Asking Detailed Information:
The dentist will ask you for detailed information about the injury to your tooth/teeth, mouth and face and ask about the symptoms you are experiencing. Extraoral Exam:
The dentist will inspect the soft tissues and bone structures of the head and neck to determine any injury/trauma such as laceration (cuts), contusion (bruising), swelling, bleeding and bone fractures.
Your jaw joints (TMJ) as well as the ligaments and muscles associated with jaw function will also be examined.
Intraoral Exam:
The dentist will examine your mouth and teeth using techniques such as:
Visual inspection: looking at the oral soft tissues and teeth for signs of trauma; looking at the soft tissues of the lip, gum and inner cheek (mucosa) for signs of any foreign body material that may have become imbedded in the tissues as a result of the injury (material such as glass or metal particles, or a piece of broken tooth or bone).
Palpation: pushing on the tooth/teeth that have been hit to determine the looseness/mobility of the teeth; gently pressing on the bone around the teeth to determine any fracture; gently pressing on the upper and lower jaw inside the mouth to determine any tenderness, swelling or mobility of the jaw.
Checking your occlusion (bite) for signs of malocclusion in order to determine if your teeth meet together properly.
Radiographs (“X-rays”); a panoramic radiograph (“Panorex”) will be taken to allow the dentist to look at the condition of the upper and lower jaws and all the teeth. Radiographs of individual teeth will be taken to examine the condition of teeth, the pulp/root canal and the supporting bone. Conventional radiographs will be shown to you on film, digital radiographs will be shown to you on a computer screen, where the images can be enlarged and enhanced to show the problem in more detail.
If at any time during the exam, your dentist thinks you need additional specialty care from an oral Surgeon, endodontist, periodontist or physician, your dentist will help make a referral to the specialist or physician on an emergency same-day basis if needed.
Treatments for Avulsed TeethCompletely Avulsed Tooth:
If the tooth has been completely knocked out less than an hour before you get to the dentist, the dentist will attempt to reimplant the tooth in its socket. The tooth may require immediate root canal treatment, either performed by the dentist or by an endodontist the dentist referred to you for emergency root canal therapy. The tooth may also be splinted using orthodontic wire, orthodontic brackets and affixed with plastic resin (bonding) material so that the tooth stays properly in place while it is healing. You will be given instructions on how to care for your mouth and may be given a prescription chlorhexidine mouth rinse to keep the area clean, prescriptions for an antibiotic to prevent infection and an analgesic prescription for pain. You may be required to see your physician to have a tetanus vaccination. You will see the dentist for follow-up visits after having your tooth reimplanted to monitor the healing and condition of your tooth and mouth.
Partially Avulsed Tooth:
If the tooth has been partially knocked-out, the dentist will attempt to move the tooth back into proper position in the socket. Root canal treatment may be required along with splinting, instructions, and prescriptions as described in the information above, about treatment for a completely avulsed tooth.
Tooth Pushed into Socket:
If the tooth has been pushed up into the socket, the dentist will attempt to save the tooth by holding on to the crown of the tooth with forceps and pulling the tooth back down in the socket in its proper position. In some cases the dentist will need to refer you to an oral surgeon and/or endodontist to accomplish this procedure. Surgery may be required to access the tooth to save it. Root canal treatment may be required, along with splinting, instructions and prescriptions as described in the above information for a completely avulsed tooth. If the tooth cannot be recovered in good condition to be replanted (for example, the tooth root is damaged, or the tooth or root are fractured) the tooth will need to be removed and replaced later with a dental implant or bridgework.
Additional Injury with Avulsion:
If additional injury occurred to your lip, gum tissue, bone structure around the teeth, jaw bone or jaw joints (TMJ), your dentist will refer you to the appropriate dental specialist or physician for closure of wounds, management of a broken jaw, injury to the TMJ, and/or for reconstructive treatments caused by bone or tissue damage/loss.
Tooth/Teeth Unable to be Reimplanted:
If the tooth can not successfully be reimplanted, the dentist or dental specialist (periodontist, oral surgeon and/or prosthodontist) will help replace the tooth with a dental implant, or a fixed bridge. If bone damage occurred where the tooth was lost, bone reconstructive procedures will be necessary to allow for proper dental implant placement or fixed bridge tooth replacement.
