During a traumatic dental injury, a tooth may become displaced in its socket. This can be one of the more serious injuries, and your endodontist may need reposition and stabilize your tooth. Root canal treatment is usually initiated within a few weeks of the injury, and a medication, such as calcium hydroxide, may be placed inside the tooth. A permanent root canal filling will be placed at a later date. You should continue to have the tooth monitored periodically by your dentist to assure proper healing.
If a tooth is completely knocked out of your mouth, time is of essence. If this type of injury happens to you, pick up your tooth by the crown, or chewing portion. Try not to touch the root. If the tooth is dirty, gently rinse it in water. Do not use soap or any other cleaning agent. If possible, place tooth back into its socket. Go to the dentist immediately.
If you cannot put the tooth back in its socket, placing the tooth in milk can keep the tooth surface moist; the less time the tooth spends drying out, the better chance for saving the tooth. Be sure to bring your tooth to the dentist immediately.
If the tooth has been put back in its socket, your dentist may stabilize the tooth with a splint and check for any other facial injuries. Depending on the stage of root development, your dentist or endodontist may start root canal treatment. The length of time the tooth was out of the mouth and the manner in which the tooth was stored before reaching the dentist may influence the type of treatment you receive and the ultimate prognosis of the tooth.
Injuries in children
An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:
One procedure, called apexogenesis, encourages the root to continue developing, as it helps heal the pulp. The injured soft tissue is covered with a medication to encourage further root growth. The apex (root tip) continues to close, and the walls of the root canal thicken. If the pulp heals, no additional endodontic treatment may be necessary. The more mature the root becomes, the better the chance that the tooth can be saved.
The endodontist places a medication into the root to help a hard tissue form near the apex, or root tip. This hard tissue provides a barrier for the permanent root canal filling. In spite of appropriate treatment, the root canal walls of a tooth treated by apexification will not continue to develop and thicken, making the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and maximize protection of your tooth.