Crown Root Fracture
Baby Teeth and Dental Trauma
In this section, we will cover:
- What is a crown root 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 a crown root fracture?
Following an injury, the tooth fractures into two or more pieces with the fracture line going through the crown and root of the tooth. The fracture line will extend from above to below the gum. The broken part of the tooth is likely to be wobbly and displaced (in a different position to normal).
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.
- If there are any broken fragments of the tooth, pick them up 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 when you first see them after the injury to make a diagnosis and as a baseline to compare future xrays against.
Sometimes no treatment is necessary for this type of injury, however this is only appropriate if it is possible to refer your child to be seen urgently (within a few days) by a dentist with experience in managing dental trauma in children.
Often, your dentist will have to remove the loose fragment of tooth and determine whether it can be restored. The following are potential treatments your child will need:
- If the tooth is restorable (can be saved) and the nerve isn't exposed, the tooth can be sealed with a glass ionomer (dental filling material)
- If the tooth is restorable but the nerve is exposed, your dentist will provide a procedure called a "pulpotomy". This procedure is carried out under local anaesthetic and involves:
- removing a small amount of inflamed nerve tissue
- placing a soothing medicine over the remaining nerve
- sealing the nerve with glass ionomer (dental filling material)
- restoring the tooth with a dental composite
This treatment 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. - If the tooth is unrestorable (cannot be saved), there are two options:
A) Remove only the loose fragment and leave the firm part of the tooth in the gum
B) Remove the whole tooth (see dental extraction)
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.