Traumatic Injuries

Chipped or Fractured Teeth

Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling. If a significant portion of the tooth crown is broken off, an artificial crown or “cap” may be needed to restore the tooth.

If 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 medications (such as Anbesol®) or ointments, or place aspirin on the affected areas to eliminate pain symptoms.

Dislodged (Luxated) Teeth

During an injury, a tooth may be pushed sideways, out of or into its socket. Your endodontist will reposition and stabilize your tooth. Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury. Medication may be put inside the tooth as part of the root canal treatment.

Children between seven and 12 years old may not need root canal treatment since their teeth are still developing. For those patients, the endodontist will monitor the healing carefully and intervene immediately if any unfavorable changes appear. Therefore, multiple follow-up appointments are likely to be needed. New research indicates that stem cells present in the pulps of young people can be stimulated to complete root growth and heal the pulp following injuries or infection.

Root Fractures

A traumatic injury to the tooth may also result in a horizontal root fracture. The location of the fracture determines the long-term health of the tooth. If the fracture is close to the root tip, the chances for success are much better. However, the closer the fracture is to the gum line, the poorer the long-term success rate.

Knocked-Out (Avulsed) Teeth

If a tooth is completely knocked out of your mouth, time is of the essence. See an endodontist immediately! Handled the knocked-out tooth very gently, avoiding touching the root surface and follow these steps to protect the tooth.

The length of time the tooth was out of the mouth and the way the tooth was stored before reaching the dentist influence the chances of saving the tooth. Again, immediate treatment is essential. Taking all these factors into account, your endodontist may discuss other treatment options with you.

Saving a Knocked-Out Tooth

1. Pick up tooth by the crown (the chewing surface) not the root.

  • Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully - touch only the crown - to minimize injury to the root.

2. If dirty, gently rinse tooth with water.

  • Do not use soap or chemicals.

  • Do not scrub the tooth.

  • Do not dry the tooth.

  • Do not wrap it in a tissue or cloth.

3. Reposition tooth in socket immediately, if possible.

  • The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.

4. Keep tooth moist at all times.

The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following:

  • Emergency tooth preservation kit (such as Save-a-Tooth®)

  • Milk

  • Mouth (next to cheek)

  • Regular tap water is not recommended for long-term storage because the root surface cells do not tolerate water for long periods of time.

5. See an endodontist or the nearest available dentist within 30 minutes.

  • Bring the tooth to a dentist or endodontist as soon as possible - ideally, within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.