KNOCKED OUT TOOTH

Dental trauma can occur at any time and when you least expect it. Trips, falls and blows to the face are all common causes of a knocked out tooth.
There are a number of other issues that can arise due to a traumatic injury to the body of a tooth, with avulsion (completely knocked out) being the most extreme. These include concussion (a knock), subluxation( a minor loosening), extrusion(the tooth has moved out of the socket and looks longer), lateral luxation(the tooth has been pushed backwards or forwards but is still in the socket), intrusion(the tooth has been pushed further into the socket and may look shorter than before).
What can you do to help a knocked out tooth?
There are a few things that you can do to help maximize the chances of your tooth being replanted, and minimizing the risk of complications.

How to fix a knocked out tooth
Teeth can be knocked out due to direct trauma through blows to the face, sports injuries and trips.

1. Assess other injuries. If the person who has sustained the injury requires further medical attention then this must be sought first. In the meantime you need to try keep the tooth clean and moist.
2. Keep the tooth moist. You can ask the patient to insert the tooth into the socket (if it is clean) or hold it in their cheek fold. Do not attempt to scrub the surface of the root-it contains very sensitive cells and fibers that are important for the healing process. Alternatively, you can keep the tooth moist in contact lens solution or milk. Allowing the tooth to dry out plays a big role in complications arising.

store knocked out tooth in milk until you get to an emergency dentist
Store your tooth in a moist medium until you can see an emergency dentist.

3. The highest chances of a successful replantation is to have the tooth professionally replanted within 1-2 hours. This minimizes the risk of complications and failure of replantation.
4. Arrange an appointment with the emergency dentist or 24 hour dentist, time is of the essence.
What will happen at the dental emergency clinic?
The emergency dentist will do a thorough examination. This may include x-rays and clinical photographs. They will also assess soft tissue injuries and injuries to adjacent teeth. You may also have an examination performed to ensure you have not broken or fractured your jaw.
An assessment will also be made of the likelihood of a successful replantation. This is dependent upon how long it has been since the injury, whether the root of the tooth has been damaged in any way, whether the tooth has been kept in a moist medium, how old the patient is and the stage of root development, and whether there are any further injuries to the supporting tissue of the root in the jaw.

Replantation of a knocked out tooth
1. You will be numbed using local anaesthetic
2. The socket will be gently flushed out with saline to ensure there is no foreign debris inside
3. The tooth may be allowed to soak in some special solution for 20 minutes to help its success at replantation
4. The tooth will be very gently replanted and an x-ray will be taken to confirm it’s correct positioning
5. The emergency dentist will place a flexible splint, it may look like a brace. This needs to be kept for 4 weeks to allow the tooth to replant with the bone and to keep it in position
6. You may be given antibiotics
7. You will be required to reassess the tooth regularly in order to make sure that no complications are arising. Complications can occur at any stage, even many years after the injury, so it is important that your regular dentist is routinely examining the tooth.

You will need to follow some basic instructions:
1. Avoid participation in contact sports.
2. Soft diet for up to 2 weeks. Thereafter normal function
as soon as possible.
3. Brush teeth with a soft toothbrush after each meal.
4. Use a chlorhexidine (0.1%) mouth rinse twice a day for
1 week.

What is a dental abscess?

 

A dental abscess is a collection of pus that forms around the tissues of the tooth and can spread into the surrounding tissues.

It is most often caused by a bacterial infection of the pulp of the tooth secondary to decay or trauma to the tooth.

They are not always immediately painful or symptomatic, such that you may not be aware of it’s presence for some time until it’s too late.

There are two main types of dental abscess, a periapical abscess (related to the main body of the tooth) and a periodontal abscess (related to the gum tissue of the tooth).

What are the signs and symptoms of a dental abscess?

  1. Severe, persistent, throbbing toothache that can radiate to the jawbone, neck or ear
  2. Sensitivity to hot and cold temperatures from the tooth
  3. Sensitivity/pain on chewing or biting
  4. Fever/raised temperature
  5. Swelling in your face or cheek or lips/chin, or the area under the eye. You may also develop a swelling in the gum besides the tooth, and this may develop a pimple like opening.
  6. Tender, painful and swollen lymph nodes under your jaw or in your neck
  7. Sudden rush of foul-smelling and foul-tasting, salty fluid in your mouth and pain relief if the abscess ruptures

    dental abscess and 24 hour dentist at emergency dentist
    A dental abscess causing a localised gum swelling.
  8. The offending tooth may feel loose and raised, such that you touch that tooth prior to any others when closing your mouth.

A dental abscess is something that you cannot ignore. Although symptoms may reduce, especially if any swelling bursts, they will not go away, may become more aggressive and may leave you open to dangerous complications.

You need to see a 24 hour dentist immediately. Left untreated the fluid may spread to other structures and cause difficulties breathing. There is also a risk of septicemia.

Signs of complications

  1. Difficulty in opening the mouth
  2. Very high fever
  3. Severe difficulty in breathing and or swallowing
  4. A raised tongue, such that your mouth feels smaller than usual
  5. In rare circumstances dental abscesses can spread to other organs including the brain
dental abscess
A swollen face can be distressing and debilitating. It is usually caused by a dental abscess

Treatment

The main principle is to manage the source of the abscess

  1. Opening the tooth to allow a portal for pus to drain (initiating root canal treatment)
  2. Removal of the offending to tooth
  3. Incisional drainage of any well-formed swelling. This is normally done inside the mouth, but in extreme cases may be required from the skin side.

    Drainage of dental abscess
    This procedure normally provides some immediate relief. Surface anaesthesia is used to numb the swelling, and a small incision is made to allow a path for drainage. a drain may be placed to help keep the incision open
  4. Prescription of antibiotics

Normally, a combination of some of these treatments is performed, the aim is to allow the abscess to resolve prior to definitive treatment.

Tips

  1. Do not ignore
  2. Do not hope that it will go away. You need to see an emergency dentist.
  3. Do not attempt to lance or drain the swelling yourself
  4. Do not attempt to remove the tooth yourself (yes, we’ve seen people try)
  5. Using your partner’s antibiotics that your girlfriend’s GP gave to her 2 years ago for a UTI will not help. You are just delaying appropriate treatment.
  6. If you are feeling very unwell, experiencing difficulties in breathing and running a very high temperature, then a trip to A/E may be in your best interest.

    emergency treatment of dental abscess
    Extra-oral drainage and drain placement

How to deal with cuts and minor soft tissues in and around the mouth

Swollen lip can occur due to direct trauma

 

There are many reasons why you may get cuts and soft tissue injuries in and around the mouth, including trauma and unexpected reasons like sharp pieces of food or unexpected foreign objects in food (like bone).

The main types of wounds to be expected are cuts, grazes, minor lacerations, puncture wounds. They can be very painful as the wound stretches during normal function and can also sting and bleed profusely.

The wounds generally tend to bleed a lot because the mouth is very heavily vascularised, and the bleeding can sometimes be surprising as it is not proportional to the size of the injury. As the blood mixes with saliva, it can appear even more serious than it really is.

Management is fairly straight forward. Most minor injuries in the mouth will heal of their own accord over the course of a few days.

First, don’t panic.

  1. Try to keep the area clean. Bathe the area with warm salty water or an antiseptic mouthwash
  2. Bleeding normally stops after a few minutes of compression with some clean gauze or cotton. If you don’t have access, a clean tea bag will do the job
  3. Avoid spicy and hot food-these will probably sting.
  4. Use painkillers if required.
Swollen lip can occur due to direct trauma
Cuts and swollen lips and mouth

If you find that the wound and pain is not improving after a few days, or if you are having difficulty stopping bleeding, then you should see your emergency dentist. Control of bleeding is a real dental emergency, and if necessary arrange to see a 24 hour dentist.

The emergency dentist will assess why your wound is not healing or stopping bleeding. To help stop bleeding, especially if the wound is deep, your dentist may apply chemicals to help or place stitches.

If the wound is not healing, the emergency dentist may check for infection. This is more common if the wound has not been cared for, if you smoke, if the wound is very deep or if you have underlying medical conditions.

Please do not place clove oil on wounds, it burns the tissue and you will find it more painful than necessary.

If you have suffered trauma that has caused the wound, you may need to go to A/E for further follow-up, including tetanus shots.