Nicolas Coomber discusses the treatment solutions available for patients who have suffered dental trauma.
Looking after your teeth also means protecting them from damage not related to dental disease. Although we do all we can to avoid them, accidents happen every day that result in damage to the mouth.
Traumatic dental injuries (TDIs) affect any age group, although young children are particularly prone. One day they can suddenly move faster or travel further or climb higher than they could a day before. When a child experiences a TDI, it is distressing for the parent or carer, who will worry about long-term aesthetic or functional consequences, or the cost of fixing it. Immature permanent teeth have “considerable capacity for healing” after luxation injury, traumatic pulp exposure or root fracture. But even an avulsed mature tooth can have a good prognosis when there is prompt action.
Dental Trauma UK is a charity set up to promote the best way to save teeth that have been injured, damaged or knocked out. The first piece of advice it gives to patients is, “don’t panic”. For adults, the ideal scenario is to pick the tooth up by the crown, rinse it, then put it back in position, biting into a tissue to keep it in place before contacting a dentist as an emergency. If no emergency appointment is available, they should call 111 (Dental Trauma UK recommends going to A&E if dental care cannot be accessed). If a tooth cannot be replanted, put it in milk before contacting the dentist. If it’s a ‘baby’ tooth, there should be no attempt to reinsert it. For a chipped, broken or cracked tooth, if the fragment has not been lost, it should be cleaned and placed in milk and taken to the dentist. As well as educating them about what to do – ensure the whole team knows the protocol – patients should understand that the practice will deliver a clinical diagnosis and tailored treatment planning, including follow-up, to support a positive outcome.
All patients can minimise their risk of a TDI by only using their teeth for the function for which they are intended – breaking down food. Habits like pen chewing, or holding keys in the mouth, must be discouraged as part of your TDIs education.
Whether being played professionally or recreationally, between nearly 40 per cent of all dental injuries are sports related. They are common in contact and non-contact sports, and prevalence is highest in children and young people, with developing dentitions. A well-fitting mouthguard can protect the teeth, also the soft tissue in the mouth. The Faculty of Sport Exercise Medicine UK, in conjunction with the Faculty of Dental Surgery at the Royal College of Surgeons of England, in its position statement on mouthguard use, is supportive of mouthguards in “sport participation at all levels”. Individual sporting bodies have different approaches, with some mandating the use of mouthguards for international/ national participation only and others starting their recommendation at the grassroots. We’re used to seeing rugby or hockey players wearing mouthguards, but the incidence of orofacial injuries in sports like water polo is also high, and most players do not wear them routinely.
The reasons for not wearing one are often performance-based, based on a belief that the appliance will compromise aerobic performance, as well as the ability to communicate with team-mates and be a distracting source of discomfort. Studies that compared ‘stock’ and custom-made mouthguards suggest the limitations with the former are negligible, but more sport-specific research is needed, to change the culture around mouthguards, so that wearing one is considered ‘normal’. Dental professionals would agree that a TDI that leaves an individual needing restorative work is not worth risking. Mouthguards custom-made by a dentist have a broad range of applications, including being a key prevention measure for an orofacial injury. If the cost of a custom mouthguard is part of the reason for reluctance, this should be put in the context of extensive and/or ongoing dental costs, in the worse-case scenario.
Thanks to modern techniques and the high-quality materials a clinician can use to deliver them, restorative solutions for all dental injuries can be efficient, cost-effective and enduring. For example, Coltene develops and manufactures premium restorative consumables, including Brilliant Crios reinforced composite bloc, enabling the in-house CAD/CAM manufacture of restorations with exceptional mechanical properties and shock-absorbing effects, also Brilliant EverGlow submicron hybrid composite for highly aesthetic and long-lasting solutions and Brilliant Componeer for one-visit veneers chairside, as the shells are prefabricated.
Dental injuries are common, and cannot be entirely prevented. Ensure your patients, particularly those who you know play sports or have an active lifestyle, also parents/carers, have access to resources to help them avoid an orofacial injury and know the action to take if one occurs. But reassure them that you will take good care for them, should an injury occur, and provide the conservative treatment and monitoring they need to regain aesthetics as well as function.