Dealing with Dental Trauma: Key Questions After Tooth Fractures

I have a few questions regarding a broken tooth due to an accident?

Hello Doctor, previously I had an accident that caused an impact to my upper front teeth.
As a result, two of my incisors broke about one-third of their structure.
Initially, both teeth were even, but after the impact, one became more prominent.
Both teeth will require ceramic crowns.
The flat tooth hurts whenever it is touched, and after examination, the doctor said the nerve is necrotic and requires root canal treatment.
The prominent tooth does not hurt, and the doctor mentioned that if I want to position the crown slightly more inward (to align it with the other tooth), a root canal will also be necessary.
If I choose not to perform the root canal, the crown will maintain the protruding appearance.
The doctor stated that while this tooth is currently painless, it may suddenly develop issues in the future, which would also necessitate a root canal.
Therefore, I would like to ask the doctor: 1.
Given the strong impact that caused the tooth fracture, and considering I felt no pain at the time, what is the likelihood of developing problems later on? 2.
Additionally, I also hit three teeth on the right side of my front teeth.
Initially, I felt an abnormal bite, but after some time, it felt normal, and there was no visible fracture.
The doctor said there was no issue at that time, but later at home, I noticed cracks under light examination.
These cracks are very subtle and almost invisible under regular lighting.
I would like to ask the doctor: Is there any treatment available for teeth with subtle cracks at this stage, or should I just be cautious in my daily life and observe regularly?

cc, 20~29 year old female. Ask Date: 2022/08/19

Dr. Lin Jiayong reply Dentistry

Hello, 1.
After a car accident, it is recommended to observe for about six months before deciding whether root canal treatment is necessary.
The body should recover to a certain extent before undergoing treatment to ensure better outcomes.
2.
At this stage, you can apply desensitizing toothpaste or high-fluoride toothpaste to reduce sensitivity.
It is not advisable to pursue too many additional treatments, as this may complicate a simple issue!

Reply Date: 2022/08/19

More Info

Dealing with dental trauma, especially after experiencing a significant impact that results in tooth fractures, can be quite challenging and raises several important questions regarding treatment and long-term care. Based on your situation, let's address your concerns systematically.

1. Likelihood of Future Problems After Initial Trauma: When a tooth is fractured due to a strong impact, the immediate response may not always include pain or visible damage. However, the risk of future complications, such as nerve damage or pulp necrosis, is significant. In your case, the tooth that has already been diagnosed with a dead nerve and requires root canal treatment indicates that the trauma has indeed affected the tooth's vitality. The fact that the other tooth is not currently painful does not guarantee its health; it could still develop issues later on. Studies suggest that teeth with a history of trauma have a higher incidence of pulp necrosis, even if they appear normal initially. Therefore, it is advisable to consider the root canal treatment sooner rather than later to prevent potential complications that could arise unexpectedly.

2. Management of Subtle Cracks: Regarding the tooth that has subtle cracks, it is essential to monitor the situation closely. While these cracks may not be immediately visible, they can lead to more severe issues over time, such as fractures that could compromise the tooth's integrity. If the tooth is asymptomatic and there are no signs of infection or significant structural compromise, the best course of action may be to maintain good oral hygiene, avoid hard foods, and schedule regular dental check-ups to monitor the condition. If the cracks worsen or if you experience any pain, further intervention may be necessary, such as bonding or crowns to reinforce the tooth.

3. Treatment Options: For the fractured teeth, your dentist's recommendation to place ceramic crowns is a common and effective treatment. Crowns can restore the function and aesthetics of the teeth while providing protection against further damage. If the decision is made to perform root canal treatment on the tooth with nerve damage, it is crucial to follow through with this treatment before placing the crown to ensure the tooth is stable and healthy.

4. Preventive Measures: Moving forward, it is essential to take preventive measures to protect your teeth from further trauma. This includes wearing a mouthguard during activities that pose a risk of dental injury, such as contact sports. Additionally, maintaining regular dental visits will allow your dentist to monitor your dental health and catch any potential issues early.

In summary, while the initial trauma may not present immediate pain or visible damage, the risk of future complications is significant, particularly with the tooth that has already shown signs of nerve damage. It is advisable to proceed with root canal treatment to mitigate risks. For the tooth with subtle cracks, regular monitoring and preventive care are key. Always communicate openly with your dentist about any changes or concerns you may have, as they can provide tailored advice based on your specific situation.

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