Is It Time to Review Your Treatment Protocol for Traumatized Teeth?
About a year ago, in my office, we reviewed our protocol for managing and treating patients with traumatized teeth. We reviewed the literature to learn how we could improve how we help our adult patients who have avulsed or mobile teeth following a traumatic event.
One of the new things we read and thought about was whether to put the patient on antibiotics. We added this to our protocol—the patient goes on antibiotics for seven days after learning what antibiotics the patient can take, i.e., will not likely cause an allergic reaction.
The literature now recommends splinting the traumatized teeth for two weeks and then removing the split after two weeks. Although there has been a conversation over the years about whether to splint or not to splint and if splinting has anything to do with the teeth ankylosing or resorption, the current recommendation is to splint but for just two weeks.
Improved Counseling of Our Patients? Yes
We learned that three common sense items needed to be reviewed with our patients, because it is easy to retraumatize teeth, and patients easily forget to be attentive to personal “gentleness.”
- We added to our protocol list counseling the patient to go on a soft diet that does not require biting down for three to four days, then longer if they sense the tooth roots are still mobile.
- Similarly, we added counseling the patient to do gentle mouth cleaning. They should brush traumatized teeth very, very gently so as not to re-traumatize or move them.
- We also added to our list making sure patients understand the importance of follow-up visits and radiography to track the health of the traumatized teeth.
Following the Health of the Teeth
We use periapical or CBT radiography to follow the teeth at one month after the initial trauma and again after two months, four months, and six months. If there appears to be healthy pulp and attachment of the teeth to the bone and connective tissue at six months, we can extend the time between making new images.