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February 10, 2012

Dental Injuries (cont.)

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What is a serious tooth fracture?

A serious fracture is one that exposes both the dentin and the pulp tissue and should be treated promptly. The tooth may be displaced and loose, and the gums may bleed. To prevent the loose tooth from falling out completely, the dentist can splint the loose tooth by bonding it to the adjacent teeth to help stabilize it while the underlying bone and gums heal. Because of the high risk of pulp death, a root canal procedure may need to be performed during the first visit. Alternatively, the dentist may elect to only apply a sedative dressing on the splinted tooth to help calm the tooth pain. The tooth will then be reevaluated in two to four weeks for root canal procedure followed by a dental filling or crown. The splint is also removed at that time.

The most serious injuries involve vertical, diagonal, or horizontal fractures of the tooth roots. In most instances, fracture of the tooth root leaves the injured tooth very loose, thus necessitating tooth extraction. The extracted tooth is replaced with a removable plate containing a false tooth. Teeth with horizontal fractures near the tip of the root may not need extraction. However, root canal treatment for the injured tooth may be required in the future if symptoms of pulp death and tooth infection appear. Therefore, periodic X-rays of the fractured tooth are performed.

What about a chipped tooth?

A minor tooth fracture involves chipping of the enamel only. The tooth is not displaced, and there is no bleeding from the gums. The only symptom of such minor chipping may be sharp or rough tooth edges irritating the cheek and tongue. The injured tooth itself may not even be painful or sensitive to food or temperature. The risk of pulp injury is small, and treatment is not urgent. A small amount of orthodontic wax or sugarless gum can be placed over the rough edge until the dentist can be reached. Definitive treatment usually involves placing a dental filling, a porcelain or gold crown, or a "cap" to protect the pulp of the tooth and to restore normal tooth contour.



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