Certain physical characteristics predispose children to dental trauma. Typically, the top front teeth protrude and do not have support from the bottom teeth. If any blow to the face occurs, such as a fall, the front teeth take the brunt of the force and can break.
When a child breaks his or her (but lets be realistic…most of the time it’s boys) front tooth, he typically falls into one of two categories: he is either a toddler or an adolescent. Toddlers tend to fall more frequently because they are still obtaining the motor skills to walk, whereas, adolescents have more sports or roughhousing related injuries.
Dental fractures fall into categories as well: they can be complicated or uncomplicated. Uncomplicated fractures involve the enamel and/or dentin layers of the tooth, while the complicated fractures expose the nerve tissue of the tooth. The uncomplicated fractures can typically be restored with dental composite (filling material) or a crown. If it is a minor fracture, some times no treatment or smoothing the roughened enamel is all that is requried. When the nerve is involved, root canal therapy may be necessary or if it is a baby tooth, removal of the tooth may be the best option.
This picture is of an eight year old boy with a history of being a thumb sucker. When a child is a thumb sucker for an extended period of time, the front teeth can flare forward and increase the child’s risk of traumatizing the front teeth. This child had fallen and broken his front tooth on the concrete a week or so prior to the appointment. The tooth started to turn dark a few days after the injury. At this point, it was uncertain if the nerve of the tooth was damaged. It was not exposed but was sensitive, so some composite restorative material was placed over the nerve to prevent it from being sensitive while we awaited the nerve’s healing. Sometimes when a tooth turns dark right after an accident, it is because of ruptured blood vessels, and it presents the same way a bruise would on the skin. If a tooth has experienced trauma but turns dark several months down the road, it is because the nerve and blood supply have been damaged beyond repair and the nerve has died. When a tooth becomes necrotic, there are two options: either root canal therapy can be completed or the tooth can be removed.
In a follow up picture taken three months following the injury, the dark coloration had almost completely disappeared and the tooth goes on to live another day!