We are in the heat of baseball and softball season and along with making great plays in the field come the awkward grounder that pops up in our face. Ouch. While our goal isn’t to catch the ball with our teeth, it happens. So what do you do after taking an injury to the face and mouth?
This question came up last week at my son’s baseball practice as a friend was relaying the story of a wayward softball that displaced a couple of front teeth in her daughter’s mouth. It’s not an uncommon injury; younger athletes sustain these injuries particularly often, with more than 20,000 dental injuries occurring annually among children under the age of 18. Of those, the highest numbers of dental injuries of children age 13 to 17 are caused by sports and sports-related activities.
Unfortunately, injuries are a part of of being active. Like any injury, a quick and accurate assessment , followed by proper treatment, can help reduce long-term negative effects, both esthetic and psychological. Below is a good step-by-step for making an assessment on next steps after a dental injury:
- It is important to start with ruling out a head concussion. Symptoms of a concussion include headache, dizziness, nausea or loss of consciousness. Signs of a concussion include change in vision, hearing, and balance, along with memory, concentration, or ability to recall information. If a concussion is suspected, it is important to seek medical care immediately.
- Once a concussion is ruled out, you can move on to a facial and dental assessment. Facial assessment includes looking for soft tissue injuries such as lacerations (cuts), bruising, and swelling. A large facial laceration should urgently be evaluated and closed by medical professionals. Bruising and swelling may simply be soft tissue injuries or could be indicative of bony injury underneath.
- Next a quick dental exam. Do the teeth come together appropriately? Any change in how the teeth come together is a sign of dental or bony injury. Next in the assessment is looking inside the mouth and at the teeth themselves. Observe any fractures or misplaced teeth. Also be on the lookout for lacerations in the mouth.
2. Chipped, fractured teeth
- A chipped tooth can involve different layers of the tooth which require different treatment. A relatively simple chip of a tooth through the outer layer (enamel) may be rather easily repaired by your dentist at a time convenient for you.
- A bigger fracture of the tooth down to the yellow dentin or into the pink and often bleeding pulp of the tooth often occurs. Immediate care should be taken to stop the associated bleeding. Next it is best to get in touch with your dentist. If the injury happens outside of a time when you can see the dentist – which almost always seems to be the case – it would still be best to contact your dentist for pain pills and antibiotics. Treatment by your dentist will depend on the severity of the injury. This may include a relatively simple filling, a crown, a root canal, or in very complicated fractures, removal of the tooth and placement of a dental implant by an oral surgeon.
- Sometimes a fracture of the tooth root can happen where the crown itself appears relatively normal, though the root is fractured. If the pain in the tooth doesn’t resolve after 2-3 days it would be best to see your dentist for evaluation. A simple x-ray can usually rule out a root fracture. In most cases if the root is fractured, it will be necessary to remove the tooth and replace it with a dental implant.
3. Tooth is Knocked out!
- First thing: find the tooth
- Pick up the tooth by the crown (the whiter, shiny part) – do not touch the root!
- Rinse the root of the tooth with cool water for 10 seconds (again do not touch the root).
- Place the tooth back into the socket as best you can. Ideally the tooth will go back into its original location, but don’t worry if the tooth doesn’t fit perfectly. Bite on cotton or gauze to help stabilize the tooth.
- If you can’t place the tooth back into the socket store in milk or ask the patient to spit into a cup with enough salvia to cover the tooth completely, or store the tooth in the patient’s cheek until you can get dental care.
- Seek immediate dental treatment from your dentist.
4. Tooth is Displaced
- If the tooth is displaced it will be moved from its normal position and it will be difficult to bite or chew.
- The injury may be displacement of the tooth from the socket (without completely knocking it out) or from a fracture of the supporting bone around the tooth.
- If it is relatively easy to manipulate the tooth back into position, do so.
- Seek immediate dental care.
5. Trauma to Primary (Baby) Teeth
- In some cases a displaced “baby” tooth can simply be left in place; other times, the damaged tooth needs to be removed and an evaluation of possible trauma to the underlying “adult” teeth needs to occur.
- Contact your pediatric dentist as soon as possible for an evaluation.
With summer season upon us, we can expect some missed catches and bad bounces. An accurate assessment, diagnosis, and appropriate treatment are the keys to avoiding long-term dental complications and get you back in the game after a dental injury.