Dental Trauma Emergencies

Broken or displaced tooth? What to do before heading out to the dentist’s

By Deborah Jeanne Sergeant

A dental emergency is traumatic, as an acute injury to a tooth can be painful and disfiguring. For the best chances of a good outcome, follow these tips from area experts.

 

Dentist Kristin Nylen, Oswego Family Dentistry

Tips from dentist Kristin Nylen, Oswego Family Dentistry:

• “If you just chip a tooth, it depends on how bad it is. If you don’t see anything red, meaning the nerve or pulp is exposed, you don’t have to go [see a dentist] that minute. You can wait until the office is open. Sometimes what I tell people who are prone to that, is if they chip a spot and it’s Sunday night and they can’t get in until Monday, put a small piece of wax over it so they don’t cut their lip or an over-the-counter patch. If a kid breaks a piece of tooth, save it and bring it in. Sometimes, it’s the only way we can fix it. The other reason is we want to make sure that piece isn’t stuck in their tongue or lip. Older people may have an old crown. If it comes out and you’re away from home, you can use an over-the-counter temporary material until you get home. It will hold you over.

• “When you breathe in air, it should not be extremely sensitive. If it is, get in right away. If you see red on the tooth or blood coming out of the tooth, also seek care immediately.

• “If a tooth has come out a little, try to gently press it back into place so when you’re biting it won’t go farther out. Except a baby tooth — don’t press that back into place. See the dentist and don’t force it up there. If it’s an adult tooth, call the dentist. It’s a serious dental emergency. Or call the hospital if evening or weekend. They won’t fix anything but the bigger ones like St. Joseph’s or Upstate they have a dental resident for trauma. It depends if they have someone on call for that. If you break a tooth, they won’t fill it but get you to the point where it’s not an urgent emergency. They’re not your dentist.

• “If a tooth gets knocked out, it’s the biggest dental emergency where time is critical. Ironically, the literature shows the poorest outcome is when a dentist puts it back in because too much time has passed. We tell the sports teams here that you can purchase from a dental supplier a small jar with an isotonic solution like Save-a-Tooth. If the tooth is dirty, don’t touch the root, only the shiny white enamel part. Then you can gently rinse it in Save-A-Tooth. You don’t want to touch the root to overly clean it as those cells on the roots can die. Put it into the solution to take to the dentist or ER. The parent or coach can gently place it back into the socket. Make sure you put it in properly. If the Save-A- Tooth isn’t available, usually the other option is the child can spit into a cup and you can use that to clean the tooth. It won’t cause the cells to die. Putting it into milk is better than letting it dry out, but milk can be a little acidic. Saliva and blood from the person’s mouth is second best. Some people think rinsing with alcohol is good. They get over concerned about germs. If you use that, it’s all over; it won’t reattach.

 

Tips from dentist Renee Pellegrino, dentist with Rochester General Hospital Dental Center:

• “You need to determine or assess the extent of the injury. Is the injury localized to the tooth? Has the accident been bad enough where you think there could be other trauma, like head injury, concussion or the face is cut? Or you think you broke something. Check if the person is woozy and can’t answer correctly. There may be something higher order than a broken tooth. Then you need to see someone medical in the ED, if there’s trauma beyond the tooth.

• “If you have no other injury, then what I’d tell the parent or patient is to assess the break of the tooth. Not all breaks are created equally. Teeth have different layers. Depending on how severe the break is, the patient will report different symptoms. If it’s contained to the tooth only, call your dentist. They can provide an emergency visit. The tooth has three layers. The enamel is the white outer layer, then there’s dentin. The blush red is the nerve. The treatment modalities will depend on the layer. If the break is to the enamel, there won’t be pain.

• “If you don’t have a comprehensive dental provider, dental urgent care is recommended. Some ERs have limited dental capabilities to address discomfort but they won’t fix a tooth. Dentists have after-hours numbers or use a call center.

• “Evulsion is when the tooth is completely knocked out. It’s a very serious injury. We need to assess if it’s a primary baby tooth or an adult tooth. We don’t put baby teeth back in as it can obstruct the eruption of the permanent tooth.

• “If you’re an active family and sports are a really big thing to you, you may want to consider Hank’s Balanced Solution, available on Amazon. It’s a storage medium for when teeth come out. You don’t want to leave the tooth out to dry if it’s been evulsed. Hank’s has a lot of the minerals that help that tooth try to survive. If you’re unsure if the tooth is baby or adult, save the tooth. You’d be surprised the number of people who don’t locate and bring the tooth.

• “If the tooth is dirty, don’t scrub it. You’re scrub the fibers off you need to attach to the bone. If there is debris, use some milk or Hank’s to get the dirt off.

• “Never put the tooth in straight water. It doesn’t have the right mineral content and it can damage those fibers.

• “If you are positive that the tooth is an adult tooth and you feel you can get it back into the socket in the right position, I encourage you to try to do so. The critical time is about an hour. After an hour, the prognosis drops. Use finger pressure and get to the ER.

• “If the patient is old enough and you don’t feel comfortable repositioning the tooth, the best place is in your cheek with your own saliva. But you have to consider the patient’s age, that they won’t swallow it. You don’t want to put a tooth in someone else’s mouth. If someone can spit in the cup, you can store the tooth there.

• “When you bang teeth around, those are forceful injuries. Let your dentist know that you had this. It needs to be monitored. Sometimes the injury won’t show for years. You may notice that tooth becomes more sensitive. Or it becomes darker. Over time, the nerve of the tooth is changing. The extent can’t always be determined at that point.”