Crown Fracture: Enamel-Dentine-Pulp
Baby Teeth and Dental Trauma
In this section, we will cover:
- What is an enamel-dentine-pulp (crown) 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 enamel-dentine-pulp (crown) fracture?
Also known as a "complicated crown fracture", this is an injury in which the crown of the tooth has fractured, exposing the nerve. The tooth will usually be very 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:
- 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). - Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
- 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.
- If there is any bleeding, you should dampen a clean handkerchief in salt water 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 as a "baseline" against which they can compare future xrays. They will also take an xray if there may be some tooth fragments embedded in the soft tissues around the mouth.
If the nerve of the tooth has been exposed, the tooth will need a procedure called a "partial pulpotomy". This preserves the health of the nerve and allows the tooth to be saved. It requires a high level of cooperation and is usually carried out by a dentist with experience in treating children and managing dental trauma. This will usually require an urgent referral by your dentist to the appropriate specialist service.
A partial pulpotomy is carried out under local anaesthetic and involves:
- Removing a very small amount of inflamed nerve tissue
- Placing a soothing medicine over the remaining nerve
- Sealing the nerve with a glass ionomer (dental filling material)
- Restoring the tooth with a dental composite
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:
- 1 week
- 6-8 weeks
- 1 year (your dentist will also take an xray at this appointment to review the pulpotomy)
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?
Not all teeth which have suffered dental trauma have long term complications.
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.