Posts for tag: dental injury
A traditional root canal procedure can be a “life-saver” for a decayed or injured tooth. But while it’s usually the best course for a damaged adult tooth, variations of the procedure are advisable for a new permanent tooth in a child or young adolescent.
This is because the inner pulp, the focus of the treatment, plays an important role in a young tooth’s development. When it first erupts a tooth’s dentin layer, the living tissue that makes up most of the body and roots of the tooth, hasn’t fully formed. The pulp increases the dentin layer over time in conjunction with jaw development.
Because a full root canal treatment removes all of the pulp tissue, it could interrupt any remaining dentin development in a young tooth. This could lead to poorly-formed roots and a less healthy tooth. For an immature permanent tooth, then, we would use variations of a root canal treatment depending on the nature and extent of the injury, the patient’s overall health and medications they may be taking.
Our main objective is to expose or remove as little of the pulp tissue as possible when treating the tooth. If the pulp hasn’t been exposed by the decay or injury, we may only need to remove the softened decayed or injured dentin while leaving harder dentin nearer the pulp intact. If, however, the pulp has become partially exposed by disease or injury, we would then perform a pulpotomy in which we remove only the exposed tissue and then place calcium hydroxide or mineral trioxide aggregate (MTA) to stimulate dentin growth that will eventually patch the exposure site.
In cases where decay or injury has rendered an immature tooth’s pulp tissue unsalvageable, we may use a procedure known as apexification that seals off the open, cylindrical root end of the tooth. This will allow bone-like tissue to grow around the root to serve as added support for the tooth. Although it can save a tooth in the short run, the tooth’s long-term survival chances may be lower.
By using these and other techniques we may be able to save your child’s immature tooth. At the very least, such a technique could postpone replacing the tooth until a more opportune time in adulthood.
If you would like more information on treating damaged teeth in children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”
All eyes were on Boston Celtics point guard Isaiah Thomas in Game 1 of the second-round NBA Playoff series against the Washington Wizards — and not just because he scored a game-high of 33 points! Even more dramatic was the moment his jaw collided with an opponent’s elbow, sending one of his front teeth flying out of his mouth and onto the floor.
Press reports said the Celtics’ team physician attempted to reinsert the tooth, but it didn’t remain in place when Thomas resumed playing the game. Over the next several days, he reportedly underwent a total of ten hours of oral surgery, and was fitted with a four-piece temporary bridge. A statement from the team noted that Thomas suffered “a complete fractured tooth and two other subluxed/shifted teeth… [He] will receive a permanent bridge at a future date.” So what does all that mean?
When we say a tooth is fractured, it means the crown (visible part) of the tooth has broken off from its roots, either above or below the gum line. Depending on the severity of the fracture, it is sometimes possible to save the natural tooth by performing a root canal to prevent bacterial infection, and then placing a crown (cap) on the tooth to restore its appearance and function. In more severe cases, however, the tooth can’t be saved and must be extracted.
Unfortunately, that isn’t Thomas’ only problem. He also has two subluxed teeth — that is, teeth that have shifted from their original position, but haven’t been knocked out of their sockets. Subluxed teeth often result from a severe blow to the mouth, and may be treated by stabilization or splinting. Team officials haven’t said exactly what was done during Thomas’ dental treatment, but it could very well have involved extracting the roots of any teeth that couldn’t be saved, and possibly placing dental implants in his jaw for future tooth restoration.
A dental implant is a small screw-shaped titanium post that is inserted directly into the bone of the upper or lower jaw in a minor surgical procedure. In time, it becomes fused with the bone itself, offering a sturdy anchorage for replacement teeth. One implant can support one replacement crown; two or more implants can support a number of replacement teeth joined together as a unit. This is called a dental bridge.
Bridges can also be supported by adjacent healthy teeth — but first, the outer surfaces of the crown must be prepared (reduced in size), so that the bridge can be attached over the remaining part of the crown. In many instances, implants are preferred because they do not compromise the structure of healthy teeth nearby.
Dental difficulties didn’t end Isaiah Thomas’ season — but an earlier hip injury that became aggravated finally did.Â As unfortunate as this is, maybe now at least the NBA star will have a chance to let those injured teeth heal, and show up next season with a smile that’s as good as new.
One went over the handlebars of his mountain bike. Another got an elbow going for a lay-up. For a third, it was that tricky maneuver on her new snowboard...
These are just a few of the ways that kids' teeth can be injured. (No doubt, parents can think of plenty more.) The good news is that modern dentistry offers more options than ever for treating the injury and restoring the appearance and function of the teeth.
Teeth that are fractured or dislodged are a serious condition that requires immediate, comprehensive treatment. The majority of dental injuries, however, are less severe: most often, they involve chipped teeth. If chips occur in the upper front teeth — as some 80% of dental injuries do — even small flaws can have a big affect on the appearance. And, especially in the teenage years, appearance can mean everything.
In many cases, small chips in the teeth can be repaired effectively using a procedure called “bonding.” In this treatment, we use a tooth-colored material made by mixing a plastic matrix and a glass-like filler, which provides adequate strength and aesthetic qualities similar to the natural teeth. In fact, this composite material can be matched to an individual's tooth color so accurately that it's hard to notice any difference.
Composite resins can be successfully bonded to most healthy teeth — and they offer some advantages over other restoration methods, particularly for children and teenagers. The bonding procedure avoids making tiny “undercuts” in the natural substance of the tooth, while metal fillings need to “lock in” to the tooth's structure. This means that bondings generally require less tooth preparation, which usually makes bonding a quick and relatively easy method of restoration.
It's true that, over time, some bonded restorations may not stand up to the tremendous biting forces of the jaw as well as porcelain restorations — but in young people whose permanent teeth have large pulp (nerve) chambers, the removal of too much tooth structure could compromise the long-term health of the tooth. Later on, we can look at performing a different type of restoration.
If you have questions about cosmetic bonding or sports-related dental injuries, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “An Introduction to Sports Injuries & Dentistry.”