Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 11/25/2006

Question
Hello,
My 3 year old daughter received a blow to her mouth 1 week ago and knocked her two front teeth loose. One is looser than the other. Her gums and teeth look normal. No color change to teeth. We saw a paediatric dentist yesterday and after a quick look suggested removing them. Without an x ray he said they are fractured at the top of the root.  I don't want to do this as she is so young. I have heard about baby root canal treatment to save them. What do you think?
Thankyou.  

Answer
Kalli -  First of all, the important thing to try to do is to totally define the extent of trauma and injury to the teeth.  It is imperative to have an x-ray taken to actually determine if the mobility of the teeth is due to a fracture or an actual spread or minor fracture of the bone.  The bone most often gives way from a spreading action and this can mobilize the teeth.  

It is, however, fairly common for the nerves within the teeth to die from this type of trauma.  This may produce swelling eventually and possibly infection.  As I said before defining the extent of injury via an Xray is imperative.  If the nerve dies, a simple procedure called a pulpotomy can be performed to removed the injured nerve and retain the teeth.  If the bone has spread then some type of stabilization is important.  

If the dentist surmised the injury correctly and the teeth are fractured at the top of the root, then the crown can be removed and the nerve along with it.  A temporary crown can be made.

The best course of action is to have the x-ray taken first to determine the extent of injury.  If the tooth is fractured, depending on the extent, the tooth may need to be removed or reconstructed if not too much is broken.  This retention would be along with the baby root canal treatment you state (pulpotomy).

So get an Xray.  If you have any further questions feel free to contact me again.