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NEW YORK, Mar 29 (Reuters Health) - If a tooth is dislodged by trauma--but hasn't actually fallen out--it's best to leave it alone rather than forcing it back into place, dentists said Thursday at the annual meeting of the American Association of Endodontists in New Orleans.
Trying to correct a tooth that is knocked out of position but still in its socket (called luxation) immediately after injury can further damage the tooth, Dr. James Gutmann of Baylor College of Medicine in Houston, Texas, and president of the American Association of Endodontists told Reuters Health.
"Trying to replace the tooth exactly back in place can actually create further damage...and that secondary damage can be worse," he said.
Dr. Jens O. Andreason of the University Hospital of Copenhagen presented data that showed that overmanipulation of the damaged tooth can cause more damage to the tooth structure and the surrounding bone. Leaving the tooth somewhat out of alignment for a period of 7 to 14 days while the tooth tissue heals is a better strategy.
At that point, Gutmann says, healing is more or less complete and the tooth can be repositioned, a root canal performed to remove any of the damaged soft inner tissue called the pulp, followed by bracing. At that point, the risk of tooth loss will be diminished.
"We have to accept some imperfection (initially) if we want the tooth to heal properly," Andreason says.
"In the past we were always concerned about esthetics, about getting that tooth back into its original position so the patient leaves with a smile," Gutmann said. "We need to reassure patients that we're trying to create the best environment for healing and that we can improve the esthetics later. "
It is estimated that half of all children will suffer some type of traumatic injury to a tooth by the time they leave high school. These injuries can range from minor chips to teeth that are knocked entirely out of the socket. Teeth that are knocked out can be replanted, treated and last several years if proper treatment is provided quickly.
The American Association of Endodontists notes that a tooth that is completely knocked out should be placed in some type of liquid--milk is the best--and transported with the patient to an orthodontic surgeon or endodontist as soon as possible after the injury.
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