There are many moving parts that influence traumatic outcome. Some of the factors are the following:
When a tooth erupts into the mouth, the root under the gum keeps growing for years. Depending on when the trauma occurs, makes a difference on treatment protocol. Teeth respond better when the tooth is more immature, there is more blood flow.
Rule of thumb: The sooner you receive treatment the better the outcome. Do not go to an emergency room for a tooth. Too much time, and never a dentist on staff. An Endodontist can triage a case more efficiently to bring in the correct team members. Often there be a subtle jaw fracture which an oral surgeon.
Accurate diagnosing and understanding the extent of injury from tooth to jaw is most critical. Traditional 2-D x-rays are important but supplemented with 3-D imaging to provides a quantitative greater detailed model of the teeth and jaw. It is now the standard. The extent of the injury may not be apparent from just a 2D x-ray.
This patient received an elbow to the mouth playing basketball. Teeth look white and normal. The dentist took an x-ray and said the dark line going across the teeth means that both teeth are fractured and need to be removed and replaced with two (2) implants. The patient came for a second opinion. A 3D image was taken. A jaw fracture went across the tooth with the red arrow appearing that the tooth was fractured. Only the tooth with the yellow arrow was fractured. The patient would have lost a perfectly good tooth from lack of detail in diagnosing.
As you can see, there are many different types of trauma. Categories 6,9 & 10 are most obvious, but the others may be initially dismissed as” it looks ok.” Now, depending on the age and the development of the tooth, makes a difference in healing. That is why it is important to see an endodontist.
In the growing years, kids may have some type of retainer. Tip! please bring it with you. It helps us place the tooth back in the correct position.
Regenerative Stem Cell Treatment {Regrowing a dead nerve}
The procedure is relatively new and allows our practice to treat a tooth that has a “dead” nerve. This procedure is for children with immature teeth that have suffered a traumatic accident an alternative of doing a root canal.
When an adult tooth erupts, what the tooth fairy does not tell you is that it takes years for the root of the tooth to grow fully. If the nerve becomes damaged, the root will stop growing leaving a weaker tooth.
We want to re-grow the nerve, so the tooth and root keeps growing. We take advantage of stem cells that are still in the area of the tooth telling the tooth you must keep growing. Children are great candidates, but of course there are variables that must be evaluated regarding success. Warning! This procedure is not for the dentist that has not done many of these. If in doubt, get the second opinion.
Factors Influencing Traumatic Outcomes
Preventive Care
Preventive Care and Bleaching
A considerable number of dental injuries occur during sporting events. Most sports were dominated by males and seasonal. In the last two decades, seasonal sports are year-round and a much larger influx of female athletes, these statistics are probably greater.
Trauma can have a delayed result to teeth, and many go undiagnosed in the beginning. Therefore, treatment may not happen until years later, which would give us a larger dollar amount spent on actual dental work.
The best type of direct education for children is the education of prevention. With respect to sports, mouth guards are the obvious tooth saving device. Let us talk in brief about mouth guards. Walk into the sporting goods store, you will see all types hanging on the wall. Yes confusing! To break it down, there are two (2) basic types:
Mouth-formed mouth guards- These are boiled and bite, purchased at the sporting goods stores. Less expensive, tend not to be uniform thickness in fit, loose fit and bulkier.
Custom made mouth guards – These are made by the dentist. Although more expensive, the literature suggests they provide better retention, comfort, less interference with speech and breathing and more adaptable to orthodontic appliances. Well fit mouth guards tend to stay in the mouth better without being pushed out of position by the athlete.
Sever dental injuries to incisors can cost $15,000 per tooth over a lifetime, multiple procedures, failed restorations, lost time, family disruptions and psychological effects.
Aside from the monetary expenses we see that there are other elements involved in dental injury cases. Missed work, missed school, physiological effects of losing your teeth, time off from your sporting activity, discomfort caused by the injury, and pain.
Tooth Whitening or Bleaching
Tooth discoloration comes from outside on the tooth surface from food stains or from inside the tooth from trauma. Outside tooth bleaching can be a in depth discussion and will not be covered here. Tooth discoloring from trauma does not discolor the outside surface, but from the inside of the tooth out. So, the tooth must be bleached from the inside out.
The discoloration comes from nerve tissue and blood inside of the tooth. It breaks down over time. If the color is there years after the root canal, it was inadvertently left. Our practice uses the same surgical microscopes used in root canal treatment to make sure it is clean in the tooth. Eye glass magnification is ok, but surgical microscopes are far superior.
