Tooth Injury

Symptoms

DEFINITION

• Injuries to the teeth

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Types of Tooth Injuries

• Avulsion of Tooth (knocked out tooth): This is a dental emergency. A knocked out permanent tooth needs to be put back in its socket at soon as possible, ideally within minutes, and certainly within 2 hours.
• Concussion of Tooth (tooth was bumped but is not loose): This is the most common dental injury. No immediate dental care is needed. A soft diet is recommended. Rarely a concussed tooth can undergo pulpal necrosis (tooth death) days to weeks later; this can be recognized when the tooth becomes darker than the adjacent teeth.
• Crown Fracture - Complicated (cracked tooth with pulp exposure): There is usually a large piece of the tooth that is broken off. There also may be small red dot or pink blush (the pulp) in the fractured area. Typically it is quite painful and is very sensitive to air and cold liquids. To reduce pain and prevent pulpal damage, fractures into the pulp need to be treated urgently. Most of these fractures will require root canal therapy.
• Chipped Tooth cated (no pulp exposure): A small painless chipped tooth can wait 24-72 hours for evaluation by a dentist.
• Cracked Tooth (infraction): This is a small hairline crack of a tooth. There is a thin fracture line without any missing piece of tooth. Generally, this should be evaluated by a dentist in 24-72 hours.
• Intruded Tooth (pushed into gum): The tooth is pushed deeper into the gum and tooth socket. Generally, this should be evaluated by a dentist in 24-72 hours.
• Loosened Tooth (subluxation): If there is only mild looseness, the tooth usually tightens up on its own (may bleed a little from the gums).
• Loosened and Displaced Tooth (luxation): All need to see a dentist to assess damage. Displaced teeth that interfere with biting, chewing or closing the mouth need to be repositioned within 4 hours for reasons of comfort and function. Mild displacement deserves evaluation within 24 hours.

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FIRST AID Advice for Knocked-out Tooth

To save the tooth, it must be put back in its socket as soon as possible (2 hours is the maximum limit for survival). Use the following technique:

• Rinse off the tooth with saliva or water. Do not scrub the tooth.
• Replace it in the socket facing the correct way.
• Press down on the tooth with your thumb until the crown is level with the adjacent tooth.
• Lastly, bite down on a wad of cloth to stabilize the tooth until you can be seen by a dentist.

Transporting a Knocked-out Tooth - Follow these instructions if you are not able to put the tooth back in its socket:

• It is very important to keep the tooth moist. Do not let it dry out.
• Transport the tooth in saliva or milk.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Knocked out (unconscious)
• Major bleeding that can't be stopped

Call Your Dentist or Doctor Now (night or day) If

• You think you have a serious injury
• Knocked-out tooth (see First Aid)
• Tooth is almost falling out
• Tooth is greatly pushed out of its normal position
• Tooth that's pushed out of its normal position interferes with normal bite
• Chipped tooth is missing a large piece, or a red dot is visible inside the chipped area
• Bleeding won't stop after 10 minutes of direct pressure
• Severe pain

Call Your Dentist Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Tooth is slightly pushed out of its normal position
• Can see a chip or fracture line in the tooth
• Tooth sensitive to cold fluids
• Tooth feels very loose when you try to move it

Call Your Dentist During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Minor tooth injury and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MINOR TOOTH INJURIES

1. Local Cold: For pain, apply a piece of ice or a Popsicle to the injured gum area for 20 minutes.
2. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
3. Soft Diet: If you have any loose teeth, eat a soft diet for 3 days. After 3 days, they should be tightening up.
4. Call Your Dentist If:
   • Pain becomes severe
   • Tooth becomes sensitive to hot or cold fluids
   • Tooth becomes a darker color
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

First Aid - Tooth - Transport in Milk

It is very important to keep the knocked out (avulsed) tooth moist. Do not let it dry out. Transport the tooth in milk or saliva. These images show how to transport the tooth in milk.

• Milk Transport - Method 1 (best): Place tooth in a small plastic bag with some milk. Put plastic bag in a cup of ice.
• Milk Transport - Method 2: Place tooth in a cup of cool milk.

First Aid - Tooth - Knocked Out

To save the tooth, it must be put back in the socket (reimplanted) as soon as possible. Two hours is the outer limit for survival. Right away is best.

Here are the steps for putting the tooth back in the socket:

• Step 1: Rinse off the tooth with saliva or water. Do not scrub the tooth.
• Step 2: Replace it in the socket facing the correct way. Press down on the tooth with your thumb until the crown is level with the adjacent tooth.
• Step 3: Lastly, bite down on a wad of cloth to stabilize the tooth until the injured person can be seen by a dentist. If your dentist is not immediately available, then go to the emergency department.

If the tooth cannot be put back in its socket: Place the tooth in either milk or saliva to keep it from drying out, and go right away to the dentist. Again, If your dentist is not immediately available, then go to the emergency department.

Special Note: Even if you get the tooth back in the socket right away, only time will tell whether the tooth will live. It may not.

First Aid - Tooth - Transport in Saliva

It is very important to keep the tooth moist. Do not let it dry out. Transport the tooth in milk or saliva. These images show how to transport the tooth in saliva.

• Saliva Transport Method 1: Put the tooth in the mouth inside the cheek. (Only fully alert adults should use this method.)
• Saliva Transport Method 2: Put the tooth in a cup and keep tooth moist with saliva (spit).