Tree vs teeth: Recovering an adult tooth proves a costly chain of events

Lughaidh, 11, was driving a go-kart when it smashed into a tree and lost an adult front tooth. Luckily, it was recovered but the chain of events will prove costly, writes his mum, Catherine Shanahan.

MARCH 27, 2017. A date, to my shame, not forever etched in memory, but at least retrievable by email.

In conducting research for this article, I came across the following, sent to a girlfriend tasked with organising a mutually beneficial weekend away: “Lughaidh smashed into a tree today in a go-kart. Knocked out a front tooth, bruised sternum, totally traumatised (us both). Spent the bones of an hour in the dentist’s trying to stop the bleeding and re-insert the tooth. Trip to the specialist on the cards.

“Yes, I need a weekend away.”

Four-and-a-half months after Toothgate, an event that traumatised the household and sent my son and his central incisor on their separate ways, I visited the scene of the crime for the first time. My 11-year-old took me through the high-speed impact that ultimately destroyed his perfect smile.

He had called for his cousin who lives adjacent to the green area near our home. His cousin was already down the green with a friend and they were riding around on a double-seater go-kart.

For reasons unsubstantiated, Lughaidh ended up in the driver’s seat at the top of a steep grassy hill where perhaps the thinner air contributed to a serious error of judgement.

The go-kart took off — investigations failed to establish if this was with or without the driver’s blessing — hit a dip halfway down, front wheels shot into the air, control over go-kart was neutralised, and in the split second when the wheels hit the ground back on the level, there was no time to regain control and the tree that had been directly in the go-kart’s path from the get-go was suddenly RIGHT THERE.

“Mum it was going SSOOOOOO FASSSSSSSST. There was NOTHING I could do. We smashed into the tree and the kart jerked forward and I jerked forward and it was SO SCARY,” said Lughaidh.

It was so scary that his eyes welled up while recounting the tale. Not scary enough to stop him doing it, though.

The aftermath of the accident wasn’t pretty. The tree lost a slice of bark. Lughaidh lost an adult front tooth. My poor father, who was minding my children, nearly lost his mind. A fraught phone call summonsed me home from work to tend to a son covered in blood and sobbing and blissfully unaware that he had narrowly cheated death.

The story almost had an upside. A woman whose sister is a dentist witnessed the trauma. She explained to my father that if they could find the tooth ASAP and put it in milk, there might be a chance of saving it. The cousin/go-kart co-pilot ran back to the park and miraculously retrieved the tooth — albeit with a piece missing. It was placed in milk and whizzed, along with Lughaidh, to the dentist.

Hilary Hogan, of Ballinlough Dental Care, Cork City, did all he could to save the tooth. He managed to re-insert it amid extensive bleeding. He subsequently splinted it and referred us on to a specialist, endodontist Michael Hartnett. (Endodontists specialise in maintaining teeth through endodontic therapy — procedures involving the soft inner tissue of the teeth, called the pulp.)

Michael, who set up up the first practice limited to endodontics in Cork in 1995 (now the multidisciplinary specialist Clermont clinic in Douglas) worked his magic, reinstated the tooth, filled it, and restored Lughaidh’s incisor.

However, as we neither knew nor adhered to the protocols necessary to save a tooth by preventing the root from dying (the reason for this article), Lughaidh will need an implant at a later stage. In the meantime, Michael will monitor his tooth and make the necessary adjustments as his face develops and changes.

He explains that Lughaidh’s tooth “will appear shorter than the adjacent teeth as the knocked-out tooth becomes fixed in position” (called ankylosis — where the root of the tooth becomes replaced with bone). This impedes normal development of the alveolar process (bone) in the area of the knocked-out tooth.

Corrective action will include removing the crown of the tooth, leaving the root below gum level (decoronation).

“This happens around the time of Lughaidh’s growth spurt or when there is approximately a 1mm-2mm difference in height between the teeth,” says Michael.

This will allow normal development of the alveolar process/bone in the area of the knocked out tooth.

An orthodontic appliance can then be placed to replace the missing tooth.

Over time, Lughaidh will have to be referred to an orthodontist, followed by a periodontist and prothodontist (don’t ask), at which point I may be bankrupt. Fortunately, the expenses to date have been covered by school insurance.

The moral of this story is be prepared for the moment you find yourself scrabbling in the dirt in search of a tooth unexpectedly sent flying — and take out school insurance.

 

Teething issues

Endodontist Michael Hartnett on accidental tooth loss:

Avulsion of permanent teeth is a very serious dental injury. This is where the tooth is completely knocked out of the mouth in an accident. Typical examples of such accidents would be where the child falls off their bike, hits their mouth on a trampoline, or bangs against another child’s head at school.

The long-term future for the knocked-out tooth will depend on the actions that are taken at the time of the accident.

IMMEDIATE AFTERMATH

  • Stay calm.
  • Act as quickly as possible.
  • Hold the tooth by the crown only (try not to touch the root as there are fibres on the root that need to be preserved).
  • Gently push the root into the socket where it has come from using the adjacent teeth as a guide.
  • Close the teeth together or bite on some tissue and go to your dentist immediately.
  • If the tooth is dirty when knocked out you can clean with saliva (lick it) or wash the root gently and quickly under water (without touching the root if possible)
  • If you are unable to replant the tooth then place the tooth in milk and go to your dentist immediately. The best chance for long-term survival of the tooth is to replant the tooth immediately (ideally within five minutes).
  • Never replant a baby tooth.

DENTIST

  • Your dentist will ensure that the tooth is in the correct position.
  • The tooth will be splinted to the adjacent teeth to stabilise the tooth, which can last for up to two weeks.
  • Antibiotics and tetanus protection may be required at this time.
  • Root canal treatment will be started on the tooth after seven to ten days and will generally be completed within one month.
  • The patient should avoid contact sport for three to four weeks afterward.
  • A soft diet is advised for two weeks and the teeth should be brushed with a soft toothbrush after every meal.

Complications can develop if the knocked out tooth is out of the mouth for more than 30 minutes before it is put back in. The tooth can become fixed in position and as the child develops the tooth will appear to be shorter than the adjacent teeth. Management of such situations will require different dental specialists.

INSURANCE

Insurance schemes are available through the school which either cover only school activities or a 24-hour cover (preferable).

After an accident, the insurance company will pay the insured expenses which are not recoverable from any other source until the need for care has ceased (this will be subject to a policy limit up to €50,000).


More in this Section

Why a good breakfast is a must for your kids

Here's four of the most common eye health conditions

Blues to soul: An interview with Mary Coughlan

Time to get beyond the myths about attention deficit hyperactivity disorder


Lifestyle

A helicopter put a piano on the 150-foot roof of Blarney Castle and other stories from the Cork Jazz Festival archives

Jazz Memories: Famous faces share their favourite moments

Live music review: The Horrors - Icy genius in a thrillingly intimate setting

New book revisits the games they just don't make anymore

More From The Irish Examiner