Dental trauma occurs when a tooth is exposed to a force that may be weaker or stronger and can result in a fracture of the hard tooth tissues and/or damage to the structures that anchor the tooth in the jawbone. The force causing trauma can be direct, such as a fall from a bicycle where the tooth directly hits the ground, or indirect, such as a blow to the lower jaw causing the lower teeth to strike the upper teeth.
Every dental injury requires urgent intervention, as delaying treatment significantly reduces the chances of saving the tooth.
Children are the population most prone to dental trauma due to their constant physical activity and frequent falls. In most cases, front teeth are affected, especially if they protrude outward, while back teeth are rarely involved. Sometimes injuries may appear alarming due to damage to surrounding soft tissues—such as the lips, the area around the mouth, or the gums. Heavy bleeding may occur, but once the injured area is rinsed with plain water, it often becomes clear that the injury is not as severe as it initially appears.
Types of Dental Injuries
Dental injuries can be divided into injuries of the hard tooth tissues and injuries of the supporting tooth structures. They can be distinguished by whether the tooth is loose or displaced from its original position. If the tooth has changed position, the supporting structures that hold it in the bone have been damaged.
Injuries to hard tooth tissues are characterized by fractured or chipped parts of the tooth. These injuries can be mild or severe. Severe injuries are present when a small bleeding point or exposed pulp (the tooth nerve) is visible on the remaining tooth structure. Milder injuries involve only a small fracture of the enamel and dentin without pulp exposure.
Injuries to Hard Tooth Tissues
- Enamel cracks – visible cracks in the enamel with preserved tooth structure; no treatment required
- Enamel fracture – a small piece of enamel is chipped; treatment: smoothing and polishing of sharp edges
- Enamel and dentin fracture – a larger portion of the tooth is fractured, but the pulp (nerve) remains intact; treatment: dental filling
- Enamel and dentin fracture with pulp exposure – a small bleeding point is visible, indicating exposed pulp (nerve);
treatment: pulp preservation if the wound is relatively clean and treatment is provided promptly / otherwise root canal treatment (pulp removal) - Root fracture – the fracture may be horizontal or vertical.
In cases of horizontal root fracture, the tooth may be saved through repositioning and appropriate treatment (root canal therapy).
If the fracture occurs in the coronal third of the root, the upper fragment is removed, the remaining root is treated and endodontically filled, followed by reconstruction with a composite post and coverage with a dental crown.
If the fracture affects the apical portion of the root, the upper part of the tooth is treated and filled, while the smaller apical fragment is surgically removed (apicoectomy).
In cases of vertical root fracture, the tooth cannot be saved and must be extracted.
How Dental Trauma Is Treated
The tissue that connects the tooth to the bone is called the periodontal ligament. During trauma, this ligament can be damaged by the force of impact, leading to tooth displacement.
The tooth may be:
- Loose (mobile but not displaced laterally)
- Partially extruded (pushed vertically out of the socket, positioned higher than adjacent teeth)
- Laterally displaced (pushed to the side, often accompanied by bone injury and heavy bleeding)
- Intruded (pushed into the bone, positioned below the level of adjacent teeth)
- Avulsed (completely knocked out of the socket)
How Dental Trauma Is Treated
For every situation described above, an appropriate treatment option exists. A traumatized and mobile tooth is stabilized using a splint—a thin metal wire or composite fiber—that immobilizes the tooth for approximately 7 days to promote healing.
If the tooth has been displaced from its natural position, it is gently repositioned and immobilized for 2–3 weeks. This period allows the periodontal ligament to heal and re-establish a firm connection between the tooth and the bone.
The success of saving a completely avulsed tooth depends on how long the tooth has been outside the mouth and the medium in which it was stored before reaching the dentist.
Within 2 hours after trauma, the chances of preserving the periodontal ligament are relatively high. However, the dental pulp (nerve) cannot be saved, as the blood vessels and nerve supply are severed during the injury. Therefore, root canal treatment is required to prevent inflammation and discoloration of the tooth.
In primary (baby) teeth and young permanent teeth where root development is not yet complete, if the tooth is replanted within 30 minutes, blood circulation may be re-established and root development may continue.
To properly assess the condition of the tooth and periodontal ligament, and to establish an accurate diagnosis, a dental X-ray is mandatory. It reveals fractures, their location, ligament damage, and other critical details.
Important Information
The best way to transport a knocked-out tooth is to place it back into its natural socket (alveolus) if possible. Other suitable storage media include saliva, milk, or saline solution.
Poor choices include a dry tissue, tap water, or alcohol, as these will dehydrate the tooth and significantly reduce the chance of successful replantation.
If replantation is unsuccessful, the avulsed tooth may still serve as a temporary solution, stabilized until a definitive restoration is completed (such as a dental implant or bridge).
If you find yourself in any of these situations, do not panic—act immediately. Rinse away blood and debris from the injured area with plain water to assess the damage. Contact your dentist immediately, who will diagnose the condition and initiate timely and appropriate treatment with the goal of saving your tooth.
