March 28, 2023
In the 14th century, the Latin vocabulary contained a word called concutere. It was used to describe things that were shook or agitated in a violent manner. Slowly this word found its usage in the medical dictionary for explaining a type of injury to the head.
In dentistry, tooth concussion refers to the mildest forms of tooth injury that usually has a favorable prognosis. Following a traumatic impact, one or multiple teeth might bear the impact of the injury. When the tooth is not displaced or mobile but only sensitive on touch or percussion, then a case of concussion can be suspected.
Clinical findings in tooth concussion
The patient with tooth concussion can present with sensitivity of the affected tooth. Clinically, the surrounding tissues appear healthy with no bleeding from the gingival tissues. Primarily, the dental surgeon checks for any abnormal discoloration of the tooth structure which is a direct indication of the extent of the injury.
A greyish appearance of the tooth indicates that the extent of the injury is deep within the tooth's core, infecting the pulp tissue. This tissue houses the blood vessels and nerves of the tooth.
A pinkish appearance indicates that the traumatic blow has triggered a resorptive process. This means that the tooth's roots have gradually started dissolving and inflammatory processes have started engulfing the root's tissues.
A dark yellowish appearance indicates that the tooth's root canals are directly affected in a way that the pulp canals in the root have started obliterating.
Radiographic findings in tooth concussion condition
In most cases no radiograph is needed. However, in order to ensure that surrounding tooth structures are healthy, one radiograph could be taken. The anatomical region between the tooth's roots and the surrounding socket is inspected for any signs of loss of attachment.
Treatment for concussed teeth
In most cases of tooth concussion, no treatment is needed. The patient is recalled at an interval of 1 week, 4 weeks and 8 weeks to check the health of the concussed tooth both clinically and radiographically. Later, the patient is recalled annually to ensure that the tooth condition has not worsened.
In adult patients, the tooth is also checked for vitality during every follow-up visit. This is done to ensure that the tooth is still responsive to external stimuli and thus has a healthy pulpal tissue.
Apart from routine oral hygiene instructions and cautioning them of repeated trauma, patients are also advised to regularly swish their oral cavity, especially the gunms, with 0.2% chlorhexidine.
Prognosis
In very rare cases does a concussed tooth suffer from necrosis, infection or resorption of the roots. But if it does, then a root canal treatment is opted for immediately.
In primary or deciduous teeth, a treatment is formulated by also taking into consideration the position of the successor tooth. Ignoring the pain of a concussed deciduous tooth might have direct adverse effects on the permanent successor. If the choice of treatment is extraction, then the pediatric dentist's opinion is taken whether or not a space maintainer should be placed or not. This is an appliance that becomes mandatory for the patient to wear until the permanent tooth erupts in the region where the extracted deciduous tooth was. If no space maintainers are given, then the adjacent teeth might occupy the space where the deciduous tooth was, resulting in ectopic eruption of the permanent tooth.
In cases where the concussed tooth is a young permanent tooth, i.e., a tooth whose roots are yet to be developed, regular follow-ups become mandatory. This is done in order to monitor whether following the concussion the tooth's roots are still developing or not. If at all the development ceases, then root canal treatments to close the blunderbuss apex of the tooth are opted for.
Concussion of a tooth is never an emergency condition. Healing of a concussed tooth usually occurs within 2 weeks. In cases of a pediatric patient, patients are advised to monitor any changes in the color of the concussed tooth for at least 3 months. During this period, the parents should ensure that the child carries out routine oral hygiene practices with a soft toothbrush. Even though concussion is the mildest in terms of severity of dental trauma, by no means should it be ignored.