Alveolar Bone Fracture
Adult Teeth and Dental Trauma
In this section, we will cover:
- What is an alveolar bone fracture?
- What should I do after the injury?
- Will I need treatment?
- What can I do to help the area heal at home?
- Will I need any follow up appointments?
- What should I look out for?
- What are the long term complications?
What is an alveolar bone fracture?
This is an injury which results in fracture of the alveolar bone which holds the teeth in place. You will usually find:
- broken segment of bone is mobile and displaced
- multiple teeth moving together
- interference/change in the bite
What should I do after the injury?
It can be very distressing if you/your child has suffered trauma to the teeth. The first thing to do is not panic.
Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.
You should:
- Take a second to collect yourself and check you/your child hasn't blacked out.
If you/your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury). - If the teeth are interfering with the bite, try to reposition the broken segment with your fingers, then gently bite down on a clean cloth.
- Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
- If there are any cuts in or around the mouth, clean them with warm water. If there is any bleeding, dampen a clean handkerchief and press it firmly on the bleeding area.
- If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.
Will I need treatment?
Your dentist will take an xray of the teeth to check for any other injuries and to compare any future xrays against.
The broken segment of bone/teeth will need to be repositioned. This procedure involves:
- Local anaesthetic to make the area numb so the procedure is more comfortable
- Reposition the displaced segment
- Splint (flexible metal wire) placed on the teeth in the injured area and the teeth either side to hold the segment in the correct position. This is left on for 4 weeks.
If there are any injuries to the soft tissues (gum, lip, tongue), you can see here for management.
What can I do to help the area heal at home?
To help the area heal at home, you should:
- Brush the teeth after every meal with a soft toothbrush
- Gently brush the injured area to prevent build up of plaque
- Carry out salt water or alcohol-free chlorhexidine mouthwash (corsodyl) twice a day.
For a young child who isn't able to use a mouthwash, use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day - Have a soft diet
- Take medicine to help manage any discomfort (ibuprofen or paracetamol)
- Avoid contact sports
- Don't smoke
Will I need any follow up appointments?
Your dentist will want to see you/your child again for a clinical examination and xray after:
- 4 weeks (splint will be removed at this appointment)
- 6-8 weeks
- 4 months
- 6 months
- 1 year
- Yearly for 5 years (minimum)
X-rays are taken to assess how the root of the tooth is developing and to identify any complications with healing.
What should I look out for?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection.
Favourable outcome
- No pain
- slight tenderness over the fracture line may be present for several months - Normal colour of the tooth
- Correct position of teeth and no disturbance in the bite
- Soft tissues healed well, no obvious scar
- Xray: healing of the bone at the fracture site
Unfavourable outcome
- Pain
- Abscess on the gum
- Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
- Disturbance in bite due to incorrect positioning of the teeth
- Soft tissues not healed properly
- Xray:
- no bony healing at fracture site
- external inflammatory resorption (see "long term complications" below)
What are the long term complications?
The long term consequences of dental trauma are unpredictable. You should monitor your/your child's teeth for any signs of infection (see "unfavourable outcome" above).
Possible long term complications of alveolar fracture include:
1) Nerve dies causing pain and infection.
- The tooth/teeth in the injured area may look grey/brown and be tender to bite on.
- This can be managed with root canal treatment.
- Once the tooth has been treated, it can be whitened to improve the appearance. You can find about more about tooth whitening here.
2) Bone fracture doesn't heal
- This is where the two parts of the bone on either side of the fracture line fail to re-join.
- You will need to be seen by a specialist (either an "oral surgeon" or "oral and maxillofacial surgeon") for further investigation and management.
- Possible treatment includes debriding (cleaning) the fracture site, a bone graft and connecting the two parts of the bone with a metal plate and screws.
3) External inflammatory root resorption
- This is where the outer surface of the root starts to "dissolve" away due to infection.
- Root canal treatment should be started immediately to try to stop it progressing.
- Your dentist may refer you to a specialist children's dentist (paediatric dentist) or root canal specialist (endodontist) to continue treatment.