Crown Fracture: Enamel-Dentine

Baby Teeth and Dental Trauma

In this section, we will cover:

  1. What is an enamel-dentine (crown) fracture?
  2. What should I do after the injury?
  3. Will I need treatment?
  4. What can I do to help the area heal at home?
  5. Will I need any follow up appointments?
  6. What should I look out for?
  7. What are the long term complications?

What is an enamel-dentine (crown) fracture?

This is an injury in which the crown of the tooth has fractured, exposing the middle layer of the tooth (dentine). The tooth will usually be quite sensitive to temperature and touch. 

What should I do after the injury?

It can be very distressing if 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:

  1. Take a second to collect yourself and check your child hasn't blacked out.
    If 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).

  2. Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.

  3. Pick up any broken fragments of the tooth if you can find them. You should take these to your dentist's appointment so they can check the fragment hasn't been accidentally swallowed and no tooth fragments are in any cuts in the soft tissues.

  4. If there is any bleeding, you should dampen a clean handkerchief in salt water and press it firmly on the bleeding area.

  5. 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?

Baby teeth with a fracture which has exposed the dentine should be restored or sealed with either:

  • Glass ionomer
    Often immediately after a dental injury, the mouth is quite sore and your child may not be able to tolerate much treatment. Glass ionomer is a temporary filling material which can be used to seal the fractured tooth at the initial appointment as it takes much less time to place than a dental composite.
  • Dental composite
    Either at the initial appointment or a future appointment, the tooth can be built up to its natural shape with a dental composite. This requires more cooperation as it takes more time to place and requires your child's mouth to stay open for much longer.

An xray is not required at this stage unless:

  • Your dentist would prefer to take an xray as a "baseline" against which he can compare future xrays
  • Your dentist thinks there may be some tooth fragments embedded in the soft tissues around the mouth. 

If there are any injuries to the soft tissue, you can see here for more information.

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
  • Use a cotton swab/handkerchief moistened in salt water or alcohol-free chlorhexidine mouthwash (Corsodyl) to clean the gum twice a day for 1 week
  • Have a soft diet for the first few days
  • Take medicine to help manage any discomfort (ibuprofen or paracetamol)
  • Avoid contact sports

Will I need any follow up appointments?

Your dentist will want to review your child for clinical examination after:

  • 6-8 weeks

What should I look out for?

The long term consequences of dental trauma are unpredictable. You should monitor your child's teeth for any signs of infection.

Favourable outcome

  • No pain
  • Normal colour of the tooth
  • Temporary darkening of the tooth to red/grey/yellow

Unfavourable outcome

  • Pain
  • Abscess on the gum
  • Increased mobility (but this can be normal as the adult tooth starts to come through)
  • Permanent grey/brown discolouration of the tooth, along with one of the signs/symptoms above

What are the long term complications?

In most cases, there will be no long term complications following an enamel-dentine fracture.

If the baby tooth becomes painful or infected, it will need to be removed (see dental extraction). There will be a gap here until the adult tooth erupts at around 6-7 years old.

Treatment can be done under local anaesthetic, inhalation sedation or general anaesthetic depending on the age and cooperation of your child.

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