“Evaluate for broken tooth.”
A simple note all too common at the urgent care dental clinic. You go in hoping it’s a small chip on an incisor and are greeted with a patient, tooth in hand, expectantly looking to you as if to say, “Can you save it?”
Why isn’t knowledge on dental trauma more common among the general public? Why aren’t we taught from a young age exactly what to do in these emergency situations? Where is the “stop, drop and roll” of dental trauma? A December 2008 literature review in Dental Traumatology reported that 33% of adults experience some sort of trauma to the permanent dentition. Such a high incidence of these events and the lack of knowledge leads to a grim discussion on why a tooth can’t be saved on many occasions.
My colleague Dan Walker, Washington ’21, approached me about creating something that showed clear and straightforward guidelines for dental trauma. In our conversations, we agreed that we’d be happy if we could save even one tooth. Dan worked with Dr. Jackie Wong (University of Washington School of Dentistry, Department of Oral Medicine) to produce the information and flowchart, while I illustrated it.
First and foremost, it is important to assess the scene of any trauma (dental or otherwise). Loss of consciousness and symptoms such as dizziness, blurry vision and seizures require immediate medical attention. From here, we can evaluate the different forms of trauma, which we devised into three categories: a broken tooth (fracture), a knocked-out tooth (avulsion) and a loose or displaced tooth (luxation).
With a broken tooth, it is important to note that small fractures can be bonded back or filled with composite. However, a larger fracture exposing the pulp of a tooth may require special attention in the form of endodontics. When a tooth is knocked out, most people are unaware that the best place to keep it is actually right back in the socket where it was lost. Some special considerations include making sure it is cleaned properly and picking it up by the crown — not the root, as this can destroy the existing PDL cells. When a tooth is loose or displaced, it is best to try to gently reposition it and stop any bleeding with gauze. Regardless of type of dental trauma, prompt dental care is advised, but taking these steps can greatly increase the chances of saving a tooth.
We hope this infographic is useful to anyone who may experience dental trauma, or even as a review for dental students and dentists as they advise patients.
~ Ali Shareef, Washington ’21