Trauma to the teeth often occurs during sports activities. One of the best ways to protect your teeth from injuries is, whenever the rules of the game allow, to wear a well-fitting helmet, a mouth-guard or a face-guard. This is especially so during sports such as hockey or boxing that requires close contact.

Signs and Symptoms

Fracture i) Superficial fracture: If you do not feel any pain after being hit in the mouth, the fracture may be superficial and confined only to the enamel, the extremely hard outer covering of the crown of the tooth. This is usually not serious unless the fracture leaves the tooth with a sharp edge. Even then, the sharp edge can be filed down easily. ii) Serious fracture: If your tooth becomes sensitive to touch, heat or cold, the fracture may be more serious. It may have exposed the inner, more sensitive parts of the tooth such as the dentine and the pulp. This can increase the risk of bacterial infections. The dentine is the part of a tooth between the enamel and the pulp. The pulp is the living centre of the tooth and is made up of delicate blood vessels, nerve tissue and cells. If you sustain any dental injuries, seek a dentist's advice immediately. If you have the fractured piece of tooth with you, bring it along to the dentist. It is sometimes possible to put it back. The dentist may also need to place a protective coating over the exposed area to reduce sensitivity and to protect the pulp from bacterial contamination.

Displacement

If the blow hasn't broken your tooth, it may have bruised the supporting tissues. This will only give you a day or two of discomfort. But if the gums have been injured, the discomfort may last longer. A more severe knock will however, displace the tooth so that it may sink deeper into the socket or hang loosely out of it. The tooth may be displaced to the side. If the blow is very severe, it may knock the tooth out completely or fracture the supporting bone. In most cases of tooth displacement, the delicate blood vessels supplying the pulp are damaged. The pulp or living centre of the tooth may die after a while. When this happens, the tooth will require a root canal treatment.

Causes

Sports activities, accidents, or violence are some of the most common causes of dental trauma.

Prevention

The good news about dental trauma is that it can often be prevented with the right protection and extra caution. You can start with the following simple steps: i) Whenever the rules of the game allows, wear a helmet, a mouth guard or a face guard in sports that require close contact (such as football, hockey, or boxing). Wearing a well-fitting mouth guard can protect your teeth and jaw, as well as prevent a concussion and other brain injuries. ii) Make sure that an emergency dental care kit is available. The kit should contain among other things, a bottle of saline solution, some gauze, and a painkiller such as Ibuprofen, which can help to prevent inflammation. Aspirin is not recommended. As an anti-coagulant, it may prevent blood clotting and cause excessive bleeding in a dental emergency.

Treatment

If your tooth has been knocked out, forced out of position, loosened or fractured, you should get to the dentist as soon as you can. Getting to a dentist within 30 minutes can make the difference between saving or losing a tooth. If your tooth has been knocked out, you should: i) Find the tooth, and if you can, re-plant it immediately. If a baby tooth, instead of a permanent tooth has been knocked out, it may not be replanted. You may try to replace the tooth in the socket, and keep it down by biting on gauze. This will protect the periodontal ligament fibres surrounding the tooth. (A note of caution: Always handle the tooth by the crown; do not touch the root, that is, the part of the tooth below the gum. Touching the root can damage cells necessary for bone re-attachment. If there is any dirt on the tooth, do not try to scrape the tooth to remove it. Rinse gently with water.) ii) Apply a cold compress to your cheek to relieve any pain or swelling. iii) Rush to your dentist immediately so that the tooth can be re-planted. Do not waste any time. Remember that the longer you wait, the less likely it is for your tooth to be re-planted successfully. iv) If the tooth cannot be replaced and you have to bring the tooth to a dentist, make sure it does not dry out. To keep it moist, you can put it in special solutions which are available from pharmacies, or you can put it in a container with a small amount of cold milk, or even your own saliva. If your tooth is broken, you should: i) Clean the broken tooth and find the broken bit. ii) Wash any dirt and debris from the injured area and apply a cold compress on the cheek if there is any swelling. Rush to your dentist immediately. Minor fractures can be easily filled in but if there is damage to the enamel, dentine or pulp, the tooth may be restored with a full permanent crown. If the trauma is too severe, the tooth may have no chance of recovery. If your tooth is pushed out of position, you should: i) Try to put it back to its normal position using very light finger pressure. Do not force the tooth. ii) Bite down to keep the tooth from moving. iii) Rush to the dentist immediately. The dentist may splint the tooth in place to the two healthy teeth next to it. If you have cut your lips, gums, or tongue, you should: i) Rinse with cold water to remove any dirt. ii) Apply cold compresses to the cut area to stop bleeding. iii) Go to a hospital emergency department if the bleeding does not stop, as you may need stitches.