Doctors’ Notes

Injuries to Teeth

Teeth are the hardest substance in the human body. They help with digestion by tearing and crushing foods to begin the journey down the digestive tract. They give each of our children a unique smile to share with everyone. Sometimes though children can injure the teeth. Here are some facts and guidelines about human teeth and what to do if a tooth is injured.

Here is a basic diagram of the tooth:

As you can see there are four different types of tissue: pulp, dentin, enamel, and cementum. Each tissue is important to the health of the tooth.

PULP

Nourishment to the tooth comes through the pulp – one part in the crown of the tooth called the pulp chamber, and the other part in the root of the tooth called the root canal. The pulp consists of nerves, blood vessels, and connective tissue.

DENTIN

The next layer surrounding the pulp is dentin – a yellowish hard substance that makes up most of the tooth.

ENAMEL & CEMENTUM

Finally there are two outer coverings to protect the vital parts of the tooth – enamel and cementum. Enamel is the hardest tissue in the human body and covers the top half or the crown of the tooth. Cementum covers the bottom half or the root of the tooth and fixes the tooth within the jawbone.

Humans are diphyodont, meaning that they develop two sets of teeth. The first 20 teeth are called primary, temporary, or “baby” teeth. These teeth begin to fall out when a child is about 5-6 years old. Eventually the first set of teeth are replaced by a set of 32 permanent teeth (secondary, or “adult” teeth) over a 15-year period as the jawbone grows into its adult form. The Tooth Fairy remains busy for quite a long period of time!

Understanding the basic anatomy of the tooth will help you in aiding a tooth injury.

DENTAL TRAUMA – AND WHAT YOU CAN DO

Dental trauma is extremely common, particularly in the 6- to 12-year-old age group. An estimated 10% to 16% of children will show evidence of damage to the permanent incisor teeth by age 15. So what do you need to do if your child injures a tooth (or teeth)?

Let’s think about the types of tooth injury first. When a child injures his mouth it’s important to calm him down first and prepare him to examine his mouth for any injuries. Have a clean, cold-water rag ready to wipe any blood away, and to be available for the child to bite down if a tooth is injured. Ask him to gently open his mouth as wide as he can, so you can visualize the teeth, lips, and gums. Identify any obvious injury to the mouth, and then begin to carefully look at each tooth. Types of injuries to the tooth to consider are loosened, partial fracture (chipped), complete fracture, dislocation, and avulsion (completely knocked out of its position in the jawbone and gum).

IF A TOOTH HAS BEEN KNOCKED OUT

If a tooth has been completely knocked out, try to locate it immediately. Carefully pick up the tooth by its crown, and avoid any contact with the root. Rinse the tooth ONLY in plain water or milk (no scrubbing), and then determine if you can put the tooth back into its place in the mouth.

Primary teeth (ie baby teeth) should not be reimplanted, because of the risk of damage to the underlying permanent tooth. If you aren’t sure if it’s a primary tooth, then err on side of caution, and reimplant the tooth if possible. A permanent tooth has a better chance of being preserved if it’s placed back into the gum tissue; studies have shown that if the tooth is reimplanted within 60 minutes, the success rate of reimplantation and viability of the tooth is dramatically improved.

The goal is to keep the cells of the pulp viable by keeping them moist. If reimplantation cannot be done, then immerse the tooth completely in a container of Hanks balanced salt solution, which is available commercially in a kit form as “Save-A-Tooth” (Phoenix-Lazerus, Inc., Pottstown, PA), or milk, or the patient’s own saliva. DO NOT USE PLAIN TAP WATER OR SALINE, because they can harbor bacteria and other potentially toxic reactions for the tooth. Another good option is having the patient keep the tooth in the mouth, positioned against the cheek and gum. This suggestion, of course, hinges on the reliability and age of the child to do this properly without causing further problems (like choking or swallowing the tooth). And then seek help from your dentist immediately!

FOR OTHER DENTAL TRAUMA

For all other injuries, it’s important to have the tooth examined by a dentist as soon as possible. he dentist will determine the extent of the injury to the tooth and present a treatment plan for any possible repairs. For a chipped tooth, a dentist can round and smooth jagged edges. For a partial or complete dislocation of a tooth, the dentist will determine if the tooth will remain alive or eventually darken and die.

If the tooth is a primary tooth, you will keep the dead tooth in place until it falls out and the permanent tooth fills its place. (The Tooth Fairy will still honor a dead tooth as well as a live tooth.)

For partial fractures of teeth, try to find the piece that broke off and preserve it as mentioned for a complete tooth avulsion. And, again, seek help immediately from the dentist.

Dr. Lucas Godinez, a Shareholder in the practice, has been a Kids Plus Provider since 2004. He teaches a monthly Expectant Parent Orientation class at our Squirrel Hill/Greenfield office.