With dental injuries to the teeth there are four different categories to consider:
1. The tooth is completely out of the socket
If a the tooth is completely displaced from the socket due to a severe impact then is is imperative to place the tooth back in its socket as soon as possible. The survival of tooth depends very strongly on the length of time the tooth is out of the mouth and how it is stored during that time. The best survival outcome is for teeth that are replanted immediately. If the tooth is out of the mouth for more than 5 minutes, it must be kept moist to prevent further damage to the dental cells. The tooth may be stored in fresh cold milk. Another way to protect the tooth is to keep it in your mouth, under your tongue as it is then kept moist and is protected. The tooth must not be handled by the root and should not be scrubbed to remove dirt. Holding the tooth by the crown, it can be gently washed with milk, saline or sterile water followed by re-implantation. It should then be held in place by biting on a clean handkerchief and the patient taken to a dentist immediately. This tooth should then be splinted for 7-10 days and the patient should be given appropriate antibiotics, a mouthwash and referred for a tetanus prophylaxis as required. The follow-up treatment depends on the stage of root development of the tooth.
2. The tooth is displaced but still in the socket
The main objective is to re-position the tooth back into its correct position and stabilize it to prevent further damage to the supporting structures, nerve and blood supply. As mentioned above, the timing of the re-positioning is very important in order to have the best chance of the tooth surviving. The displaced tooth will require long term follow-up with X-rays and may require root canal treatment if irreversible damage to the nerve and blood supply of the tooth has occurred.
3. Fractured of the crown part of the tooth
The fracture may involve one or all of the following dental tissues: enamel, dentine, pulp (nerve) of the tooth. Fracture like this is usually associated with extreme sensitivity to cold air and pain. The main objective following this type of injury is to maintain the vitality of the pulp and prevent pain.
If the nerve of the tooth is not involved, then the tooth can be built-up with composite (tooth-coloured filling material). If however, the nerve is exposed, depending on size of exposure and time since it occurred, the nerve might need to be treated. In most cases, even if the nerve is removed, the tooth can still be restored.
4. Root fracture
Sometimes the traumatized tooth may look normal, have increased mobility or the tooth may look displaced. Multiple dental X-rays are necessary to assess the level and extent of the fracture. Some root fractures require immobilization, and prompt treatment of such fractures increases the chance of healing and hence tooth survival.