Trauma During Treatment
Unfortunately things happen. Trauma to the face can happen in an instant especially during sports, and it can be quite scary.
If the soft tissue (gums, tongue, cheek) in the mouth gets cut or injured, there can appear to be a lot of blood because it mixes with saliva and looks like it is more than it is. Additionally, the soft tissue is very vascular (lots of blood vessels). Therefore, even a small injury can lead to bleeding. Luckily most injuries to the soft tissue in the mouth heal relatively quickly. When you are wearing braces, the roughness of the braces can cause additional cuts during a hit to the mouth, or the braces can get stuck on the soft tissue. If this happens, try to gently dislodge the tissue from the braces and use an ice pack to help with swelling. If the injury to the soft tissue is severe, it may require stitches. If the injury is in a visible area such as the lips or skin, it may be necessary to see a plastic surgeon for the repair to achieve the most esthetic outcome.
It may not seem like it at the time, but I cannot tell you how many times I have told patients they were lucky after a traumatic event! When a patient is wearing braces they have wires and brackets holding firmly onto their teeth. Having these braces on has been the difference between cuts in the mouth and actually losing teeth!
In some instances the trauma to the mouth or face is so significant that it is beyond soft tissue injury. Trauma to the mouth can occur in a lot of different ways. I have seen a patient injure a tooth after a decent knock from a spoon! Of course, that is less uncommon. Much more common is trauma that occurs due to sports. A ball or elbow to the face… Getting hit with a hockey stick… Running and falling… Injury can occur to the soft tissue as well as the teeth and bone. A hit to the face can result in a broken tooth, a tooth with a bruised or destroyed nerve, or a tooth that has loosened or come out of it’s socket. There could also be injury to the bones of the face.
If you get hit in the face, first try to stay calm. Then check to see if you have any injuries to the bones and the teeth, then soft tissue, and finally check the integrity of the braces. If you experienced a concussion or have an obvious bone fracture, please go the Emergency Room as soon as possible. You may have sustained serious injury to the face, head and neck and you need to be evaluated and treated.
Injury to the teeth themselves is a common occurrence. If there is just a small chip or fracture in the enamel (outer layer of your tooth), then most often this can be repaired by your general dentist with composite bonding material. If the break is much deeper, depending upon the severity your dentist may repair with composite, a veneer, or a crown. In some instances a root canal may be needed first if the pulp/nerve is affected. If the teeth look generally intact, please still let us know about the occurrence at your next visit. We will still want to monitor your teeth over time because there could be injury below the surface that is not visible. If there was injury to the nerve of the tooth due to trauma, sometimes the effects do not show up immediately but will appear over the course of several weeks. We will want to watch and see if any color changes occur. If your tooth or teeth start to grey, this could be a sign of damage to the inside of your tooth. Often times the treatment for this is a root canal- and for that we would send you for an evaluation with your general dentist or endodontist. If the dentist finds that the root of the tooth is fractured, the repair could be more significant.
If a tooth feels a little loose after trauma, but looks intact and not broken, we will likely place a very thin wire in your braces to gently hold the tooth in position, and monitor with little to no movement of these particular teeth for about 4 months. If the tooth shows signs of internal bruising/damage, we will ask your general dentist to evaluate as needed to possibly have a root canal. If a tooth is significantly dislodged out of position, comes completely out of the socket, and or/the bone has broken around the tooth, it is best to see an oral surgeon as soon as possible. The oral surgeon will most likely numb the area and reposition the tooth and compress the bones, pushing things back into place.
It is important to get seen right away if a tooth is knocked out, ideally within 30 minutes if possible. It is possible to save a tooth that has been out for 1-2 hours, but the most promising window is within the first half hour. Locate the tooth, and pick it up by the crown not the root. If the tooth is dirty because it landed on the ground do not scrub the dirt off. Rinse the tooth with water only, and do not use any chemicals to clean it. Also, do not dry with a towel. IF possible, put the tooth back into the socket and hold it in place with your fingers until you can be seen. If this is not possible, keep the tooth moist by keeping it carefully in your cheek (in saliva), or placing it in a cup of milk.
Once the tooth is repositioned by an oral surgeon, call us so that we can replace any broken brackets or wires that will serve to hold the tooth in position. Over time the tooth will be monitored to see if it solidifies in the bone. Since the tooth was out of it’s socket and it’s nerve supply was broken, the tooth will no longer be vital and will likely need treatment and possible restoration with the general dentist, however having your own tooth in the bone is always preferable.
If any of these scenarios occur, please remember that the braces should be last on the list of concerns. If braces or wires become loose or broken, these can always be fixed at a later time. It is important to attend to any serious bodily, facial, head, or mouth injury first. If the extent of the injury is uncertain, it is advisable to be ‘safe than sorry’, and go to and Emergency Room for evaluation.
Many traumatic injuries can be avoided with some simple precautions. Wearing a mouthguard whenever you are involved in sports is highly recommended. Of course a mouthguard cannot ward off all injuries, but it can often prevent serious injury to the mouth and teeth. There are braces-friendly mouthguards that are specifically made to fit over braces and still allow movement of teeth.