Traumatic Injuries with Orthodontic Braces
Injuries to the head and neck occur during orthodontic treatment. Sustaining trauma to the face with braces on can be a blessing and a curse: a blessing because the braces may actually prevent your teeth from being knocked out; a curse because your lips generally get more cut up than if you didn’t have them. What should you do if you have an accident while wearing braces? What can you do to prevent injuries to your teeth?
Life goes on pretty much as normal while you have your braces. Patients eat, sing, work, AND play while in treatment. Along the way, patients may get hit in the mouth. The trauma that occurs can affect the teeth, the supporting bone, and the soft tissues. When a traumatic emergency occurs, all three systems must be evaluated. And since you have braces on your teeth, you need to notify your orthodontist so that he or she can point you in the right direction to receive the help you need.
A blow to the mouth can cause damage to the teeth themselves. The visible or clinical crown of a tooth may sustain damage that may or may not be visible. The most common damage appears as chipped or broken enamel. Depending upon how deep the fracture is, the tooth may be sensitive to heat and cold. Fixing a chipped or broken tooth may require bonding, veneers, or a full crown. If the damage is more severe, root canal treatment may be necessary. A fracture of the crown of the tooth at or below the level of the bone may render the tooth non-restorable and removal will be necessary. Fractures of the roots of the teeth are generally non-restorable. While your orthodontist will need to work with your dentist because there are braces on the teeth, your dentist will be the one who repairs your broken tooth.
If the position of the teeth changes as a result of the accident, it is likely that the bone surrounding the teeth was damaged. This is a blessing in disguise. Bone is weaker than the teeth themselves and so it typically will give way before the roots of the teeth fracture. This is fortunate because bones heal while teeth do not. If your teeth are moved or displaced by trauma, you should see an oral surgeon to have the area evaluated, numbed up, the teeth repositioned, and the bone around the teeth compressed back into its normal position. If you have braces in place and they are bent or broken, the oral surgeon will probably remove the wire and send you back to your orthodontist to have it replaced after he treats the trauma. Having the braces attached to every tooth at the time of trauma binds them all together and in many cases is the only thing that prevents the teeth from being lost completely.
Damage to the lips and cheeks is unfortunately more common when wearing braces. While the teeth are better protected as described above, the soft tissues are often cut or smashed during the accident. If the lips or cheeks are caught on the braces, the first step is to peel them off. This is temporarily uncomfortable, but necessary for healing to begin. As with all soft tissue injuries, cold packs should be applied to the damaged area to reduce the swelling for the first 24 to 48 hours. The mouth has a lot of blood vessels. The high vascularity means that there will typically be more bleeding when an injury occurs. On the other hand, this vascularity also accelerates healing compared to other areas of the body. Most mild to moderate trauma to the lips, cheek, and tongue does not require stitches. Moderate to severe trauma where gashes or cuts have edges that do not come back together and stay on their own should be evaluated by an oral surgeon (if on the inside) or a plastic surgeon (on the face) to see if stitches will be needed to aid in healing and provide a more esthetic appearance later on.
While not all injuries can be prevented, many can. Specially designed mouthguards that fit over your braces are available to protect your lips and teeth during treatment. Unlike the ones you boil and adapt to fit tightly over the teeth, these are held in place by the bite, lips, and braces themselves. Because the position of the teeth changes during treatment, the boil-and-fit mouthguards won’t fit well at best and may actually prevent orthodontic movement of the teeth at worst. Let your orthodontist know that you need a mouthguard anytime you participate in activities where you know that you might get hit in the mouth.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.