Posts for: September, 2020
We Americans love our sports, whether as participants or spectators. But there's also a downside to contact sports like soccer, football or basketball: a higher risk of injury, particularly to the mouth and face. One of the most severe of these is a knocked out tooth.
Fortunately, that doesn't necessarily mean it's lost: The tooth can be reinserted into the empty socket and eventually return to normal functionality. But it must be done as soon as possible after injury. The more time elapses, the lower the chances of long-term survival.
That's because of how teeth are held in place in the jaw, secured by an elastic, fibrous tissue known as the periodontal ligament. When a tooth is knocked out some of the ligament's periodontal cells remain on the tooth's root. If these cells are alive when the tooth is reinserted, they can regenerate and reestablish attachment between the ligament and the tooth.
Eventually, though, the cells can dry out and die. If that has already happened before reinsertion, the tooth's root will fuse instead with the underlying bone. The tooth may survive for a short time, but its roots can eventually dissolve and the tooth will be lost.
Your window of opportunity for taking advantage of these live periodontal cells is only 5-20 minutes with the best chances in those earlier minutes. You should, therefore, take these steps immediately after an injury:
- Find the tooth, hold it by the crown (not the root end), and rinse off any debris with clean water;
- Reinsert the root end into the empty socket with firm pressure;
- Place clean gauze or cloth in the person's mouth between the tooth and the other jaw, and ask them to bite down gently and hold their bite;
- Seek dental or emergency medical care immediately;
- If you're unable to reinsert the tooth, place it quickly in a container with milk and see a dentist immediately.
You can also obtain an Android or IOS smartphone app developed by the International Association of Dental Traumatology called ToothSOS, which will guide you through this process, as well as for other dental emergencies. The quicker you act, the better the chances that the injured person's knocked out tooth can be rescued.
If you would like more information on what to do in a dental emergency, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When a Tooth is Knocked Out.”
Each year, millions of children and teenagers wear braces or clear aligners to straighten a crooked smile. But there may be a way to treat some of these bite problems and avoid braces—by intercepting the problem at an earlier age.
This can often be done if the bite problem stems from abnormal jaw development rather than misaligned teeth. An example of this occurs when the upper jaw growth outpaces the lower jaw, causing the upper teeth to protrude beyond the lower teeth. Aside from the effect on appearance, protruding front upper teeth may extend beyond the protection of the lip and be more prone to injury.
A device called a Herbst appliance could prevent this from happening. The top of the device has two hinged metal tubes that connect to elastic bands bonded to the back teeth on both sides of the upper jaw. The bottom also has tubes affixed in the same way to the bottom teeth, except they're slightly smaller and fit within the upper tubes.
The lower tubes sliding within the upper tubes produces slight pressure against the lower jaw to ease it forward. This gradually influences the lower jaw to grow at a pace equal with the upper jaw to decrease the chances of poor bite development. Unlike other corrective methods, the Herbst appliance fixed in place and out of the way won't interfere with sports or other physical activities.
An installed Herbst appliance may change a patient's sensations during swallowing, eating or speaking, but most children adapt to the changes within a few days. And, because the device can create challenges for keeping the back teeth clean, many dentists recommend adding a fluoride rinse to daily brushing and flossing as an added boost against tooth decay.
The Herbst appliance is most effective during the period of most rapid physical growth between the ages of 11 and 14, but if the teeth are already beginning to protrude it can be undertaken as early as 8 or 9. Either way, this important orthodontic tool could help address a complicated bite problem and reduce the need for more costly orthodontic treatment later on.
If you would like more information on early interventions for poor bites, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Herbst Appliance.”