Broken or Knocked-out Teeth (cont.)
- For teeth that are just loose in their socket, treatment is simple. Avoid hard foods. Teeth with significant motion will need to be stabilized using wire, metal arch bars, or a plastic bond for 10-14 days.
- For knocked out permanent teeth, the sooner the tooth is put back in its socket, the better its chances. The best chance for survival occurs if the tooth is reimplanted within 30 minutes. Once implanted, the tooth must be stabilized using the techniques just described for 2-4 weeks.
- Broken teeth are managed according to their Ellis classification. For a minor chip (Ellis I), no acute treatment is necessary. You might need mild pain medication for comfort. This injury typically needs a cosmetic repair that can be completed by a dentist.
- For the more significant tooth fractures (Ellis II and III), certain steps are employed to reduce infection, control pain, and reduce the chance of permanent damage to the pulp.
- You may be given antibiotics in the Emergency Department. Pain medication can include acetaminophen (Tylenol), ibuprofen (Motrin), or a narcotic medicine, such as hydrocodone (Vicodin). In some cases, a nerve block (injecting a long-acting local anesthetic near the injured tooth) can be performed.
- In Ellis II fractures, the exposed dentin is covered with calcium hydroxide, which provides a protective covering for nerves and blood vessels.
- An Ellis III injury (where the pulp is exposed) will need continued dental care. A pulpectomy may need to be performed. Immediate bonding is another option.
- For adult teeth that are pushed into the gum line, no acute treatment is necessary if the tooth is stable and not likely to fall out. An x-ray will be needed to look for a fracture in or near the socket. In most cases, the tooth will push itself back out, returning to its normal position. The only exception occurs with a primary (baby) tooth. If it injures the developing adult tooth below it, permanent damage may occur, resulting in cosmetic disfigurement or loss of the permanent tooth.
- In general, any time a tooth is struck, microscopic nerve or blood vessel damage may occur, even without apparent initial injury. The damage may show as a color change over a period of days to months and lead to the death of the tooth.
Joseph J Sachter, MD, FACEP
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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