By Beth Wolfe, CAGS, ATC
Dental injuries and emergencies are not new to the profession of athletic training. Trauma to the maxillofacial area can be painful and unaesthetic for many, and Athletic Trainers provide a crucial role in preventing and treating these dental injuries. It is important to recognize when a dental injury is a dental emergency, and it is imperative to always be prepared in the event a dental emergency occurs.
About Dental Injuries
Teeth and facial bones can be easily damaged with and without protective dental/facial equipment. Wearing a mouth guard and helmet with a cage will significantly reduce the risk of sustaining a dental injury. However, depending on the type and amount of force exerted on the facial region, injuries may still occur despite the use of protective equipment. Emergency Action Plan (EAP) activations do apply to some types of dental injuries, and Athletic Trainers need to be prepared to activate their EAP in the event a dental emergency occurs. Furthermore, Athletic Trainers need to have the proper supplies to effectively treat and care for a dental injury/emergency as the viability of a tooth will depend on the resources and immediate care of the healthcare provider.
Types of Dental Injuries
Some of the most common injuries to the facial region include (Knowlton, et al., 2014):
• Fractures to the maxilla and mandible
• Fractures to the tooth/teeth
• Lacerations to the lips, gums, cheeks or other soft tissues
• Tooth intrusion/extrusion
• Tooth avulsion
Many dental injuries may cause the patient to bleed; however, not all bloody injuries are emergencies. If a patient is bleeding it is best to control the bleeding with direct pressure by gauze, and the patient may assist by holding pressure with their hands or biting down. Once the bleeding has subsided, it will be easier to assess the injury to determine if it is a dental emergency. Tooth intrusions and extrusions, as well as facial lacerations, are uncomfortable and will need advanced medical care within 2-3 hours of the injury. However, unless there is suspicion of a fracture to either the bony structures of the face or to the pulp/root of the tooth, these dental injuries do not need activation of the EAP.
There are 4 types of tooth fractures: enamel (most superficial), dentin (middle layer), complicated crown (inner layer that can bleed and is pink/red in color) and root (deepest portion, imbedded in gum) (Knowlton, et al., 2014). A picture of these types of can be found in Figure 1. – Types of Tooth Fractures. Enamel and dentin fractures can be painful and unaesthetic, but these are not emergencies. These 2 types of tooth fractures do need advanced dental care; however, emergency room physicians will not be able to provide much care besides splinting, pain medication, antibiotics and a referral to a local dentist (A. Colangelo, personal communication, March 19, 2015). Fractured pieces of the tooth may be kept in a cup of the patient’s saliva, cold milk or tooth storage solution (i.e., Save-A-Tooth or Hank’s Balanced Solution). Do NOTstore fractured tooth pieces in tap water or saline as this can cause damage to the remaining live cells in the tooth (A. Colangelo, personal communication, March 19, 2015).
Dental Emergencies and Care
A dental injury can become a dental emergency very quickly, and some of the most common dental emergencies are:
• Complicated fractures of the tooth/teeth (pulp or roots exposed)
• Avulsion of the tooth (tooth comes out of socket)
• Suspicion of facial bone fracture or TMJ injury
These injuries DO need immediate medical attention, and activating the EAP is recommended. For tooth avulsions and complicated fractures hold the tooth by the crown ONLY and refrain from touching the roots. Rinse dirt and blood off the fractured or avulsed tooth using saline, tap water, milk or the patient’s saliva. Refrain from scrubbing or rubbing the tooth as this may remove the remaining periodontal ligament and/or other live tooth cells (A. Colangelo, personal communication, March 19, 2015). In order to increase the likelihood of survival of a fractured or avulsed tooth, it is recommended that the tooth is relocated and placed back into the socket as soon as possible and preferably within 15 minutes (A. Colangelo, personal communication, March 19, 2015). If the tooth is relocated, have the patient bite down on gauze or wear their mouth guard (if they have one already molded to their mouth) in order to keep the tooth/teeth in place until they arrive at the hospital.
Information provided for this post was retrieved from the Crest Oral B Sport-Related Dental Injuries guidelines and Dr. Augustus Colangelo, Assistant Professor of Emergency Medicine and Attending Physician at Tufts Medical Center.
Knowlton, R, Kratcher, CM, & Smith, WS. (2014). Sports-Related Dental Injuries and Sports Dentistry. Crest Oral B Continuing Education Course. Retrieved from: http://www.dentalcare.com/media/en-us/education/ce127/ce127.pdf.
Levkiv, MO. (n.d.). Non-carious lesions of teeth that appears before teeth eruption. Classification, pathomorphology, clinic, diagnosis, differential diagnosis and treatment of un-carious lesions. Retrieved from: http://intranet.tdmu.edu.ua/data/kafedra/internal/stomat_ter/classes_stud/en/stomat/ptn/Therapeutic%20Dentistry/5%20year/X/01.%20Non-carious%20lesions.htm.