The reason why we’re looking at accidental ground-level falls is that they’re the leading cause of facial trauma and, what interests us, dental trauma. This is especially true for older adults who are more likely to fall due to slips, trips, and similar mishaps.

Surely, beyond the actual injuries, there’s the public safety issue that precedes the incident initially and needs to be addressed and acknowledged, but we’re here to look at dental trauma.

For dental clinicians, these types of trauma are quite common, but they can be extremely complicated. For patients, this often results in multiple painful and long surgeries, financial worries (e.g., loss of income), and possible disfigurement.

In this article, we’ll go over some of the most frequent dental injuries resulting from accidental ground-level falls.

Most Common Dental Injuries

Here’s a quick list of the most common injuries that dentists/dental specialists get to see:

Crown Fracture: Also known as ‘chipped tooth’ or ‘broken tooth’, it’s a fracture when the white outer part/layer of the tooth’s enamel breaks off, and if the damage goes deep, it can expose the inner, sensitive pulp. This way, a ‘simple’ fracture can turn into a ‘complicated’ fracture, which is (usually) very painful and requires urgent care. The nerve also might get exposed, further complicating the issue.

Tooth Luxation: A tooth that has been knocked loose or completely knocked out. This injury is not a break, but the injury or damage done is to the ‘shock absorber’ ( the periodontal ligament) that holds the tooth in the jawbone. 

There are a few forms of luxations:

• Subluxation: The tooth is loose and sore, but it hasn’t shifted.
• Extrusion: The tooth is partially pushed out of the socket.
• Lateral Luxation: The tooth is jammed into a new position (often sideways).
• Intrusion: The tooth has been thrust into the jawbone.
• Tooth Avulsion: The entire tooth, including the root, has been knocked out of the socket. This is considered an emergency as the time to save the tooth is limited (often requires the patient to place the tooth in milk as soon as it’s recovered).

Alveolar Bone Fracture (Broken Jawbone Socket): If the part of the jawbone that holds the teeth is fractured, several teeth will move together as a single unit. Obviously painful and requires urgent care.

TMJ (Temporomandibular Joint) Trauma (Jaw Joint Injury): This is the hinge that connects your jaw to the skull. The impact of a fall can lead to injury to this joint, which leads to pain, clicking, popping sounds, trouble chewing, and possibly lockjaw. Sometimes this injury is not immediately apparent til you try to open your mouth to eat. This’ll require specialist care.

Cuts (Lacerations): Soft tissue injuries usually bleed a lot and should be checked for embedded debris. These often happen to lips, cheeks, and gums and are usually caused by your own teeth cutting your mouth or a tooth being embedded in a lip on impact.

The Long-Term Clinical and Patient Impact

Clinically, any of the above-listed injuries have potential for infection and/or complications and will require follow-up care.

For the patient, this means they could be facing a long-term financial burden for all the follow-up treatments that might be required. Also, there’s the issue of the patient having to live with a broken/missing tooth for a while until the issue has been solved, causing social problems that persist. 

The financial aspect usually becomes the prime issue, as not all insurance will cover these types of injuries, which means the entire burden is on the patient to bear.

These are issues that’ll need to be discussed with the dental team and reflect on the patient’s overall well-being and oral care.

From a public health perspective, walkway or broken sidewalk injury cases are highly preventable. But this, of course, depends on the law that’s bestowed upon us. In states like Illinois, property owners bear a clear responsibility for sidewalk repair. And this causes a problem because if a property owner or municipality fails to address a hazardous condition, this oftentimes becomes the central issue in broken-sidewalk injury cases. 

But in states like Colorado, the responsibility falls on the city, which means these issues are more likely to be handled quickly, resulting in fewer such cases (not a rule of thumb).

If such cases go to court, it’s the patient’s dental records that often become key evidence, as they objectively document the cause and extent of the injuries sustained and the long-term follow-ups required.

Conclusion

Whenever there’s a dental injury involved, please don’t sit on it. Don’t book an emergency appointment at your dentist immediately. In most cases, the pain will force you to do so, but even if you don’t feel that much pain, there could be a fracture and/or the nerve might be damaged and will die off, causing rot to follow if you do nothing about it.

Don’t let it come to being too late to save your tooth or prevent the lockjaw, or another condition caused by the fall. While there’s a lot that can be done to help prevent hazards on the streets – we didn’t go into that in this article – we can do our best to deal with the aftermath in a way that helps us.

Speak up and hold those responsible accountable so it prevents someone else from the same trauma.

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