Tooth Trauma – Now What?

Accidents happen and your teeth can suffer. Dr. Anthony Bielkie discusses knocked out teeth, missing crowns, toothaches and more.

If someone has an accident and their tooth gets knocked out, what should they do right away to try to save the tooth?

Dr. Anthony Bielkie: That’s a great question. I think first we need to determine how severe of a trauma. First we want to make sure if someone had a severe head injury – automobile accident –  that physically they’re stable and they’re evaluated by proper medical team in the emergency room to make sure that all their vitals are standard. We’re going to talk today more what happens for trauma to the tooth as opposed to some kind of real serious injury. Once the tooth is knocked out, it’s very important that we collect the tooth or the fragments and if possible, we reinsert the tooth. If someone is at a dentist, it’s a little difficult to tell if the tooth broke or if part of it is still there. If the tooth is completely avulsed- it is completely out of the mouth –  we want someone to grab the crown of the tooth, not the root because the root is the part that all the vital structures are on. If it is full of dirt, it can be gently rinsed but never scrubbed. We want to try to get that tooth back inside of the socket as quick as possible.

Frequently while one member of a family is doing that, another one is calling a dentist and smartphones are amazing these days. I get photos all the time – of somebody who was a water-skiing accident up in Northern Michigan and they’re four hours from my office but they wanted to give a little heads up. It’s important that people have a dentist that they’re comfortable with and we see questions all the time for people that are visiting from out of state or out of town and help – but prompt, urgent care is the most important thing.

When a crown falls off unexpectedly, what is the process for replacing that crown?

Dr. Anthony Bielkie: That’s another great question. That can come in various ways. The first thing we would check is why did the crown fall off and frequently a crown falls off because there is decay underneath the crown. Occasional again, with some advice, you could contact our office and we’ll discuss about how to try to get through whatever events you are, if you’re out of town, at a wedding, what people have done, temporary cements and things like that. The best thing is if you’re in town is to come on in. We make time everyday for emergencies. We’re not going to tell you we’ll see you in 6 weeks or something like that. We’ll bring you in right away, evaluate why the crown came off. Occasionally if there was a fracture or there is tooth decay or sometimes the cement is washed away and it just needs to be put on again. We’d love to see people as soon as it comes off.

Sometimes people will come in and say, “Oh it came out 6 weeks ago but it didn’t bother me.” The problem sometimes is then the crown doesn’t fit because the teeth can shift and move so the more prompt we get to see the problem, the better and hopefully more affordable for the patient.

If someone has a horrible toothache, how do you determine if they need a root canal or if something else is wrong and how long does getting a root canal take?

Dr. Anthony Bielkie: The duration for a root canal can really vary depending on the complexity of the situation so from 30 minutes to a couple hours to multiple treatments if the tooth is severely infected. When someone has a horrible tooth ache, we’ll start discussing a flow chart of what and why. Does the tooth hurt to hot or cold, is it prolonged, is it intense and then we remove the cold to make it feel better right away. All of those things will help tell us the health of the pulp of the tooth. Once it’s determined that a tooth needs a root canal, it’ll never heal itself. It may go dormant for awhile, but when it comes back it could be potentially life threatening if these infections get out of control. It is very imperative that we make a decision. Once a root canal is determined is needed, it’ll never heal on its own so either we need to do the root canal treatment or we need to possibly remove the tooth.

The things that fall into play: the importance of that particular tooth in the mouth, the way it works with the bite, how significant the problem is, the cause of the root canal, did it fracture, is it non-restorable even if we wanted to save it, and then unfortunately cost always plays a factor so we always give multiple different options from the most expensive to the least expensive and we try to predict how long somebody can go without having to go ahead and have this treatment done. Frequently, sooner is better in that.

What does the terms splinting teeth mean and when would someone need that?

Dr. Anthony Bielkie: Occasionally … We’re going back to our trauma topic. If someone is for some reason hit in the mouth and their front teeth are loose, to stabilize the tooth, we will sometimes splint it to other teeth making sure that things are stable and healthy allowing the tooth to heal itself. It shouldn’t be splinted for an extended period of time. Depending on how loose that particular tooth is will determine how long it will be splinted.

Also, occasionally if somebody has severe periodontal disease and we’re trying to splint the teeth together for support, we would connect multiple teeth together so that the forces of biting are spread over multiple teeth and multiple roots to try to get that to come along. Splinting is something we do in dentistry. It’s not something that’s done everyday but in particular cases, it is of paramount importance that it gets done and done quickly and correctly.

Lastly, we’ve all heard the saying ‘prevention is the best medicine.’ As it relates to dental care, does wearing a mouth guard really help protect teeth from getting knocked out or chipped?

Dr. Anthony Bielkie: Absolutely. Mouth guards are one of the single most important ways for active individuals to really take care of their mouth. We often think about chipped or broken teeth and the cost and the lifelong things that that entails as far as bonding and re-bonding and root canals and crowns and implants, so if we can prevent all of that from starting by wearing a mouth guard, that’s incredible.

The other thing, really … As dentists, we don’t just treat teeth, we treat the whole person and there’s been many studies that have shown that mouth guards will help prevent concussions so when someone is hit hard on the jaw and the teeth bite together, it really … obviously on tv and football, that’s all becoming very apparent and so mouth guards really severely help decrease the amount of concussions that we’ve received.

We’ve also had individuals in our practice that were playing lacrosse and were hit very hard on the jaw and actually broke their lower jaw even though they had their cage on but their teeth were fine, thanks to their mouth guard. They definitely work and I’m a testament to that.

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If you are interested in speaking with Dr. Anthony Bielkie, visit or call (586) 739-6400 to schedule an appointment.

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