What to do after an accident?

In this section, we will cover:

What should I do straight after the accident?
What can I do to help the area heal?
What signs should I look out for after an accident?
Will I need treatment?
What are the long term complications?

What should I do straight after the accident?

First of all: don't panic!

You should:

Take a second to collect yourself and check you haven't blacked out.
If you hit your head and think you may have lost consciousness or feel nauseous or dizzy, you should get checked out by your doctor or local A&E department to rule out a concussion
Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
If the tooth has broken, pick up any broken fragments of tooth.

If the whole tooth has come out, pick it up ONLY by the crown (the white part) to avoid damaging the root surface. See here (LINK) to find out about first aid for a tooth which has been knocked out.

You should place the fragments/tooth in some cold milk. Time is of the essence here - the longer a tooth is kept dry, the poorer the prognosis. If milk is not available, you can place the tooth in the gap between the lower teeth and the cheek. This is NOT a suitable option for a child who may swallow the tooth by accident.

If the tooth has been pushed backwards/forwards/out of the socket, try to gently reposition it with your fingers.
If there is any bleeding, you should dampen a clean handkerchief in salt water and press it firmly on the bleeding area.
If you suffered an injury in a place thought to be unclean, you could be at risk of tetanus. You should check your tetanus vaccinations are up to date with your GP.

What can I do to help the area heal?

To help the area heal at home, you should:

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
Avoid contact sports
Don't smoke

What signs should I look out for after an accident?

Teeth which have suffered dental trauma are unpredictable. You should monitor the teeth for any signs of infection. Sometimes the teeth either side of the obviously damaged tooth can also develop symptoms.

Favourable outcome

No pain
Tooth is a normal colour
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 discolouration of the tooth, along with one of the above signs/symptoms

Will I need treatment?

This depends on whether it is a baby tooth or an adult tooth, how severe the damage is and whether there are any complications with healing.

The aims of treatment are:

Relieve any pain or discomfort
Prevent damage to the underlying adult tooth
Maintain the tooth for as long as possible (more relevant to adult teeth)

The treatment which can be offered depends on your/your child's level of anxiety and co-operation with dental examination and treatment.

Often no treatment is a good option for young pre-cooperative children. You and your dentist can monitor the tooth for any signs of an unfavourable outcome (see above) and manage them when they arise. This prevents any unnecessary anxiety for your child.

What are the long term complications?

If a baby tooth has been injured, there is a risk of damage to the underlying adult tooth which is forming under the gum. For most people, there won't be any problems with the adult tooth but in rare cases, the following complications may occur:

Adult tooth doesn't erupt
If the adult tooth hasn't erupted by 7 or 8 years old, your dentist will take a series of xrays to check where the tooth is and what the root looks like.

Sometimes the tooth can be brought into the mouth through the gum with a procedure called "expose and bond" - LINK. This involves a surgical procedure to uncover the tooth and braces to pull the tooth in line with the rest of the teeth.

If this is not possible, the tooth can be removed (see here).

The tooth can also be left under the gum but it will need to be monitored with xrays to ensure it doesn't cause problems over time.
Discoloured patches on enamel (hypomineralisation)
You can find out more about hypomineralisation here (LINK).
Thin enamel (hypoplasia)
You can find out more about hypoplasia here (LINK).

If an adult tooth has been injured, possible long term complications include:

Nerve damage
- Root canal constricts as more dentine is formed. This is called pulp canal obliteration. The tooth may look more yellow or brown. This doesn't need any treatment unless the nerve dies. If this happens, you may need to see a specialist endodontist for root canal treatment.
- Nerve dies causing pain and infection. The tooth will look grey and be tender to bite on. This can be managed with root canal treatment.
- Tooth starts to "dissolve" from the inside out. This is called internal resorption. The tooth may have a pink-ish tinge to it. This can usually be managed with root canal treatment if detected early. Sometimes, the tooth will have to be removed (see dental extraction).
Outer surface of the root is replaced by, and fused to, the surrounding bone. This is called ankylosis and is most common when the tooth has been completely knocked out of the mouth.

In a growing child, the damaged tooth will start to look shorter than the surrounding teeth. This is called infraocclusion (i.e. below the line of bite). You can find out more about it here - LINK avulsion.
Abnormal root development
This is more relevant if the injured tooth has erupted in the last 3 years, as the root is still growing.

- Root starts to grow at a funny angle. No treatment is needed but if the tooth needs root canal treatment or extraction in the future, you may need to be referred to a specialist.

- If the nerve dies, the root stops growing. This means the tip of the root is left wide open. It can be managed with root canal treatment and a special material called "MTA", which is a bit like a cement. MTA is used to "plug" the hole at the tip of the root during root canal treatment.
The gum may shrink away from the tooth, making the tooth look longer.

If you don't like how this looks, you can see a gum specialist (periodontist) who can discuss the option of a gum graft - LINK. This is a small surgical procedure which can recontour your gum line.