Concussion

Concussion is defined as an injury to the tooth's supporting structures without abnormal loosening or displacement of the tooth. There may be bleeding around the gingiva as a result of injury to the tooth supporting structures. Concussed teeth will be tender to percussion due to an inflamed and injured periodontal ligament. Pulp sensibility testing is likely to give positive results. Radiographic examination reveals the tooth to be in its normal position in the socket.

Treatment objectives are to optimize healing of the periodontal ligament and maintain pulp vitality. This is accomplished by relieving the tooth from occlusion. Splinting is usually not indicated unless the patient complains of tooth mobility. The patient should be placed on a soft diet for two weeks.

In the primary dentition parents should be informed the traumatized tooth may darken. However no treatment, other than observation, needs to be undertaken unless the patient complains of pain, the tooth becomes mobile, or infection develops. If the root of the primary tooth is intact, a pulpectomy may be performed. If root resorption is present, extraction is recommended. Parents are told the tooth may lighten after a period of one to two months. If that does not occur and there is no pathology, the tooth may be lightened with the use of composite material.

Image: Traumatized tooth that has darkened.
Image: Radiograph of traumatized tooth.

Mature permanent teeth with closed apices may undergo pulpal necrosis due to associated injuries to the blood vessels at the apex and will require endodontic therapy.

In the primary dentition follow up treatment consists of clinical observation at one week and radiographic examination at six-to-eight weeks and when symptoms occur.

In the permanent dentition follow up treatment consists of clinical observation and radiographs at four weeks, six-to-eight weeks and one year.