Death, Taxes, and Dental Trauma
Every other month, I have the opportunity to brainstorm on my next "dental" topic to discuss with the readers of 406 Woman Magazine. I focus on maintaining relevance and reader interest with the otherwise "unsexy" profession of dentistry. Now that I've got you two sentences deep, thanks for reading, and please see my previous articles at 406 Woman.com.
I recently had the unique opportunity to perform an aesthetic porcelain crown restoration on a tooth that had spent the better part of fifteen minutes in the murky depths of Whitefish Lake some years earlier during the patient's teenage years. While swimming with some friends and family, the patient was struck by a knee board causing the complete avulsion (loss) of his front left incisor. The patient's father had the wherewithal and persistence to perform multiple dives to the bottom of the lake searching for the lost tooth. Upon eventual discovery of the tooth, the father replaced it in its God-given natural location in the patient's maxillary jaw bone and visited the dentist immediately. The tooth was temporarily stabilized and ultimately a smile was saved.
The above story demonstrates a parent educated in dental trauma protocol. As a dentist I see dental trauma routinely, and it has become clear to me that a refresher course will benefit our amazing Montana women and their families. So grab a refreshing beverage, get comfortable in your favorite chair and think of the teeth that will be saved.
First, let me briefly describe the anatomy of the human tooth. The outer shell of the tooth consists of approximately 1 to 2 millimeters of hard enamel; the hardest tissue in the human body. Beneath the enamel is a yellowish layer called the dentin. And in the middle of it all is a chamber housing called the pulp, or the nerve and blood supply of the tooth. All of these layers mimic the outer anatomy of their respective teeth much like Russian nesting dolls. Below the gumline, the enamel and dentin layers converge into the root composed of a tissue called cementum.
Fractures:
A tooth fracture that does not involve the pulp is categorized as an Uncomplicated Tooth Fracture and is easily restored or contoured by your dentist depending on the extent of tooth loss. Also, within the uncomplicated tooth fracture category are Infractions, or fractures that are visible but do not result in the loss of tooth structure. It probably goes without saying, but tooth fractures that involve the pulp of the tooth and are considered Complicated Tooth Fractures. These fractures require immediate dental intervention and will require some form of pulp therapy.
Luxation:
If following dental trauma, the tooth is tender to touch, has increased mobility (can be wiggled; is loose), or is no longer in its natural position (displacement), the tooth has suffered trauma referred to as Luxation. If a tooth is only tender to touch without displacement or increased mobility, then it has sustained a type of luxation known as Concussion. If the tooth is not displaced but has increased mobility and is bleeding around the gums, then it has sustained Subluxation.
More severe luxative injuries involve the tooth being displaced from it's natural position in any direction: up (intrusive), down (extrusive), front or back (lateral), etc. If the force is severe enough (like, let's say a hockey stick to the mouth) the result will be a complete loss of the tooth or Avulsion.
The above guidelines are specifically for permanent adult teeth but translate seamlessly to the treatment of pediatric tooth trauma, with the exception of tooth avulsion. In this case it is recommended not to replace the baby tooth. Take your child to the dentist to discuss the best treatment for the missing tooth, It should also be noted that tooth replacement might not always to allow the tooth and its supporting be possible. If that is the case place the tissue to heal. The majority of these tooth in a suitable storage medium, e.g. a glass of milk or saline. The tooth can also be transported in the mouth, keeping it between the molars and the inside of the cheek. If the patient is very young, he or she could swallow the tooth therefore it is advisable to get the patient to spit in a container and place the tooth in it. Avoid storage in water.
Following any of the above forms of luxation or avulsion, your dentist will initially stabilize the tooth with a flexible splint for approximately 4 weeks to allow the tooth and its supporting tissue to heal. The majority of these injuries result in what we refer to as a necrotic pulp, and the tooth takes on the characteristic darker gray color often called “dead” tooth. Your dentist the inside of the cheek. If the patient will discuss with you a treatment plan is very young, he or she could swallow that will ultimately restore your tooth the tooth therefore it is advisable to get aesthetically and functionally.
Prevention:
In the interest of ink and paper, wear a mouth guard when necessary. Your dentist can make you a custom low-profile mouth guard equivalent to what professional athletes are wearing. You name the sport and tooth trauma has likely occurred. I once heard of an aggressive checkmate resulting in a luxated tooth...not seriously, but use common sense and let's not rely on hindsight's perfect vision.
In this day and age we have many great options for tooth replacement if one is lost, but none of these options (implant, bridge, etc.) can mimic the subtle anatomy that a natural tooth root has on the gums around a tooth. The gums and gingival anatomy are equal partners with the teeth in creating that healthy vibrant smile that we all want. I want to thank those readers who have made it to the end and offer my standard disclaimer: I have only given you the cliff notes on the topic and invite you to visit dentaltraumaguide.org for a more in depth discussion on the topic. There you will find definitions and images along with a great flow- chart called the "trauma pathfinder". This will allow the user to make a diagnosis based on the signs and symptoms. Enjoy what remains of another amazing summer here in Montana and don't forget to smile.
Read Dealth, Taxes, and Dental Trauma and other Smile Montana articles by Dr. John F. Miller, DDS, in 406 Woman magazines.