Traumatic Dental Injuries

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment involves the inside of your tooth. Inside your tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called pulp. It contains blood vessels, nerves, and connective tissue, and creates the surrounding hard tissues of the tooth during its development.

The pulp extends from the crown of your tooth to the tip of the roots, where it connects to the tissues surrounding the root. It’s vitally important to your tooth’s growth and development, however, once your tooth is fully mature it can survive without the pulp; your tooth continues to be nourished by the tissues surrounding it.

All dentists, including your general dentist, received training in endodontic treatment in dental school. General dentists can perform endodontic procedures along with other dental procedures, but often they refer patients needing endodontic treatment to endodontists.

Endodontists are dentists with special training in these procedures, providing only endodontic services in their practices because they are specialists. They’ve completed dental school and an additional two or more years of advanced training in endodontics. You can feel confident visiting an endodontist for anything from routine to difficult and very complex endodontic procedures, including endodontic surgery. Endodontists also are experienced at finding the cause of oral and facial pain that has been difficult to diagnose.

Chipped or Fractured Teeth

If you’ve chipped or fractured your tooth’s crown, it’s likely it can be repaired either by reattaching the broken piece or by putting a tooth-colored filling in place. If a significant part of your tooth crown is broken off, an artificial crown or “cap” may be needed to restore it.

When the pulp is exposed or damaged after a crown fracture, root canal treatment may be needed. These injuries require special attention. If breathing through your mouth or drinking cold fluids is painful, bite on clean, moist gauze or cloth to help relieve symptoms until reaching your dentist’s office. Never use topical oral pain medication (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Injuries in the back teeth, such as fractured cusps, cracked teeth require root canal treatment and a full coverage crown to restore function your tooth if the crack extends into the root. More seriously injured split teeth may require extraction.

Dislodged (Luxated) Teeth

During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist or general dentist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started several days following the injury. Medication may be put inside your tooth as part of the root canal treatment; once treatment is complete and has been deemed successful a permanent root canal filling or crown will be put in place at a later date.

Children ages 12 and under may not need root canal treatment since their teeth are still developing. New research indicates that stem cells present in the pulps of children can be stimulated to complete root growth and heal the pulp following injuries or infection. When a child’s tooth is injured, an endodontist or dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Multiple follow-up appointments are likely to be needed.

Knocked-Out (Avulsed) Teeth

If one of your teeth is completely knocked out of your mouth, see an endodontist or dentist immediately! Time is of the essence and if you receive treatment quickly, preferably within 30 minutes, there is a chance to save your tooth.

Handle a knocked-out tooth very carefully and don’t touch the root surface. Following a few important steps will help increase the likelihood of saving your tooth. Your endodontist or dentist will evaluate the tooth, place it back in its socket and examine you for any other dental and facial injuries. A stabilizing splint will be placed for the next few weeks. Depending on the stage of root development, your dentist or endodontist may start root canal treatment a week or two later.

Depending on the length of time your tooth was out of your mouth and how it was stored before receiving treatment it may be necessary to discuss other treatment options with your dentist or endodontist.

Root Fractures

A traumatic injury to your tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of your tooth. The closer a fracture is to the root tip, the better the chances of success and long-term health; fractures closer to the gum line are more debilitating for your tooth. Sometimes, stabilization with a splint is required while the tooth heals.

Chipped primary (baby) teeth can be esthetically restored. Dislodged primary teeth can, in rare cases, be repositioned. However, primary teeth that have been knocked out typically should not be replanted because it may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone.

Children’s permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment. In an immature permanent tooth, blood supply to the tooth and stem cells in the region may enable your dentist or endodontist to stimulate continued root growth.

Endodontists will do all that is possible to save the natural tooth and have the knowledge and skill to treat incompletely formed roots in children so that, in some instances, the roots can continue to develop. Look to these specialists for information and their expertise when your child is the victim of dental trauma.

Factors that affect the long-term health of your tooth after an injury include: the nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body’s response. Getting treatment as soon as possible is very important with dislodged or knocked-out teeth in particular, in order to prevent root resorption.

Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury. Following an injury, you should return to your dentist or endodontist to have the tooth examined and/or treated on a regular basis for up to five years to ensure that root resorption is not occurring and that surrounding tissues continue to heal. Unfortunately, some types of resorption are untreatable.