Tooth injury

About dental injuries

There are a number of ways you can get a dental injury, including chipping or breaking (fracturing) your tooth. Having a dental injury can also cause your tooth to come out of its socket (dental avulsion).

Any number of things can cause a dental injury. For example, you may have a fall, get hit in the face or be in a road traffic accident. Sometimes even eating something very hard can break your tooth, particularly if it’s been weakened by tooth decay.

While most dental injuries are accidental, there are some factors that make these accidents more likely to happen. Some of the most common are listed below.

  • Playing contact sports, such as rugby or boxing, or any sport that involves physical contact or moving objects such as bats and balls.
  • Having upper front teeth that stick out.
  • Being unsteady on your feet or having a medical condition, such as epilepsy.

First aid for dental injuries

If you have a dental injury, or someone you know has one, it's important to get the right help.

For example, if the accident causes you or someone you know to be knocked out (lose consciousness), or if there is a lot of bleeding, it's important to call for emergency help. Otherwise, you should contact a dentist straight away. If it's outside usual opening hours, go straight to the accident and emergency department at the nearest hospital.

Try to do the following if your tooth has been knocked out.

  • Try not to touch the tooth's root - it's best if you only handle it by the crown (the white bit at the top).
  • If possible, put the tooth back into its socket in your mouth. This is called re-implanting the tooth. If the tooth is dirty, gently rinse it with milk or saline solution (for example, contact lens solution) for a few seconds. Don't use water or scrub the tooth. Try to put it in the right way round, but don't worry too much as your dentist can fix this. The important thing is to put it back in as quickly as possible. Don't put children’s milk (baby) teeth back in the socket as this can damage the developing adult teeth.
  • When your tooth is back in its socket, bite down gently on a clean handkerchief or a piece of gauze to keep it in place.
  • If you can't re-implant your tooth straight away, store it in milk or saliva (by spitting into a container) or place it inside your mouth between your cheek and gum until you can get to a dentist. However, this isn't recommended for young children as they could swallow or inhale the tooth.
  • If you haven't got the whole tooth, don't try to put a broken tooth back in your mouth. Store it in a pot of saliva or milk as your dentist may be able to reattach it.

Even if you don't think your tooth is broken, it's still important to see your dentist as soon as possible. There may be an injury below the gum line that you can't see.

Treatment of dental injuries

If your tooth has been loosened or knocked out

When you see a dentist, he or she will look inside your mouth to see if your tooth has been re-implanted properly. If not, your dentist will try to re-implant it as soon as possible. However, this may not always be appropriate - ask your dentist for information.

You will need to have your tooth splinted (joined to your neighbouring teeth) to hold it in place as it heals. There are different types of splint; the most common is made of clear plastic. Another type is a thin piece of wire, which attaches your loose tooth to those on either side of it. If you handled your tooth carefully and re-implanted it quickly, you will need to keep this on for one to two weeks. If your injury was more severe and caused root damage, you may need to wear the splint for several weeks.

Your dentist may take some X-rays to see how serious your injury is and if there are any pieces of broken tooth stuck in your lip, gum or tongue. If you think you have inhaled a piece of tooth, your dentist may refer you to hospital for a chest X-ray.

If your tooth has been chipped

Treatment for a chipped tooth will depend on where your tooth has broken. Teeth have a core of blood vessels and nerves at their centre called the pulp. If your tooth is injured, the pulp can be damaged and the blood vessels may die.

If a piece of your tooth has chipped off but the pulp isn't damaged, your dentist will smooth the uneven edge and replace the corner with a tooth-coloured filling. If the pulp is damaged, you may need to have root canal treatment to remove the damaged blood vessels and nerves from your tooth.

Your dentist may also check your mouth to see if the chipped tooth has caused any further damage to your mouth. You may need to have an X-ray to check that a piece of your tooth isn’t embedded in your lip, for example.

If your tooth has broken roots

Your teeth have roots that are set in your jawbones. If a root fractures, it's possible that your tooth won't look any different because the fracture is hidden by bone and gum. However, your dentist may be able to see a fractured root on X-ray images.

If your tooth is quite firm, your dentist may just ask you to come back for regular X-rays and tests to make sure that the pulp stays healthy. However, if your tooth is wobbly, it will need to be splinted for a few weeks to help the fracture heal.

If your dentist finds that the pulp has been damaged and isn't going to recover in the weeks and months after the root fracture, he or she may recommend that you have root canal treatment to save the tooth.

Some fractures are unlikely to heal, particularly if they are near the gum or the tooth has broken lengthways. Your dentist may recommend that you have your tooth taken out.

After your treatment

If at any stage you feel pain or notice any change in colour to your damaged tooth, it's important to visit your dentist as the pulp can die a long time after a dental injury. If you have had your tooth re-implanted, continue to get it checked as you may need treatment in the future.

Dental injuries in children

Young children who injure their milk teeth may need different treatment to that given to adults or teenagers. For example, if a milk tooth gets knocked out, the dentist is unlikely to try to re-implant it. This is because it could damage the permanent tooth when it develops. Occasionally, an injury to a milk tooth can cause damage to the developing adult tooth. This will be monitored at check-ups.

Prevention of dental injuries

If you regularly play a sport that puts you at any risk (eg rugby, boxing, cricket, hockey) you may wish to consider getting a mouthguard. This will offer some protection and can reduce the likelihood of you getting an injury. Mouthguards are usually made of rubber and form a cover that goes over your teeth and gums.

You can buy mouthguards in some sports shops but it's better to ask your dentist to make one that is specially fitted for you. If your mouthguard has been made properly, you should not have any problems talking or breathing normally while you are wearing it. Your dentist will take a mould of your teeth using a putty-like material. This is then sent to a laboratory where your mouthguard is made. Children will need to have their mouthguards replaced as new teeth develop and their mouths grow.

I lost a tooth in a hockey match but I don't like wearing the false tooth that my dentist made. Are there any alternatives?

Answer

Generally, alternatives such as bridges or implants can be used to fill the space. Or, your dentist may recommend that you have orthodontic treatment to move the teeth inwards to fill the gap. However, everyone is different so you will need to speak to your dentist to know what alternatives are suitable for you.

Explanation

A denture with a single artificial tooth is an effective way to fill the gap as the socket heals. This can give you the time you need to discuss the long-term options with your dentist.

A bridge can be a very effective option - this is an artificial tooth that is permanently attached to the tooth or teeth either side of the gap. There are a number of types available; your dentist will be able to recommend the best design for you.

You may be able to have an implant to replace your missing tooth. This is a small rod made of titanium that's placed in the jawbone where your tooth used to be. After three to six months your bone will fuse with the metal implant. A small attachment will be left poking through your gum and an artificial tooth is screwed or clipped onto this attachment. You won't be able to remove the artificial tooth and the implant won't be visible.

Depending on the condition of your teeth, it might be possible to hide the gap by moving adjacent teeth into the space. You will need to wear orthodontic braces and the treatment will take some months or years to complete.

You can help to prevent further dental injuries by wearing a well fitting mouthguard.

One of my front teeth was pushed into my gum in an accident so it looks shorter than the one next to it. Will it go back to how it used to be?

Answer

This is called an intrusion injury and you can have treatment to correct it. The success of your treatment will depend on the age at which you had the injury and how far your tooth has been pushed into your gum.

Explanation

Adult front teeth come through to replace the milk (baby) teeth at around the age of six to seven. However, the roots of these teeth continue to develop for the next couple of years. This is a crucial factor that affects the treatment of intrusion injuries. 

If you have an intrusion injury to one of your front teeth before the root of your tooth has developed, your tooth is likely to recover. It will usually move back through your gum (re-erupt) within about three weeks. If it doesn't, you can have a special orthodontic brace fitted to help pull it into the correct position.

However, if the root is fully developed, the tooth will be less able to recover. The core of blood vessels in your tooth (the pulp) will probably get cut off during the injury and your tooth will die. If this happens, the root of your tooth may start to dissolve quite quickly (root resorption). This can lead to you having a wobbly tooth that you may eventually need to have taken out. Your dentist probably won't leave your tooth to see if it re-erupts. He or she will usually recommend an orthodontic brace to pull your tooth down straight away, as well as root canal treatment to remove the pulp. Your dentist will also place a special dressing inside your tooth to help prevent root resorption.

My child fell and cut the inside of his lip with his front teeth. Will this affect the developing adult teeth?

Answer

The main factors that determine whether or not your child's adult teeth will be affected include his age and how severe the injury is. Take your child to the dentist as soon as possible so that his teeth and gums can be checked for any wobbliness, swelling or discolouration.

Explanation

Any potential long-term effects following a dental injury mostly depend on your child's age. Adult front teeth start to form deep inside the gums in babies. At about six to seven years old the front milk (baby) teeth fall out and the adult ones come through in their place. By the age of about eight, the crowns (the white parts) are completely formed.

The crucial time for the development of the crowns (the white parts that will be visible in your child's adult smile) is up until the age of about eight. If the front milk tooth is injured during this time, it's possible that the enamel of the developing adult crown could be affected. This could alter the colour or shape of the adult tooth.

If the damage is more severe, the angle at which the adult tooth grows might change, or it may not come through as expected. However, this is only likely if your child's injury was more serious, for example if the tooth was pushed up into the gum.

If your child's teeth look the same as they did before the injury and the only sign of the fall is a cut lip, it's likely that the adult teeth won't be affected. See your dentist for more advice.