Posts Tagged ‘traumatic dental injuries’


Apexowhat?! Yes, this is definitely quite a new word to wrap our heads around. What can I say? It’s a two-for-one deal: learning a little bit about dentistry while simultaneously sharpening your vocabulary skills. How convenient, right?

Anyway, in the previous post, I introduced the concepts of apexogenesis and apexification. Apexogenesis will be briefly discussed in this post.

Apexogenesis is a procedure performed after an injury that helps a young adult tooth root to continue growing and the the pulp to heal correctly. Medication is used on the surrounding soft tissues to prevent infection and ensure proper recovery. If the procedure is successful, the apex (remember, the root’s tip which has a slight opening) continues to close as the tooth grows, and the root canal walls thicken. A successful operation also relieves the patient of any further endodontic treatment, provided the pulp heals completely and the tooth’s life is fully preserved.

If, however, the apexogenesis therapy did not prove to be successful, apexification may be required. Details coming!

Dr. Sperbeck, West Los Angeles


Traumatic Dental Injuries: Children’s Cases

Dealing with injuries in children’s teeth is a little different than with grown adults; their incoming adult teeth have not fully come through and developed a strong, established root.

The apex, or tip of the root (way down/up in the gums), in a tooth that has not yet matured in a child’s mouth, has a far larger opening than a mature tooth. The reason why this opening is wider during the young stages is so that nutrients can more easily enter the tooth to help it develop strength and health as the child grows up. Compare it to an ice cream waffle cone, where the crown of the tooth is where the scoop of ice cream goes, and the apex is the pointy part at the bottom. If you were to bite a hole in the bottom of the cone, it would leave an opening… and ice cream would drip out.

Well, the anatomy of a tooth is similar. In a still-developing adult tooth, the hole is just much wider, and the walls of the root canal are thinner. As the child and his teeth mature, the apex opening grows smaller, the walls thicker, and the tooth becomes nice and sturdy.

If an injury were to occur to these young adult teeth, special care is needed if the health of the tooth is to be preserved to its full potential. One of two kinds of procedures may be needed: apexogenesis or apexification. I will cover these in future posts.

Dr. Sperbeck, West Los Angeles

Traumatic Dental Injuries: Other Injuries and Further Treatment

Besides fracturing immature adult teeth, the aforementioned dislodging or knocking out completely are some things that young people have to endure sometimes, unfortunately. However, modern dentistry has so much more to offer now than it ever did, thanks to science, technology and really, really smart people; so the level of treatment, restoration, or therapy only depends on the severity of damage done. The good news is that something can always be done.

If a young adult tooth were to be minorly dislodged (which means moved out of its natural position, remember?), extensive treatment may not even be necessary. The tooth may be only monitored over a period of time, possibly with minor adjustments made here and there, to ensure it continues to grow and develop normally. A tooth severely dislodged, surgery may have to be performed to restore stability and strength. In both of these cases, though, the tooth’s natural potential for strength will never be reached because of the injury, no matter what kind of treatment is performed.

If this immature tooth has been knocked out completely, if it can be put back into its socket and stabilized within one hour and watched closely by a dentist for a few weeks, chances are good that it can be saved. Changes in the tooth’s appearance and feeling will be monitored as well, and if any signs of decay or infection arise, then measures — particularly apexification — may have to be taken to keep it alive and well. If the tooth has been out for longer than an hour, it has probably dried out and must be filled with medication, put back into the socket, and re-stabilized as a “dead” tooth.

In either of those cases, the tooth is likely to not last as long as the others, in which case other options (say, an implant) will have to be discussed with the endodontist.

Dr. Sperbeck, West Los Angeles

Traumatic Dental Injuries: Root Fractures

The definition of a root fracture is exactly that — a fractured root.

In the tooth, of course.

Root fractures are horizontal cracks near the root of your tooth, occurring beneath the gum line (therefore requiring x-rays to find… when telltale pain and wiggly teeth first bring you to the dentist). The location of the fracture in relation to the ends of the tooth, the tip of the root (the apex) or the tips of the crown (the visible chewing surface), determines the lasting strength and health left in the tooth. The closer the fracture is to the root tip, the better the chances of a successful healing are. But the closer the fracture is to the crown, chances are it will not successfully heal on its own. A splint is also designed for this type of injury, to be worn temporarily as the tooth heals (if, of course, the fracture is minor enough to be left alone). If the pulp inside the tooth is damaged, a root canal may be required to disinfect and seal off the problematic area.

Dr. Sperbeck, West Los Angeles

Traumatic Dental Injuries: Avulsed Teeth

An avulsed tooth means it has fallen out — or been knocked out — completely. Even though it has been separated from your mouth, the tooth can still be saved if you act quickly. Try not to touch the root part of the tooth when you pick it up, and use only water to rinse it off if it is dirty. You must see a dentist immediately to try and put it back into its socket. Until that time, the more moist you can keep the tooth (i.e. by keeping it in a glass of water or milk with a pinch of salt), the better your chances will be of saving the tooth. Otherwise, if the tooth becomes infected or dies, an artificial tooth will probably have to replace it.

If, however, your dentist was able to salvage your real tooth and put it back into your socket, and design a splint to hold it in place for a while as it heals and re-stabilizes in your mouth. A root canal may be required to avoid or eliminate infection. The length of time the tooth was out of your mouth and the way the tooth was preserved will influence the decisions made on how your treatment will be carried out.

Dr. Sperbeck, West Los Angeles