Root Fracture
Baby Teeth and Dental Trauma
In this section, we will cover:
- What is a 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 root fracture?
This is an injury in which the root of the tooth has fractured below the gum. You will not be able to see the fracture but the tooth may be wobbly or displaced from its original position. This looks similar to a lateral luxation injury.
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 stay calm.
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.
Not all teeth which have been diagnosed with a root fracture will need treatment. This decision will be based on how loose the tooth is and whether it is interfering with the bite:
- If the tooth is still in its original position, no immediate treatment is needed but the dentist will want to monitor the teeth.
- If the tooth is displaced (not in its original position) but not interfering with the bite, or there is only a slight interference, no immediate treatment is needed but the dentist will want to monitor the teeth.
- If the tooth is displaced, wobbly and interfering with the bite, there are two options:
A) Dental extraction: the broken wobbly part of the tooth will need to be removed. The root, which is still firmly in the bone, can be left until it is pushed out by the adult tooth (around 6 years old)
B) Reposition the tooth: the wobbly part of the tooth will need to be gently repositioned to its original position (or as close to it as possible) under local anaesthetic. If the tooth is loose, a splint (flexible metal wire) can be placed on the injured tooth and the teeth either side of it for 4 weeks to hold it in place
This treatment generally 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 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
- Have a soft diet
- Take medicine to help manage any discomfort (ibuprofen or paracetamol)
- Avoid contact sports
Will I need any follow up appointments?
The number and frequency of follow up appointments will depend on what treatment was needed after the injury.
If no treatment was needed, your dentist will want to see your child again for a clinical examination after:
- 1 week
- 6-8 weeks
- 1 year
- Once a year until the adult tooth has erupted (usually at 6 years old)
If the tooth was repositioned and splinted, your dentist will want to see your child again for a clinical examination after:
- 1 week
- 4 weeks (to remove the splint)
- 8 weeks
- 1 year
If the wobbly part of the tooth was extracted (but the root left in the gum), your dentist will want to see your child again for a clinical examination after:
- 1 year
If your dentist is concerned there may be long term complications, they will review the area every year until the adult tooth has erupted (come through the gum).
An x-ray is not usually needed at follow up visits unless your dentist is concerned about damage to the nerve/infection.
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
- Tooth repositions itself in line with the rest of the teeth
Unfavourable outcome
- Pain
- Abscess on the gum
- Increased mobility (but this can be normal as the adult tooth starts to come through)
- Permanent grey discolouration of the tooth, along with one of the above signs/symptoms
- Tooth remains displaced from normal position
What are the long term complications?
In most cases, there will be no 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.