I got into a fight on New Years eve, and took a pretty good punch to the mouth. My gums were bruised, and the gum on my right front tooth receded so that part of the root is visible.

Any help would be greatly appreciated, thanks.

Answer:

Well there are a couple of things to take into consideration when looking at your scenario.  For starters, is the tooth mobile?  This plays a HUGE role as to whether the tooth will “heal” or not.  If mobile, the tooth may need to have a splint attached by the dentist to immobilize the tooth so that healing can begin to occur.

We will answer your questions under the assumption that the tooth is not mobile.

Will it heal?

Yes and no.  Yes in that the periodontal ligaments (the fibers that attach the tooth to the socket and bone) have undergone extensive trauma and will begin to reattach so that the tooth can function normally.  No, in that the gums that have receded will not grow back over the exposed root without assistance from the dentist.  What will actually happen is that the pdl fibers will reattach on the remaining gingiva (gums).

Will I require dental surgery?

Yes.  You will need something referred to as periodontal plastic surgery (believe us, sounds much more complicated that what it actually is).  The dentist uses a free gingival graft or connective tissue graft to cover the area.  This means that he/she will remove some gum tissue from one part of your mouth, and place it over the area of recession in order to stimulate growth.

Do I need to avoid smoking?

Yes is an understatement!!  Smoking severely compromises the amount of blood supply to your gums.  Insufficient blood supply=delayed healing!

Will it get infected if I don’t take care of it?

Let’s consider the anatomy of teeth when looking at this question.  Unlike the crown of the tooth, which is covered by enamel, the root of the tooth is covered by a substance called cementum.  The composition of cementum is a little different than enamel, as it was made to function below the gums, and not actually in the mouth like enamel.  This means just continue to practice good oral hygiene, which means brushing after each meal and flossing once a day.  Be sure not to let food or any other debris accumulate in this area.

What are the signs that the tooth is dying besides turning dark?

This varies.  Some signs can include sharp pain, increased sensitivity, a long, dull, continuous pain, sensitivity to hot, cold, or when chewing, or, as you mentioned, color change.  Also, a tooth can undergo the process of necrosis (dying) with no signs or indications.  A dentist can run several tests to determine whether the pulp is still vital.

We hope these answers helped you out.  In a situation like this, it’s pretty hard to tell exactly what’s going on without running some tests and taking a look clinically.  But hopefully these answers can guide you down the right path.  It’ll be best to go to the dentist and have an x-ray taken of the tooth and a couple of diagnostic tests performed to determine the status of the tooth.  Don’t wait too long to visit the dentist, especially if the tooth is mobile.

Hope this helps and good luck!!

What is enamel?

Enamel is the hardest substance in the entire body.  It’s the outside layer of the tooth, completely covers the dentin, and is actually transparent in color.  That means the color of our teeth is due to dentin and not enamel.  However, enamel is comprised of enamel rods which can hold stain quite easily, including red wine, coffee, tea, and cigarettes.

What is enamel comprised of?

Enamel is comprised of 96% calcium hydroxyapatite and 4% organic material and water.  Bone is composed of 50% hydroxyapatite and 50% organic material including collagen, thus making enamel the hardest substance in the body.

If I chip or break enamel, will it repair on its own?

Unfortunatley, enamel does not contain any living cells.  Therefore, if chipped, it will not repair itself.  However, dentin can repair itself if damaged.

What is hydroxyapatite?

Hydroxyapatite is a storage form of calcium in the body.  99% of calcium in bone is stored as hydroxyapatite.  The chemical formula for hydroxyapatite is Ca₅(PO₄)₃OH.

What is dentin?

Dentin makes up the bulk of the tooth.  It completely surrounds the pulp, and is covered by enamel on the crown portion of the tooth, and by cementum on the root of the tooth.  Dentin is usually yellow in color and ultimately determines the color of the tooth, being that enamel is transparent.  Dentin is composed of dentinal tubules that communicate directly with the pulp.  This means that is bacteria reaches the dentin, usually some type of pain will be felt.  Dentin is composed of 65-70% calcium hydroxyapatite, 20-25% organic material, and 10% water.

What is cementum?

Cementum covers dentin on the root surface of the tooth.  Cementum connects the tooth to the periodontal ligaments and is therefore somewhat responsible for securing the tooth in the bone.  It is composed of 50% calcium hydroxyapatite and 50% organic material and water, the same consistency as bone.

What is pulp?

Pulp is the livelihood of the tooth.  Pulp supplies nutrients, blood, and nerves to the tooth.  This means that the pulp is responsible for keeping the dentin, cementum, and dentin strong.

Well what if my pulp is removed with a root canal?

Once bacteria reaches the pulp, depending on how extensive, it’s usually recommended to have the pulp removed.  This is because the pulp communicates directly with the rest of the body, and if harmful bacteria is present in your pulp, and it easily move to other areas of the body, including the brain!!  Please see the article on root canal for further information on this subject.