Lesson

Tooth fractures

Tooth fractures are a very common and potentially devastating injury for football players. It is imperative that the clinician can rapidly identify the degree of severity of the fracture, as this may determine the return-to-play status of the athlete.

The management of a tooth fracture depends on which part of the tooth is involves. The following graphic illustrates the different types of dental fracture – as well as how these injuries can be diagnosed and managed. It is important to note that any athlete who has a dental fracture should have an X-ray.

Fracture of enamel only

In most cases, athletes with this type of injury can return to play. The tooth appears uniformly white with no red “pulp” visible. Treatment will involve restoration or reattachment of the fractured segments if retained.

Fracture of enamel and dentin – no pulp exposure

It is important that the missing piece of tooth be accounted for to ensure it has not been aspirated or imbedded in the soft tissue. If the athlete can tolerate any discomfort from the exposed dentin, and the sharp edges do not put the player at any risk of soft tissue injury, the athlete can return to play with this injury. Treatment will involve either restoration with composite resin or possible reattachment of the fractured segment.

Fracture with pulpal exposure

A pulp (nerve) “blush” occurs when the underlying nerve is just slightly visible on examination. The nerve may be marginally exposed, or there may still be a very thin layer of opaque tooth structure covering the nerve. When the nerve is clearly exposed, both pain and the risk of infection demand that the athlete be removed from play and referred for immediate treatment. This is needed to help preserve the health of the nerve and prevent infection or necrosis. In many cases, this treatment may involve removal of the nerve, although in some cases the nerve may receive a medicated dressing and might remain vital.

Root fracture

Not all tooth fractures are visible on clinical examination. Any tooth that has been traumatised – regardless of the clinical appearance – should be referred for radiographic assessment to help identify any potential root fractures. The treatment and prognosis for these root-fractured teeth is dependent on the location of the root fracture, with fractures in the coronal third of the tooth having the worst potential for recovery.

It is vital that the touchline doctor identify the location of any fractured tooth segment. These may be embedded in an opponent’s head or elbow, somewhere on the field of play, buried in the player’s lip, swallowed or aspirated. Soft tissue radiographs may assist with identifying the location of these lost pieces. Segments that have been retrieved should be retained in a moist, semi-sterile solution (saline, contact lens solution, Save-A-Tooth kit) for possible reattachment.

Dr Paul Piccininni

Sport, Cosmetic and Restorative Dentistry