Traumatic dental injuries can occur at any age and at any time, but mostly occur within the seven to 12-year-old age group. The extent of injuries ranges from a crown or root fracture to a seemingly innocent concussion of the tooth. All these injuries could cause the tooth to become non-vital and have more impact on the maxillary (upper) than the mandibular (lower) teeth.
Many individuals can recall when the trauma occurred and present mostly in adulthood to the endodontist with a discoloured front tooth, having the desire to 'bleach' the tooth back to its original colour. This discolouration is the result of pulpal necrosis (death of the blood vessels and nerves). Depending on the age or stage of the trauma, a necrotic pulp can cause an infection, which could retard the growth of the tooth apex or cause resorption to occur.
An examination by the endodontist is done, complete with the taking of digital radiographs and sensibility testing of the tooth. The findings of such investigations dictate the type of treatment necessary to bring the tooth back to health.
Treatment options include, but are not limited to, root-canal therapy and internal bleaching. Root canal therapy entails the removal of necrotic pulp tissue and disinfection of the internal canal system of the tooth, thus effectively arresting inflammation and any resorption that might be occurring. This treatment can occur in one to two visits to the endodontist.
If the apex of the tooth is open, it is closed using dental materials designed for such an area. Internal bleaching of the tooth is then carried out to bring the tooth back to its original colour.
References: 1) Hargreaves. K, Cohen. S, Cohen's Pathways of the Pulp, 10th Edition.
Dr Kema White, DDS, MSc (Endo), works at Endodontic Solutions, #31 Barbican Business Centre, 88 Barbican Road (6). Tel: 946-0584; 424-5137.