Home > Encyclopedia of Nursing & Allied Health > Dental Trauma

Definition

Dental trauma is an injury to the mouth and teeth, including oral structures such as the lips, tongue and cheeks.

Description

Dental trauma can occur during contact sports, motor vehicle accidents, falling and hitting the face, fighting and/or from untreated tooth decay. It can be caused by physical abuse or domestic violence.

Causes and symptoms

Injuries to a broken or knocked out (evulsed) tooth can cause severe pain. If the lower jawbone is cracked or broken, the patient will be unable to move the jawbone without pain and discomfort. Broken fillings or old crowns are susceptible to decay. They can weaken and undermine the tooth structure, causing the tooth to break. This could result in sharp edges and corners that may damage the tongue tissue.

Diagnosis

X rays (taken to reveal the extent of dental trauma to hard tissue) together with a thorough examination, aid in finding the source of the trauma.

Treatment

Tooth movement

If the entire tooth is knocked out of the socket (evulsion), the tooth must be found and repositioned back in the socket. If this is done in the first 20 minutes, there is a 90% chance of tooth survival. Thirty to 60 minutes cuts the tooth survival rate to 75%.

• The tooth should be picked up gently and held by the crown, not the root.
• The tooth should be carefully rinsed with water; it should not be scrubbed.
• The tooth should be kept moist; it should not be dried.
• If possible, the tooth should be placed in the socket; if this is not possible, it should be placed in a cup of milk.

If a tooth is bumped and still in the socket, but in the wrong position (luxation), dental help should be sought immediately. The following steps should be followed, depending on the position of the tooth.

• An upper tooth hanging down or lower tooth raised up (extrusion) should be repositioned in the socket using firm pressure. The tooth should then be stabilized by having the patient bite down firmly, or bite on a piece of cloth or a handkerchief.
• A tooth pushed back toward the tongue or pulled forward toward the face (lateral displacement) requires repositioning by using firm pressure. This may cause severe pain and biting down on a piece of cloth or handkerchief will help alleviate some of this pain and help to stabilize the tooth.
• Teeth pushed into the gum tissue or teeth that look short (intrusion) require no intervention. Repositioning may damage both tooth nerve and tissue.

Broken and fractured teeth

The fractured area should be cleaned, and a cold compress outside the cheek area should be applied. Dental help should be sought promptly. If a piece of the outer tooth has chipped off, but the inner soft tissue core (pulp) is undisturbed, the rough edges may be smoothed by the dentist and a simple filling placed. If most of the tooth is missing, but the pulp is not damaged, the tooth will require a protective covering with a crown. If the pulp has been damaged, the tooth will require root canal treatment and a crown. A tooth fractured below the gum-line will require root canal treatment and protective restoration. A tooth with little remaining structure to retain a crown may have to be removed (extraction).

Cuts, abscesses, and pain

Cut lips, gums, or tongue require mild rinsing with cold water to remove debris. A cold compress should be applied to the injured area. Most cuts and abrasions are minor; a dental visit is not required. Dental care, however, should be sought if bleeding does not stop and the cut is deep. Pain and swelling can be controlled by ibuprofen (e.g., Advil, Motrin), which is an anti-inflammatory and a painkiller.

Abscesses and swollen gums are due to infection in the gum tissue or bone; ice should be placed on the swollen cheek to alleviate discomfort. Antibiotics and painkillers are generally needed to fight infection. If left untreated, the local infection can enter the bloodstream, causing serious illness. It could become life threatening in some cases. Treatment for the cause of an abscess should also be addressed. A periodontal abscess requires therapeutic sealing and root planing. An endodontic abscess requires a root canal and sometimes an apicoectomy (surgical removal of the tooth root).

Severe pain is caused mainly by trauma, but can be caused also by gum abscesses, tooth infection, bone infection, and some dental procedures. Prompt dental care can alleviate worries and aid in pain control.

With jawbone injuries, the jaw should not be moved. A handkerchief or towel should be tied around the jaw and over the head to secure the jaw in place. Immediate dental care should be sought. Severe pain may stem from temporomandibular joint (TMJ) disorders or trigeminal neuralgia.

Prognosis

The key to a good prognosis for a dental trauma is taking quick steps, remaining calm and getting dental attention within the first 20 minutes. Prevention is the best method.

Health care team roles

The dentist may delegate treatment to other staff members (e.g., registered dental assistants), who can take x rays and comfort the patient, while the office manager takes care of all financial matters and billing questions. The registered dental hygienist may administer an anesthetic agent where needed. All team members can alleviate patient fears during a trauma.

Prevention

According to the study by the American Academy of Sports Dentistry, most dental traumas can be avoided if mouthguards are worn. They recommend that athletes, regardless of their age or gender, use mouth guards where facial impact is possible.

The American Dental Association's February 2000 news press release recommended preventive measures for avoiding a dental trauma:

• Yearly dental exams (including x rays).
• Teeth should be brushed and flossed thoroughly at least once a day.
• A mouthguard and helmet should be worn while playing all contact sports (football, soccer, hockey, baseball, boxing, basketball).
• A seatbelt should always be worn when in a moving vehicle.
• Foreign objects (pencils, fingernails, pens) should be kept out of the mouth.

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KEY TERMS

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Crown—1. The natural part of the tooth covered by enamel. 2. A restorative crown is a protective shell that fits over a prepared tooth.

Eruption—The process of a tooth breaking through the gum tissue to grow into place in the mouth.

Evulsion—The forceful, and usually accidental, removal of a tooth from its socket in the bone.

Extraction—The surgical removal of a tooth from its socket in the bone.

Intrusion—A condition in which a tooth is forced upward into the bone tissue by a force outside the mouth.

Lateral displacement—A condition in which a tooth is forced out of alignment forward or backward, but remains in its socket.

Luxation—The movement of a tooth still in its bony socket.

Pulp—The innermost soft tissue of a tooth containing blood vessels, lymphatics, and nerves.

Root canal treatment—The process of removing diseased or damaged pulp from a tooth, then filling and sealing the pulp chamber and root canals. Also known as endodontic therapy.

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Cindy F. Ovard, RDA