Teeth have an outer hard enamel layer, and 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.

Types of dental trauma

• Superficial fracture means the fracture is confined only to the enamel, the 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.
• 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.
  

Displacement
A more severe knock may 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 and the tooth will require a root canal treatment.

Causes

Dental trauma may be inflicted in a number of ways:

• contact sports
• motor vehicle accidents
• fist fights and wrestlingfalls at home
• eating hard foods and drinking hot liquids
  

Diagnosis

Dental trauma is diagnosed by:

• Examination by a dentist/maxillofacial surgeon
• Dental X- rays to determine the extent of the damage of broken teeth
• X- Rays of the mandible to diagnose a broken jaw
  

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:

• Find the tooth, and if you can, re-plant it immediately. If a baby 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).
• Apply a cold compress to your cheek to relieve any pain or swelling.
• Rush to your dentist immediately so that the tooth can be re-planted. Remember that the longer you wait, the less likely it is for your tooth to be re-planted successfully.
• 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:

• Clean the broken tooth and find the broken bit (for the adult tooth only).
• 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:

• Try to put it back to its normal position using very light finger pressure. Do not force the tooth.
• Bite down to keep the tooth from moving.
• 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:

• Rinse with cold water to remove any dirt.
• Apply cold compresses to the cut area to stop bleeding.
• Go to a hospital emergency department if the bleeding does not stop, as you may need stitches.
  

Trauma Outcome

For Fractures, the outcome may be:

• Healing without complications
• Non -Vitality
• Root resorption

For displacement, the outcome may be:

• Healing without complication
• Replacement resorption(Ankylosis) where the bone can fuse with the teeth
• Non -Vitality
• Tooth is lost
  

Prognosis

Infection is a common complication, but can be managed with a course of antibiotics. With timely interventions and appropriate treatment, the prognosis for healing following dental trauma is good.

Prevention

Most dental trauma is preventable and these precautions minimize the risk of dental trauma.

• Car seat belts should always be worn to protect from injuries during accidents and young children should be secured in appropriate car seats.
• Homes should be monitored for potential tripping and slipping hazards which increase the risk of dental trauma.
• Child-proofing measures should be taken especially for toddlers and these include measures such as placing gates across stairs, padding sharp table edges and tucking the electrical cords.Mouth guards should be worn by athletes taking part in contact sports such as football, wrestling, and boxing and should also include non-contact sports such as skateboarding, in-line skating, and bicycling.