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When teeth get damaged

Most dental trauma happens to younger people. But we adults damage our teeth plenty, too. Errant basketballs and baseballs, mountain bike spills — they’ve landed more than a few in the dentist’s chair. Age in general takes a toll on our sense of balance, so stumbles become more common. Pitch forward, and your teeth may get the worst of it.

The damage might not show right away. If your teeth are chipped or knocked loose, they’ve probably absorbed most of the force and it will be obvious that you need dental work. But even if your teeth are intact, the jawbone and underlying dental tissue may have been injured because they absorbed some of the force.

Hard on the outside, pulp on the inside

The white outside layer of the tooth is made of enamel, a lifeless matrix of calcium and phosphorus that is the hardest substance in the body. Inside the enamel is a layer of dentin, a bone-like but porous substance. The dentin is nourished by the inmost layer, called the pulp, a lacy network of nerves, connective tissue, and blood vessels. Our teeth are set into the jawbone with prong-like roots and held there by tiny bands of fibrous tissue called the periodontal ligaments.

Chipped. If you find the chip, save it. But if you can’t find it, that’s okay. Even without the chip, dentists today can fix the tooth with white resins.

If you’re lucky, only a small piece of enamel broke off. Usually that can be repaired in one trip to the dentist. A bigger chip may require a crown that fits over the remainder of the damaged tooth. The dentist has to take an impression of the tooth to mold the crown, so you’ll need at least two visits.

If the chip exposed the dentin or the pulp — even just a little bit of it — chances are that bacteria in the mouth will infect the pulp. The trauma itself may also cause damage. In either case, you’ll have to wait at least a few weeks before the dentist knows for sure whether the pulp is viable. It’s a bad sign if the tooth hurts, changes color, or is sensitive to temperature (especially heat); the pulp is probably irreversibly damaged and dying. You’ll need a root canal procedure, which involves removing the pulp and replacing it with a plastic filling, called gutta percha.

But you don’t have to walk around with a crooked smile during this wait-and-see phase. Have your dentist patch the chipped tooth. Sometimes people get temporary crowns (they resemble little caps that fit over the tooth) that can be put on and taken off if further dental work is necessary. In any event, insist that the tooth be repaired sooner rather than later.

Knocked out of position. You should see a dentist as soon as possible. If the tooth isn’t badly displaced, she can gently move it back into the proper position. Doing so soon after the trauma may help preserve the periodontal ligament tissue. You may still need a root canal because the pulp inside is damaged, but at least you’ve improved the odds that the tooth will reattach to the jawbone. If it’s been knocked badly out of position, the tooth may need to be “splinted.” A dental splint looks like a small set of braces. Wires are attached to the injured tooth and those on either side of it, holding it in place while it heals and reattaches to the jaw.

Knocked out completely. Find the tooth and put it back in the socket as soon as possible. If it’s dirty, you can gently rinse it off with milk or water. Don’t scrape or scrub it. When a tooth is knocked out, it tears the periodontal ligament tissue, some of which will cling to the tooth. Scraping or scrubbing will harm the tissue and reduce the chances of the tooth reattaching to the jaw.

If you can’t get the tooth back in (don’t force it), put it in cold milk or a saltwater solution until you can see a dentist, which should be as soon as possible. If there’s no milk or saltwater solution handy, saliva is better than plain water. Never put the tooth in a napkin or tissue. That dries it out, which damages the periodontal ligament tissue.

Root canal is a popular metaphor for excruciating pain, but the reality is far less painful than many people imagine. Dr. Jarshen Lin, a faculty member at the Harvard School of Dental Medicine and an expert on the procedure, goes further; he says a root canal should be pain free, because of better anesthetics, powered instruments made of flexible metals, and high-tech imaging equipment that allows the dentist to see inside the tooth.

June 2005 Update

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