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Dr. Karen Lawitts

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Syracuse, NY 13205

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Posts for tag: dental injury

ToothTroublesforNBAStarIsaiahThomas

All eyes were on Boston Celtics point guard Isaiah Thomas in Game 1 of the second-round NBA Playoff series against the Washington Wizards — and not just because he scored a game-high of 33 points! Even more dramatic was the moment his jaw collided with an opponent’s elbow, sending one of his front teeth flying out of his mouth and onto the floor.

Press reports said the Celtics’ team physician attempted to reinsert the tooth, but it didn’t remain in place when Thomas resumed playing the game. Over the next several days, he reportedly underwent a total of ten hours of oral surgery, and was fitted with a four-piece temporary bridge. A statement from the team noted that Thomas suffered “a complete fractured tooth and two other subluxed/shifted teeth… [He] will receive a permanent bridge at a future date.” So what does all that mean?

When we say a tooth is fractured, it means the crown (visible part) of the tooth has broken off from its roots, either above or below the gum line. Depending on the severity of the fracture, it is sometimes possible to save the natural tooth by performing a root canal to prevent bacterial infection, and then placing a crown (cap) on the tooth to restore its appearance and function. In more severe cases, however, the tooth can’t be saved and must be extracted.

Unfortunately, that isn’t Thomas’ only problem. He also has two subluxed teeth — that is, teeth that have shifted from their original position, but haven’t been knocked out of their sockets. Subluxed teeth often result from a severe blow to the mouth, and may be treated by stabilization or splinting. Team officials haven’t said exactly what was done during Thomas’ dental treatment, but it could very well have involved extracting the roots of any teeth that couldn’t be saved, and possibly placing dental implants in his jaw for future tooth restoration.

A dental implant is a small screw-shaped titanium post that is inserted directly into the bone of the upper or lower jaw in a minor surgical procedure. In time, it becomes fused with the bone itself, offering a sturdy anchorage for replacement teeth. One implant can support one replacement crown; two or more implants can support a number of replacement teeth joined together as a unit. This is called a dental bridge.

Bridges can also be supported by adjacent healthy teeth — but first, the outer surfaces of the crown must be prepared (reduced in size), so that the bridge can be attached over the remaining part of the crown. In many instances, implants are preferred because they do not compromise the structure of healthy teeth nearby.

Dental difficulties didn’t end Isaiah Thomas’ season — but an earlier hip injury that became aggravated finally did.  As unfortunate as this is, maybe now at least the NBA star will have a chance to let those injured teeth heal, and show up next season with a smile that’s as good as new.

If you have questions about treating injured teeth, please contact us or schedule an appointment for a consultation.

By Dr Lawitts
February 27, 2020
Category: Oral Health
Tags: dental injury  
WhattoDoForMouthInjuriesYourChildMightEncounter

Famed educator Maria Montessori once said, “Play is the work of the child”—and most kids take their “work” very seriously. But their avid enthusiasm might also raise the risk of blunt force injuries, particularly to the mouth.

While you should certainly take steps to protect their mouth (like a custom-made guard for contact sports), you can’t completely erase the risk. You should know, therefore, what to do in case of a mouth injury.

The lips, tongue, and other soft oral tissues often get the brunt of any contact injury, ranging from minor bruising and swelling to severe cuts that require medical attention. First, clean the area as thoroughly as possible to remove trapped dirt or debris in the wound. If bleeding occurs, apply continuous gentle pressure with a clean cloth or gauze for 10-15 minutes until it stops, and cold compresses for any swelling. If the wound looks deep or severe, take them to an emergency room.

Blunt force can also impact teeth in a variety of ways. If part of a tooth chips, attempt to find the pieces and see a dentist as soon as possible—they may be able to bond the pieces back to the tooth. If a tooth gets moved out of place, call your dentist immediately or go to an emergency room after hours.

If a permanent tooth gets completely knocked out, find it and rinse off any debris with clean water. Then, place it gently back into its socket, or alternatively between the child’s cheek and gum or in a glass of cold milk. You’ll need to see a dentist as soon as possible to have the tooth replanted. With this kind of injury, time is of the essence.

A hard impact can also fracture the jawbone, which may be suspected if the face appears distorted or the teeth can’t make contact with each other when the jaws are shut. Control any bleeding, apply cold compresses or mild pain relievers to ease any pain or swelling, and go to an emergency room immediately.

A traumatic injury can heighten everyone’s emotions, including yours. You can avoid your emotions turning into panic, though, by following these common sense guidelines to help your child get through this unfortunate event.

If you would like more information on handling children’s dental problems, please contact us or schedule an appointment for a consultation.

AChildsDamagedToothmayrequireaDifferentApproachthananAdults

A traditional root canal procedure can be a “life-saver” for a decayed or injured tooth. But while it’s usually the best course for a damaged adult tooth, variations of the procedure are advisable for a new permanent tooth in a child or young adolescent.

This is because the inner pulp, the focus of the treatment, plays an important role in a young tooth’s development. When it first erupts a tooth’s dentin layer, the living tissue that makes up most of the body and roots of the tooth, hasn’t fully formed. The pulp increases the dentin layer over time in conjunction with jaw development.

Because a full root canal treatment removes all of the pulp tissue, it could interrupt any remaining dentin development in a young tooth. This could lead to poorly-formed roots and a less healthy tooth. For an immature permanent tooth, then, we would use variations of a root canal treatment depending on the nature and extent of the injury, the patient’s overall health and medications they may be taking.

Our main objective is to expose or remove as little of the pulp tissue as possible when treating the tooth. If the pulp hasn’t been exposed by the decay or injury, we may only need to remove the softened decayed or injured dentin while leaving harder dentin nearer the pulp intact. If, however, the pulp has become partially exposed by disease or injury, we would then perform a pulpotomy in which we remove only the exposed tissue and then place calcium hydroxide or mineral trioxide aggregate (MTA) to stimulate dentin growth that will eventually patch the exposure site.

In cases where decay or injury has rendered an immature tooth’s pulp tissue unsalvageable, we may use a procedure known as apexification that seals off the open, cylindrical root end of the tooth. This will allow bone-like tissue to grow around the root to serve as added support for the tooth. Although it can save a tooth in the short run, the tooth’s long-term survival chances may be lower.

By using these and other techniques we may be able to save your child’s immature tooth. At the very least, such a technique could postpone replacing the tooth until a more opportune time in adulthood.

If you would like more information on treating damaged teeth in children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”

MouthguardsFoundtobeEffectiveinPreventingTeethandMouthInjuries

Athletes in contact sports are at significant risk for traumatic injury to their teeth and mouth. It’s estimated 600,000 emergency room visits each year involve a sports-related dental injury.

Athletic mouthguards have become the premier safeguard against sports-related oral injuries. First worn by professional boxers in the 1920s, mouthguards are now required for use by various sports associations and leagues — from amateur youth to professional — for a number of sports. The National Collegiate Athletic Association (NCAA), for example, requires their use during play for hockey, lacrosse, field hockey and football. The American Dental Association recommends mouthguards for 29 sports or exercise activities.

But do mouthguards actually prevent injury? To answer that question in a scientific manner, the Journal of Sports Medicine published an evidence-based report in 2007 on mouthguard effectiveness for preventing or reducing the severity of oral-facial injuries and concussions. While the report objectively analyzed many of the problems and issues associated with mouthguards (like materials, design and durability), it concluded the risk of an oral-facial injury was nearly two times greater without the wearing of a mouthguard.

That being said, most dentists and other professionals in sports safety would advise not all mouthguards are alike. The stock, “off the shelf” mouthguard found in many retail stores with limited size offerings is the least expensive, but also least protective, of mouthguard types. Mouth-formed or “boil-and-bite” protectors, which are softened in boiling water and then bit down on by the player to form the fit, are better than the stock version — however, they often don’t cover all of the player’s back teeth.

The best option is a custom-designed guard made by a dentist for the individual patient. Although relatively expensive (costs range in the hundreds, compared with $25 or less for a stock guard), they provide the highest recognized level of mouth protection.

The bottom line: a mouthguard is a must-wear part of any uniform for any sport that involves contact or high velocity objects of play. If you or a family member is a contact sport athlete, it’s essential you protect your teeth and mouth with a custom-fit, high quality mouthguard.

If you would like more information on mouthguards, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Athletic Mouthguards.”

By Drs Lawitts
October 07, 2014
Category: Oral Health
ToothTraumaDoesntHavetoMeanToothLoss

Tooth decay and other oral diseases aren’t the only dangers your teeth face — accidental injuries also pose a risk. Fortunately, much can be done to save injured teeth, if you act quickly.

Dental injuries where part of the enamel crown has chipped off are the most common. Even if only one tooth appears damaged, adjacent teeth and bone might also have been damaged internally. Most chip injuries can be repaired either by reattaching the broken crown or with a tooth-colored filling or veneer. If the damage has extended into the inner tooth pulp then a root canal treatment might ultimately be necessary.

Teeth that have been knocked loose from normal alignment (dislodged) or where the entire tooth with its root has separated from the socket (avulsed) are rare but severe when they occur. It’s imperative to see a dentist as soon as possible — even more than five minutes’ of elapsed time can drastically reduce the tooth’s survivability. Dislodged teeth are usually splinted to adjacent teeth for several weeks; we would then carefully monitor the healing process and intervene with endodontic treatment (focused on the tooth’s interior) should something unfavorable occur.

With the possible exception of a primary (baby) tooth, an avulsed tooth should be placed back in the socket as soon as possible. This can be done by someone on scene, as long as the tooth is handled gently, the root not touched, and the tooth rinsed with cold, clean water if it has become dirty. If no one is available to do this, the tooth should be placed in milk to avoid drying out the root, and the patient and tooth transported to a dentist immediately. Once in the socket, the treatment is similar as for a dislodged tooth with splinting and careful watching.

The damaged tooth should be checked regularly. Your body’s defense mechanism could still reject it, so there’s a danger the root could be eaten away, or resorbed. Some forms of resorption can’t be treated — the aim then is to preserve the natural tooth for as long as possible, and then replace it with a life-like restoration to regain form and function.

If you would like more information on the treatment of injured teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trauma & Nerve Damage to Teeth.”



Dr. Karen Lawitts

Dr. Karen Lawitts

 

 

Dr. Lawitts was born and raised in Syracuse, NY. She received her Bachelor of Science and D.D.S degree from Northwestern University in Chicago.  
       
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