An injury to one or more front teeth caused by a mechanical force is called anterior tooth trauma. Most often, anterior tooth trauma is the result of an accident. Children and adolescents are most often affected. In many cases, it is possible to preserve the injured front teeth.
What is anterior tooth trauma?
Anterior tooth trauma occurs when a mechanical force is applied, usually in accidents. In this case, the injuries to the teeth can occur in several ways. Anterior teeth include the upper and lower incisors and canines. In the case of an injury, either one tooth or several can break off. However, the bone compartment and the surrounding gums can also be affected by the injury. In the worst case, complete loss of the tooth or teeth can occur. Anterior tooth trauma occurs quite frequently. Canines and incisors in the upper jaw are more commonly affected than anterior teeth in the lower jaw due to their location and size. It is often possible to preserve the teeth affected by anterior tooth trauma.
Causes
Anterior tooth trauma is always caused by mechanical forces. Most often, these are accidental injuries. They can be caused by an impact or blow. But a fall can also cause the injury. Sports activities and, in the case of children, accidents during play are often the reason for the resulting injury to the anterior teeth. Statistics show that every second person is affected by a front tooth trauma by the middle of his life at the latest. In children and adolescents, the probability of suffering an injury to the anterior teeth is even higher. Anterior tooth trauma is particularly common here when falling from climbing greens and trees. However, modern trend sports such as skateboarding, rollerblading and parkour also lead to numerous injuries to the dental apparatus. In this age group, anterior tooth trauma is almost as common as tooth decay.
Symptoms, complaints and signs
As a rule, the complaints and symptoms of anterior tooth trauma are relatively clear, so that an early diagnosis and treatment can also take place. Those affected suffer primarily from very severe tooth pain. In many cases, this pain cannot be relieved by painkillers and must therefore be treated by a doctor. Frequently, the pain also spreads to neighboring regions, so that pain can also occur in the ears or on the head. The quality of life of the affected person is considerably restricted and reduced by the front tooth trauma. Bleeding in the oral cavity can also occur. Due to the pain, the intake of food and liquids is no longer possible without further ado, so that some patients suffer from deficiency symptoms or dehydration. If the anterior tooth trauma is not treated, the teeth often remain crooked or broken. Re-growth of the teeth does not occur. Usually, anterior tooth trauma can be treated well, although surgical procedures may be necessary. Without treatment, anterior tooth trauma can also cause speech defects. The life expectancy of the affected person is usually not negatively affected by the condition.
Diagnosis
After anterior tooth trauma has occurred, the dentist’s diagnosis essentially refers to an assessment of the damage that has occurred to the affected canine or incisor teeth. Depending on the type and severity of the injury, a distinction is made between peripheral and central tipping and tooth fractures. The type of injury is determined by careful palpation of the damaged tooth and an X-ray examination. Peripheral tipping is when the tooth or teeth are loosened and tilted. All degrees of loosening and tilting of the tooth, up to complete tooth loss, may be present. If the anterior tooth is tilted inward and thus into the jawbone, it is a central tilt. Tooth fractures are classified as tooth cracks, enamel, root or crown fractures, and longitudinal, transverse or oblique fractures, depending on the extent of the fracture. The less the tooth is loosened or tilted, the more likely it is to fracture. The course of an anterior tooth trauma always depends on the individual case. The incident that led to the trauma and the subsequent treatment are always decisive for the course of the injury.In most cases, both the function and appearance of the affected teeth can be restored after anterior trauma.
Complications
Anterior tooth trauma usually results in severe pain and bleeding in the front teeth in the patient. Therefore, immediate treatment by the doctor is necessary to prevent secondary damage. If the teeth are not treated, crooked front teeth may remain. Likewise it comes to broken teeth. Due to the pain and bleeding, a normal intake of food and liquids is not possible. This reduces the quality of life and may lead to underweight. If the anterior tooth trauma occurs in children, there are usually no complications. In children, the milk teeth can be extracted so that the new teeth will grow in later. If a tooth is broken or cracked, the affected areas can be straightened with fillings or crowns. If the front tooth trauma involves the root of the tooth, it is removed in most cases. Treatments at the dentist are performed under anesthesia, so there is no pain or complications. If the root of the tooth is removed, the affected tooth will no longer feel any stimuli. If the tooth is completely knocked out during anterior tooth trauma, a gap is created. This looks unattractive and can reduce the patient’s self-esteem. Gaps are filled with implants. Again, no further complications occur.
When should you go to the doctor?
A doctor should be seen after a fall, accident or impact to the mouth or facial area. Even without pain or obvious damage, there may be an anterior tooth trauma that should be examined and clarified by a dental professional. In some patients, fractures form on the tooth or below the gum. These can only be found and repaired in a dental examination. Damage to the roots of the teeth or displacement of the teeth must be treated and taken care of by a doctor. Without a visit to the dentist, a slow process can lead to impairments and permanent problems of the jaw. If the jaw can no longer be moved as usual or if bleeding gums appear, it is advisable to see a doctor. If dentures were worn during the accident, they should be checked by a dentist to ensure they are intact. Loosening of the teeth, pain or a feeling of pressure in the mouth should be presented to a doctor. If the affected person hardly eats any food or there is a loss of weight, a doctor is needed. If there is a headache, difficulty swallowing, or unusual hypersensitivity to temperature effects, a doctor should be consulted. If there are problems with chewing, if there is an altered voice, or if a speech impediment develops, a physician should be consulted.
Treatment and therapy
Treatment of anterior tooth trauma depends on the type of injury, as well as the type of tooth involved. If baby teeth are affected, the injured teeth are usually extracted. If permanent teeth are affected, different therapies are used depending on the type of injury. Tooth cracks are treated by applying a protective film to the tooth. Tooth fractures can be repaired in some cases by fillings or crowns. Sometimes, however, the front tooth cannot be saved and must be extracted. This is usually the case with a tooth fracture in the middle or upper root area. Teeth loosened by an anterior tooth trauma receive splinting. In this way, the affected teeth are protected and fixed and can grow back. If gum injuries are present in addition to the tooth damage, the cracks are treated with ointments or rinses after the initial dental treatment. If the anterior tooth trauma has resulted in tooth loss, it may be possible to reimplant the knocked-out tooth. However, it depends on the individual case whether this is possible. If reimplantation is no longer possible, the resulting tooth gap must be filled with a dental prosthesis. In this case, implants or bridge constructions are used after tooth loss in the case of anterior tooth trauma.
Outlook and prognosis
The prognosis for anterior tooth trauma depends on how much damage has been done to the tooth structure or jawbone. Anterior tooth trauma can affect only the tooth structure. However, they can also affect the periodontium or the alveolar bone, as well as both together.If permanent teeth are affected by anterior tooth trauma, the procedure depends on the severity of the damage. The preservation of the tooth structure is of primary importance. The more carefully the immediate medical measures are carried out, the better the prognosis. If the tooth has been completely knocked out, it can only be reimplanted after very short interim storage. Here the prognosis is poor because the visit to the doctor is usually too late. If there is an enamel fracture, the prognosis is good, provided the anterior trauma is detected and observed. If there is a crown fracture with loss of tooth structure, the prognosis depends on whether the tooth nerve is exposed or not. With professional immediate treatment of an anterior tooth trauma affecting the tooth nerve, the tooth can usually be saved. In root fractures, the prognosis depends on the radiographic findings. Root fractures in which the oral cavity is injured may be affected by inflammation or bacterial colonization. Here, tooth loss is imminent if the anterior tooth trauma is not treated promptly. The prognosis is similar for tooth dislocation resulting from anterior tooth trauma. If the wiggling tooth is not loaded, it can grow back in. It may need to be straightened.
Prevention
Anterior tooth trauma can only be prevented to a limited extent, since it usually occurs as a result of an accident. Especially in children and adolescents, it is difficult to avoid accidents by controlled caution. If an anterior tooth trauma with tooth loss should occur, the knocked-out tooth should be collected and properly stored until it reaches the dentist to enable reimplantation under certain circumstances. To do this, the tooth lost in an anterior tooth trauma should be stored in moist conditions.
Aftercare
Anterior tooth trauma can result in a loose or knocked-out tooth or the breakage of most of the tooth structure in the visible area. Hard-substance injuries in the dentition are by no means only beauty-related. In addition to the aesthetic problem, biting or jaw problems can also arise. Anterior tooth trauma can be divided into concussions, subluxations, extrusions, luxations, avulsions and intrusions. Dental therapy depends on the severity of the damage caused. Likewise, follow-up care depends on how the anterior tooth trauma was treated and whether the jawbone was affected when the tooth was injured. Proper treatment and careful aftercare will ensure healthy teeth for years to come. If the tooth is completely knocked out and therefore has to be reimplanted, the aftercare must be carried out with particular care. It must be ensured that the reimplanted tooth has grown firmly back into the jaw. Since adolescents are often affected by anterior tooth trauma, follow-up care must also take into account the growth of the adolescent and the duration of the durability of tooth repairs. The repaired area may be different in color. It may remain more susceptible to further repairs from then on. It may be necessary to decide to crown the repaired anterior tooth during follow-up care. In addition, follow-up care must ensure that no sequelae remain after anterior tooth trauma by sensitivity testing of the anterior teeth at specific intervals.
What you can do yourself
If possible, the teeth in the anterior region should not be exposed to any further stress after an anterior tooth trauma. Biting off food should generally be avoided until healing or medical treatment. Biting down on soft foods is also not recommended. If possible, existing dentures should be removed temporarily if they cause pain. Only after consultation with the dentist and clarification of the symptoms can they be used again. In order not to trigger any further complaints, vibrations of the mouth, jaw and head should be reduced or completely eliminated. Sporting activities or situations with potential danger are to be avoided. In everyday life, this means that martial arts or ball sports should be limited or avoided. If there is no alternative for these situations, an individually adapted mouthguard must be worn. Jaw clenching and chewing with the front teeth should be avoided. When eating, food should be crushed with the middle or back teeth. In order to avoid further diseases despite the anterior tooth trauma, the teeth should be cleaned thoroughly every day.Care should be taken to ensure gentle cleaning. Depending on the existing complaints, the use of a soft toothbrush and mouthwash can be helpful. The use of force should be avoided when cleaning the teeth.
