Expert: Gary Backlund, DMD, MSD - 11/2/2008

Question
QUESTION: Hi - I would love your opinion on the situation with my daughter's tooth.  She was hit in the face and had her top front tooth pushed quite a ways back.  We went to the emergency dental clinic at the hospital where they repositioned and splinted it.  We were told that she would definitely need a root canal.  We were told to go see her own dentist (or come back to them) in 7-10 days to see if the tooth was stable (no movement).  If so they would begin a root canal.  An appointment is made for Tues. (which is day 10 - the soonest I could get her in to her own dentist).  Today is day 7 and she has told me that her tooth is still moving and that she can taste that the tooth is dying.  I do not know much about dentistry stuff  - my question is: Do we wait for the tooth to be secure before getting the root canal?  If we wait, what can happen to the tooth? Tuesday's appointment is just for the dentist to assess the situation....the actual root canal appointment is not for 3 more weeks.  I could always take her back to the emergency dental clinic at the hospital if need be.  I understand you may not be able to answer these questions without more info but any information that you feel I should know would be greatly appreciated.  Thank you so much!

ANSWER: Hi Noel,

I am SO sorry to hear your daughter has had this type of injury. It is really traumatic to ALL involved. I don't blame you for being concerned.

Now, I going to give it to you straight. Get your daughter to an endodontist ASAP!!!! Trauma to teeth is one of the hardest things to treat correctly and you only get one chance. Your daughter's tooth is at risk! When a tooth is traumatized like this, in about 30% of cases, a process called resorption can get started. Has anyone talked to you about this? This process will cause the root of the tooth to be eaten away and can result in the loss of the tooth...no matter whether a root canal is done or not as it occurs on the root surface, not inside the tooth. In our office, we treat ALL these teeth as if they will resorb. We open into the tooth, pack it with a medication, called calcium hydroxide, which decreases the chances of resorption. It will be left in there for several months, sometimes it is repacked, and we will not finish the root canal for 6-12 months depending on how treatment and the tooth responds. Most general dentists don't see enough of these types of cases to treat them correctly, that's why you need to get your daughter to a specialist.

In addition, a solid fixed splint will actually induce resorption of left on for toot long. Splints can stay on for longer, put they need to allow the tooth to gently move around and act like a tooth. If the tooth is rigidly splinted, the body may start to "eat it up".

As you can probably tell, I'm quite passionate about this. It comes from seeing the mistreatment of kids that then end up in my office too late for me to help...it's a real bummer, believe me.

I hope I have really scared you....:-)....and given you some good info. Write back if you need more or clarification.

Gary Backlund DMD, MSD


---------- FOLLOW-UP ----------

QUESTION: First off Gary I want to thank you so much for taking the time to answer my questions.....know that today you may have just saved a young girl her front tooth. I have just been following the directions I am given by the professionals because I have NO knowledge in this area.  So I will have to start researching what a endodontist is...My follow up question is: have we left this too late - remember today is day 8 and I am sure it will take many days if not weeks to get in to see a endodontist.  Have we done any damage in the steps we have already taken?  I am so happy that I wrote you....please tell me I didn't wait too long!

Answer
Hi Noel,

You didn't wait too long!!! Usually we don't do anything for 7-10 days anyway, unless it is obvious that treatment needs to be started earlier. That gives the tooth a chance to begin to reattach before beginning treatment.

When you find an endodontist, make sure to tell their office that your daughter has had a recent injury and no treatment, other than splinting, has been done. You are a semi emergency in that your daughter should be seen, evaluated, and a plan made for how and when to proceed. The front office should know the situation, but you may need to be firm & pushy to get her in ASAP.

As for finding an endodontist, they should be in the yellow pages. Make sure they are members of the AAE and are specialists since the yellow pages doesn't differentiate between REAL specialists and those that are looking for business but are really general dentists. You can get more info about all this on our national website...www.aae.org. There's info there too about trauma to teeth. Here's a link:

http://www.aae.org/aae-cms/Templates/internal_heading.aspx?NRMODE=Published&NROR

Just copy & paste it..it's long, but it will get you there.

Good luck!!!

Gary Backlund DMD, MSD