage the permanent tooth when it develops or if it’s already developing.

See our frequently asked questions for more information about dental injuries in children.

Prevention of dental injuries

If you regularly play a sport that puts you at any risk of dental injury (for example rugby, boxing, cricket, hockey), you may wish to consider getting a mouthguard. This will offer some protection and can reduce the likelihood of you getting an injury. Mouthguards are usually made of rubber and form a cover that goes over your teeth and gums.

You can buy mouthguards in some sports shops but it's better to ask your dentist to make one that has been individually made to fit you. This will protect your teeth more effectively. Your dentist will take a mould of your teeth using a putty-like material. This is then sent to a laboratory where your mouthguard is made. Children will need to have their mouthguards replaced as new teeth develop and their mouths grow.

 

Reviewed by Polly Kerr, Bupa Health Information Team, September 2013.

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