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Dental Injury

Avulsed Tooth

Coming off a log-drop on the Tibble Fork downhill, you dig the front tire. Smack! Your mouth hits the stem. What's that your tongue is moving around? It's a loose tooth.

Survival of the tooth depends on rapid replacement into the socket. If the thin tissue that's clinging to the roots of the tooth dries before the tooth is replaced, the tooth won't heal into the socket. (Only permanent teeth should be replaced. If your young child knocks out a baby tooth, it's usually best not to put it back -- it may form a bridge to the bone that interferes with the development of the permanent tooth underneath.)

Immediate care:
If the tooth stayed inside the mouth, don't try to clean it. Don't touch the roots. Have your biking buddy grab the chewing end of the tooth, turn it so it looks right, and ram that sucker hard back up into the socket. Then bike back to your dentist.

If the tooth went onto the ground and is covered with dirt, squirt it off with your water bottle or rub it around in your mouth with your tongue until it's clean. Don't scrub the roots of the tooth. If there's a pebble stuck into the root, pick it off with the knife-tip of your multi-tool, but don't scrub the roots! Put the tooth back as above.

If the tooth is sloppy and won't stay, you've probably broken the alveolar ridge bone that holds the tooth. Try to stabilize the tooth in the socket. If you have tissue paper, fold several thicknesses and slightly wet it. Push the tooth into approximate position, then fold the paper over the teeth. Hold the paper in place with your tongue and lips. A tooth that keeps "sneaking out" of the socket can be held in place by biting on a small stick. If you have nothing to keep the tooth in place, you could consider biking with the tooth loose in your mouth (there's always the danger that you'll swallow it). A second choice is to dump it in your Gatoraid. (You've probably heard that milk is a good transport medium for a tooth. How often do you have milk with you as you bike?) The worst thing you can do is stick the unprotected tooth in the back pocket of your bike jersey.

Ongoing care:
See the dentist or oral surgeon immediately. The goal is to stabilize the tooth until the supporting ligaments heal. The pulp of the tooth will die, however, so expect a root canal later.

Crooked Tooth

The Corkscrew downhill section of the Alpine Days Race has gotten very loose as riders brake through the numerous twisting turns. As you slide into a sharp turn, your front tire washes out, just enough to hang up on the brush on the side of the trail. The tire rips off as you potato-chip the rim, then the bike flips sideways into the brush. You make a face-first landing. Your central incisor is now crooked.

When a tooth has been pushed out of place, it often tears the nerve and blood vessels at the tip of the root(s). Sometimes the root is cracked, or the bone surrounding the tooth may have crumbled.

Immediate care:
If the tooth has popped somewhat out of its socket (for example, an incisor that sticks down into the mouth more than the adjacent tooth), it should be pushed back into position. Just shove it back into the socket.

If the tooth seems floppy or loose, try to stabilize the tooth in the socket. If you have tissue paper, fold several thicknesses and slightly wet it. Push the tooth into approximate position, then fold the paper over the teeth. Hold the paper in place with your tongue and lips. A tooth that seems stable at first, but keeps "sneaking out" of the socket can be held in place by biting on a small stick.

Ongoing care:
Ride back to civilization, and see your dentist or oral surgeon as quickly as possible. Usually, this should be within 24 hours. After a few weeks, the tooth may darken. This means the tooth has died. If it becomes painful, or the appearance bothers you, see the dentist for a root canal.

Chipped Tooth

Today's the day you're finally going to ride the razorback ridge on the Wasatch Crest. You wait until all the sensible bikers walk down the jagged spine of the mountain pass, then you make your move. But halfway down, you choke, hold the front brake, and endo. You feel a crunch as your mouth smacks the rock.

Chipped teeth vary in how quickly they must be fixed. If the fracture involves only the outer layer of the tooth, the problem is mostly cosmetic and can be fixed at your convenience. If the pulp is exposed, it requires immediate repair.

Immediate care:
Don't bother looking for the chipped piece. It can't be replaced. But if you've also cut your lip, consider the possibility that your piece of tooth is inside the cut.

bf-toot2.jpg (7871 bytes) Check to see how serious the chip is. If the broken surface of the tooth is pink or has blood on it, it means the crack involves the pulp. If the broken spot is yellow, the crack involves the dentin. If an injury hurts like a toothache, or is sensitive to cool air or foods, it's serious.

This tooth requires rapid repair. The surface is sensitive and there's exposed pulp (a drop of blood on the broken surface).

You can make a chipped tooth less sensitive (while waiting for the dentist) with clove oil, teething gel, or sucking a baby aspirin. Covering the exposed surface of the tooth tends to help.

Ongoing care:
If you're sure the chip involves only the outer layer of the tooth, make an appointment with your dentist for a repair. If the chip involves the deeper tooth, you should get in as quickly as possibly, ideally within 24 hours. If you delay, you'll need a root canal for sure.

Jaw and TMJ Injury

Coming down off the exquisite Entrada sandstone at Bartlett Wash, your front tire digs into the loose sand of the valley floor. You dive forward as the bike endos, landing on your chest and stomach. Your chin bangs the dirt. Strange -- it hurts in front of your ear when you move your jaw.

Most of the time, a jaw injury ISN'T at the location where you bumped. The force is transmitted up to weaker areas. Jaw pain at a place you didn't bump is a strong sign of trouble. The most common areas broken are the angle (where the bone turns upward at the back of the jaw) and the temporomandibular joint (TMJ) area where the jaw hinges under the skull.

If a jaw injury isn't treated properly, the teeth might not match up correctly, or the "fit" of the jaw joint may be changed. The change can be subtle, but it can lead to chronic TMJ pain and teeth breaking down over time. Even if there's no fracture, there can be injury to the cartilage in the TMJ.

See the doctor or oral surgeon if:
    - the teeth don't fit together perfectly
    - there is pain in the TMJ area (just in front of the ear)
    - the jaw can't be opened fully
    - eating is painful

Immediate care:
Cold-pack the painful area. Go see the doctor.

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