Dental Trauma: What Is It and What Types Are There?
Suffering dental trauma is very common during childhood and adolescence, but it can happen to adults too. After cavities, it’s the second-most common reason to go to the dentist.
Trauma is an injury to the teeth and the tissues that surround them because of an impact or blow to them. This causes aesthetic, chewing, and speech problems in the person who suffers from it. Acting right away when it happens improves the prognosis of the situation.
In this article, we’ll tell you why these injuries occur, what types there are and how to treat them. Also, we’ll talk about how to reduce the risks of getting hit in the mouth.
Risk factors for dental trauma
A blow to the mouth that causes dental trauma can happen at any time and age. However, some factors make them more common in certain circumstances:
- Starting to walk: When kids first learn to walk on their own, they still don’t have control over their balance, and it’s common to fall. Bumping their mouth against low furniture, tripping on rugs or other objects, and falling are all situations that can cause dental trauma.
- Children’s games: Playing roughly, throwing objects, falling off swings, bikes, skates, and skateboards.
- Sports: Practicing some sports, especially contact sports, predispose injuries to the teeth.
- Car accidents: This is a cause that can lead to dental trauma at any age.
- Physical abuse: Blows to the mouth by an abuser can cause dental trauma. Research considers child abuse as a cause of injuries to children’s teeth.
- Fighting: Fighting with physical aggression is also a predisposing factor for tooth injuries.
- Medical conditions: Patients who have mobility problems, epilepsy, inattention, or hyperactivity are at a higher risk of hitting their mouths.
- Addictions: People with alcohol and drug addiction problems are also more likely to suffer dental trauma.
- Mouth conditions: Facial and oral morphology make some patients more at risk of injuring their teeth when they suffer a blow. Certain malocclusions, having the upper incisors turned out from sucking their thumb, using a pacifier or bottle too long, mouth breathing, or a short lip can cause these parts to be damaged more quickly.
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Types of dental trauma
Dental trauma can manifest itself in different ways, affect different tissues and have varying degrees of severity. Additionally, traumatized teeth can be temporary or permanent. The treatment will depend on these factors.
The different types of dental trauma are differentiated below, depending on the affected tissues.
Trauma to the dental crown
Here, the injury involves the visible part of the tooth. Depending on the affected tissues, we can distinguish the following types of crown fractures:
- Incomplete or infringement of the enamel: The fracture line doesn’t reach or stops at the amelodentinal junction. Therefore, it only hurts the enamel, without involving the dentin. It looks like a fissure in the enamel, and there is no loss of tooth tissue, so they are hard to see with the naked eye. A dentist will be able to diagnose them with transillumination and treat them promptly.
- Uncomplicated or amelodentinal coronary artery without gums involvement: In this case, there is loss of dental tissues and the lesion involves only enamel or enamel and dentin, but without exposing the gums.
- A complicated or amelodentinal coronary artery with gum involvement: This tissue loss involves both enamel and dentin and is deep enough to expose the gums.
Tooth root trauma
In these cases, the area of the tooth root that lies within the bone is compromised by the trauma. There are two types that we can distinguish according to the area where the injury occurs.
- Intraalveolar root fracture: In these cases, the fracture occurs in the root of the tooth. It can be in the coronal, middle, or apical third of it. Also, they can be horizontal or vertical.
- Crown fracture: The fracture involves both the crown and the root of the tooth. There may or may not be gum exposure and the tissues involved are enamel, dentin, and root cement.
Trauma to periodontal tissues
Bumps in the mouth can also affect the tissues that protect and support teeth. These are some conditions of the periodontal tissue:
- Subluxation: The periodontal fibers that support the tooth are damaged, but the tooth remains in its normal position within the socket. There is no displacement of the structure, but there is mobility and it bleeds from the inside.
- Lateral luxation: The periodontal tissue is also damaged and the tooth shows mobility, but it also moves forward or backward. In these cases, the alveolar bone is also usually fractured.
- Extrusion: Damage to the periodontium causes the tooth to loosen and move partially out of the socket. It sticks out compared to the other teeth.
- Intrusion: The dental element moves apically, into the alveolar bone. The tooth looks like it’s sunken into the bone tissue. The damage involves periodontal ligation and root cement. The socket is usually fractured and the neurovascular supply to the gums is interrupted.
- Dental avulsion: This is the most complex and serious clinical situation. Here, the tooth is completely expelled out of its socket. Sometimes it’s even out of the mouth. When this happens in a permanent tooth, it’s best to find the tooth and put it in a container, and go to the dentist immediately. Then, they can implant it back into the mouth.
Damage to the mouth can fracture the alveolar bone. The injury involves only the bone tissue or is combined with one of the other injuries that we already mentioned.
Teeth with alveolar fractures usually move en bloc with all the surrounding tissue. There are more serious accidents where the jaw bones or face are compromised.
Diagnosis and treatment for dental trauma
After suffering dental trauma, make sure to go to the dentist as soon as possible. Treating injuries immediately greatly improves the prognosis of the situation and helps it be as successful as possible.
The professional will examine and palpate the affected area, take X-rays, evaluate the soft and hard tissues, analyze tooth mobility, its vitality, and determine the best treatment for each particular case.
The therapy afterward will also depend on whether it’s temporary or adult teeth. Some therapies that may be required are:
Soft tissue treatment
A blow to the mouth doesn’t just affect teeth. It’s also common for soft tissues like the lips, tongue, and cheeks to be injured.
The dentist, upon receiving the patient, will examine everything involved. Mouth tissues bleed easily and profusely, so the dentist will clean and apply pressure to stop the bleeding. In some cases, you might need some stitches.
When dental trauma only affects the enamel, the edges of the affected area are polished to avoid friction with the soft tissues. In addition, the adamantine tissue is protected by placing fluoride on the tooth surface.
If the dental trauma has caused the loss of tissue from the dental crown, it must be rebuilt. Dentists do this on both primary and permanent teeth.
In general, fillings made of aesthetic materials restore the lost shape and anatomy of the tooth. If the patient brings part of the lost tooth, and if it’s permanent, the dentist may try to adhere it to the fractured part.
Gum protection and root canals
When the fracture affects the gums in addition to the enamel and dentin, you need to treat it specially. The type of treatment will depend on the type of teeth, the extent of the fracture, and whether the root apex is open or already closed.
In baby teeth, the time remaining for the tooth in the mouth will also be considered. If it will fall out soon, it’s best to remove it and wait for the permanent tooth to grow. On the other hand, if it will be a while before it’s replaced, the dentist will protect the gums to preserve the space.
In permanent teeth, if the end of the root has not closed yet, they will apply special substances to help the apical closure. However, if it’s fully formed, they will need orthodontics.
Then, they rebuild the crown to restore the anatomy of the tooth. You can do this using dental crowns if the patient has lost a lot of tissue.
Relocation of the tooth and immobilization with splints
When root fractures, alveolar bone fractures, or extrusions affect permanent teeth, or there is mobility, they need to be relocated in their socket. For this, the dentist anesthetizes the area. Then, using X-rays, they reposition the tooth.
Next, they immobilize it using a wire and resin splint that will hold it in position until the supporting tissues heal. Avoiding occlusal contact and seeking preoperative care is very important to avoid complications and speed up recovery. Also, you should go for check-ups and gum treatments.
However, if these issues affect temporary teeth, the dentist will check the damage of the underlying permanent gum. Usually, they decide whether or not extraction is the best option. If they pull the tooth and it will be a while before the permanent one grows in, they will put in a spacer to save the place.
Wait or stimulate the eruption
Dentists do this in some cases of tooth intrusion. X-rays are vital to see the position of the tooth within the bone and its relationship to other structures.
If it’s a temporary tooth, they will check the damage to the permanent tooth’s gums that is forming in the bone. If it’s affected, they need to remove the temporary element. On the other hand, if there’s no damage to the permanent element, it’s possible to wait for the tooth to grow on its own.
If the tooth doesn’t go down on its own, it can be relocated under anesthesia and then splinted, as we mentioned before. Or, the tooth can be lowered using orthodontics. Endodontic treatment of the tooth will be necessary.
If a permanent tooth has been completely pushed out of the mouth, putting it back in place to preserve it is the goal. A temporary tooth that has come out should never be re-inserted since there’s a risk of damaging the final tooth that is growing inside the bone. In these cases, you should expect a permanent tooth to grow. If it takes a long time, the professional will place a spacer to save the place.
To put the tooth back into its socket, it’s essential that the patient looks for the tooth and goes to the dentist as soon as possible. When the tooth is found, don’t touch the root. You have to wash it underwater for a few seconds without rubbing it. Then, add it to a glass with milk and distilled water. If possible, put it in the patient’s mouth, being careful not to swallow it.
When the patient arrives at the dentist’s office, the professional will put the tooth back in place after anesthetizing the area. They will immobilize it with splints to help it fit back into the oral cavity.
You need to wear this in to avoid contact with the other teeth. Also, follow a soft diet, and go to your check-ups to make sure that it’s healing properly. You will also need endodontics, and the patient needs to have the tetanus vaccine.
Treating the symptoms with anti-inflammatories and using antibiotics if needed is vital for the tissues’ recovery and the treatment’s success. Eating a soft and cold diet also helps reduce inflammation and helps the area recover.
In addition, it’s important to monitor and pay attention to the region that was hit. If the gums become inflamed, if you notice a pimple or pus, or if the tooth changes color, call your doctor right away.
Check this out: 8 Ways to Care for Your Mouth After a Tooth Extraction
How to prevent dental trauma
In general, it’s impossible to avoid blows to the mouth. Still, putting some of these tips into practice can help lower your risk of dental trauma.
- Create safe spaces for young children and don’t use walkers.
- Avoid violent games
- Wear mouthguards while playing sports, riding a bike, or roller skating.
- Wear seat belts when traveling.
Finally, as we already mentioned, if you do experience dental trauma, acting quickly and calmly can make a difference. Going to the dentist as soon as possible will help restore your smile.