Traumatic injury to the front teeth is a problem we deal with all the time in the dental office. My observation about the number of Canadian men with a crown on one or more front teeth leads me to the question of how the injury occurred…Hockey? Beer? Or a combination of hockey and beer? While this “joke” covers an astounding number of the injuries, there are other causes as well…ice skating, falls, “horsing around” with siblings or children…the common thread is that these injuries occur during activities where mouth guard protection wouldn’t be commonplace.
When dealing with a traumatic injury, the “problem” seems obvious at the time–broken tooth, needs crown to rebuild, and possibly root canal treatment if the fracture is severe. Many times I am meeting new patients to my practice who relate their tales of childhood tooth injury, and now are presenting with secondary problems of tooth color change, more breakage, ill-fitting or ill-matching crown placed 20+ years prior, or even looseness of the tooth. These additional problems can occur anywhere from months to many years after the original injury. The way I describe it is as though the obvious part of the injury is only the tip of the iceberg, but what lies beneath the surface can take a long period of time to discover.
Why Are There Problems Later On?
Just like a pebble hitting your windshield creates a small hole or crack, but after time that crack spreads to be a bigger problem…often the full extent of the injury isn’t known and cannot even be seen on an xray. So what seems like a small crack at first can be repaired then with perhaps just some bonding, but several years later the tooth turns much darker than the one next to it. What happened there? The force of the bang that broke the tooth in the first place also damaged the nerve of the tooth, and often this type of damage doesn’t cause much discomfort, so the patient thinks everything is fine. Over time, the nerve of the tooth slowly dies, and when this happens the tooth changes color.
My Tooth That Was Fixed A Long Time Ago Looks Terrible Now!
How about the tooth broken badly enough to need a crown, but now maybe that crown looks really “fake”, or the gum tissue above it feel sore when you press on it. The newer crown materials are much more like natural tooth, so they are often indistinguishable from the natural tooth beside it, and simply replacing this crown may give the desired esthetic outcome. If the gum tissue feels sore, there may be an infection present within the root of the tooth requiring further treatment, perhaps even a root canal.
My Tooth Actually Feels Loose! What Does That Mean?
What if the tooth had a root canal and crown, and now many years later you notice the tooth is loose? This is typically the worst scenario, and may mean that the tooth is so badly infected that it cannot be saved. My recommendation to patients in this situation is to treat this area sooner rather than later so there is the least amount of bone loss in that area. Saying this, I know it can be a very emotional decision to have a front tooth removed; however, with the use of dental implants to replace a single missing tooth (or several missing teeth), there is no need to worry and every reason to treat the problem.
Bottom Line, Best Practice?
The bottom line is…once you have “traumatized” a front tooth, it is in your best interests to “keep an eye” on that tooth by a dentist’s visual examination yearly AND an xray at least every 2-3 years after the injury to monitor the area.