# Dental Trauma Day: Correct Management

## Supported by Waikato Bay of Plenty branch with NZSE 

Please see full recordings below of this wondering full day dental trauma course, presented in May 2023 at Hobbiton, Matamata.

Dental trauma is accounting for much of the new damage to oral structures. This course will cover how to make a correct diagnosis, what the treatment options are, and how to get an excellent and stable outcome. 

### Speakers at the course: 

**Steve Manning**- Steve is a specialist in the field of endodontics. He has been in the same practice in Christchurch for 30 years which has allowed him to view the cases he treated many years ago. The management of dental trauma is an area of keen interest. He has participated in multiple courses for NZ dentists, organized a booklet for general dentists on the Dental Trauma management, ran the Avulsed Tooth poster campaign to multiple schools and sport cubs, and helped ACC with their dental trauma
registration form.

**Andrew Newsom**- Andrew completed a Bachelor of Science Degree at Canterbury University before completing a Dental Degree at Otago University. Following two years working in New Zealand, he moved to the UK and studied at the Eastman Dental Institute in London and completed a Diploma in Restorative Dental Practice and gained advanced skills in dental implants and advanced dental care. Andrew is also a member of the Royal
Australasian College of Dental Surgeons and in 2009 he studied at the University of Sydney in a specialist Prosthodontic program, completing a Doctor of Clinical Dentistry with credit. Andrew’s practice is in Tauranga he is the only specialist Prosthodontist in the Bay of Plenty.

**Katie Ayers**- A registered specialist in Paediatric Dentistry, with a keen interest in Dental Public Health, Katie balances her time between clinical practice in Hamilton and Tauranga, and her role as Oral Health Advisor to and Approving Dental Officer for the Midland District Health Boards. Katie has recently completed her term as President of the New Zealand Dental Association. She has chosen to continue her involvement with the NZDA by continuing as the Spokesperson on Access to care. She is also a Director of the Braemar Hospital and of the Braemar Hospital Charitable Trust.

**Mike Gordon**- Mike is currently working in specialist practice in Hamilton. After completing a Masters of Dental Surgery
in Endodontics at the University of Otago in 2004 he gained membership of the Royal Australasian College of Dental Surgeons in endodontics in 2005. He has numerous publications in peer reviewed journals and recently published a chapter on working length in the text book “Best Practices in Endodontics”. He currently reviews articles for the Australian Endodontic Journal and the New Zealand Dental Journal. He has a special interest in evolving technology in endodontics and the operating microscope and holds memberships with The NZ Society of Endodontics, The Australian and New Zealand Academy of Endodontists and the International Association of Dental Traumatology.

**John Bridgman**- John has been in private practice in Tauranga for 18 years and as is a visiting Surgeon to Tauranga Public and Grace Hospitals. He undertook the New Zealand Oral and Maxillofacial training scheme and undertook additional training in the UK and Germany.





nzse-favicon.png

NZSE

### Definition
Endodontics is the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and peri-radicular tissues. The study and practice of endodontics includes the biology of the normal pulp and peri-radicular tissues and the aetiology, prevention, diagnosis and treatment of diseases and injuries that affect these tissues.

### General overview
Endodontic treatment is a specialised branch of dentistry known also as root canal therapy. Endodontics is carried out by general dentists and specialists endodontists to relieve dental pain and resolve infection or a disease process in teeth. The aim is to save teeth by locating the infected or irreversibly inflamed dental pulp in the root canals. The canals are thoroughly cleaned, then sealed to prevent re-infection.

Toothache can arise from a number of causes and appropriate treatment options can only be considered after a detailed mouth examination, x-rays and other tests in order to make a diagnosis. Factors such as a patient's medical history, oral cleanliness and health of the gums, and the amount of tooth and bone support remaining are important considerations in deciding whether a tooth has a reasonable long-term future or whether extraction should be considered. Replacement options for extracted teeth continue to improve but are generally much more expensive and less satisfactory than natural teeth.

### What's Inside a Tooth?
The outermost layer of the tooth material is called "enamel", which is hard and solid. The inner layer of the tooth material is called "dentine". Both are hard and mineralised layers. Inside the tooth there is a small, delicate space called the "dental pulp" or what people normally refer to "tooth nerve". The dental pulp is a delicate structure that contains nerves and blood vessels that help nourishes the tooth and provides the tooth with sensation. The pulp is also responsible for most of the early growth and development of the tooth in childhood. See the illustration bellow which describes these structures.

### What is endodontic treatment?
Endodontic treatment is a procedure carried out to preserve a tooth that may otherwise require extraction. There are many advantages of saving natural teeth including;
1. Proper function, appearance and ability to talk.
2. Natural teeth maintain the height, thickness and shape of your jaw bone. Loss of natural teeth can compromise the bony support for face muscles, affecting face shape.
3. Loss of a single tooth that is surrounded by natural teeth would allow the adjacent teeth to drift into the space that is created by the lost tooth. That can create problems with the bite or open spaces between the adjacent teeth that may contribute to gum problems.


### What caused the problem with my tooth?
The most common cause of pulp damage is deep tooth decay. Other factors could also damage or expose the pulp to bacteria that cause pulp inflammation or infection. Among the other causes are tooth fracture, traumatic injury such as a blow to the mouth, a cracked or loose filling or repeated restorations, and less frequently periodontal (gum) disease.

### How many appointments are necessary?
Endodontic treatment is usually completed over two or three visits. In some cases it could be completed in one session.


### How long will the tooth last?
With proper restoration and care endodontically treated teeth can last as long as any other tooth. There are many factors that determine the long-term survival of a root filled tooth including, but not limited to, the condition of the tooth before treatment, the type of tooth restoration following the treatment, the way teeth bite together and habits such as grinding or clenching teeth. Good oral hygiene, avoidance of a high sugar diet and periodic dental check-ups facilitate the long term survival of endodontically treated teeth.


### Does endodontic therapy hurt?
Root canal procedure is usually carried out under local anaesthetic. The procedure should not be painful. However, when tissues are very inflamed causing severe toothache, this is the most difficult situation in which to achieve complete relief of pain. In these situations more than one method or technique for administering local anaesthetic may be required to achieve good pain control.

### Will there be pain after procedure?
The majority of patients experience no or very minor discomfort. Sometimes teeth may be tender to bite on for 2-3 days after treatment. This is not uncommon and should be controlled by ordinary pain relief. Some teeth take more time to settle however, if the pain persists you should contact your dentist or endodontist.

### How much does endodontic treatment cost?
The cost of root canal procedure can vary depending on several factors. The front teeth are usually easier to treat and therefore treatment may be less expensive than treatment of back teeth. The factors that determine the cost of the procedure are the difficulty of the treatment, complexity of procedure, time required for the treatment and the materials used for the procedure. You need to discuss cost with your dentist or endodontist. Generally, endodontic treatment is much less expensive than extraction and replacement of teeth with a bridge or an implant.

### What are the alternatives to endodontic treatment?
The alternative to endodontic treatment is usually tooth extraction. The options after extraction are to accept a gap or replace the tooth with an artificial replacement to restore function and aesthetics. The prosthetic or artificial replacement options include implant-supported crown, bridge restoration or removable partial denture (Plate). It may be important to confirm that a replacement option is possible before electing to have a tooth extracted.

### Can all teeth be treated endodontically?
With the recent advances in this field, endodontic treatment options can be offered for an increasing number of teeth that were traditionally considered not treatable. Even back teeth that are difficult to access can be effectively and satisfactorily treated. An individual assessment needs to include consideration of the medical history, acceptance/tolerance of the procedure itself, a detailed assessment of the tooth in question, the long-term outlook for the tooth and each individual patient's wishes.

### Can endodontic treatment fail?
Endodontic treatment has high success rate. The success rate of this procedure varies depending on several factors. Generally, and if performed to high standards, root canal procedure does enjoy high success rate in the long term. Problems, however, do occur with root filled teeth. If the root filled tooth develops decay or its restoration fails or leak it could lead to endodontic treatment failure. In some other cases and despite good care the tooth may not heal as expected. Further endodontic treatment or surgery may be indicated if appropriate to deal with the treatment failure. A tooth that develops vertical crack or fracture can also fail, which often require extraction.

### Will I need to return for any additional treatment?
It is usual for healing to be reviewed about 6 months after root canal treatment to determine whether healing has occurred. Sometimes, more than six to twelve months are required to confirm that healing has taken place. You may need to return back to your dentist for the permanent definitive crown restoration if healing has been confirmed and your tooth needs a crown.

### Want to know more?
If you have more questions before, during or after your treatment, your dentist will be happy to answer your questions.

Find an Endodontist

### What do I do after endodontic treatment is completed?
Following your root canal treatment, the crown of the tooth should be restored with a permanent restoration which protects the remaining tooth from the risk of fracture. Your dentist may suggest you have a crown to protect a tooth where it has been heavily filled.

Patient Information

Auckland

Hamilton

Tauranga

Palmerston North

Wellington

Nelson

Christchurch

Dunedin

## Journal

The New Zealand Endodontic Journal is the publication in its field and provides a forum for the exchange of information about new and significant research in Endodontics in New Zealand and throughout the world.  The Journal publishes review articles, clinical developments, clinical opinions and treatments as well as other key issues of relevance to Endodontics.

NZSE Vol 61

Archived Journals

NZ Endodontic Journal

## Join NZSE

We encourage you to join the New Zealand Society of Endodontics. The Society was established to serve as a source of continuing education in the field of Endodontics for the society members and for the dental profession in general. It also supports research in the field of Endodontics and provides general information about root canal treatment and management of dental traumatic injuries to the New Zealand public.

### Advantages of Joining the New Zealand Society of Endodontics
- Get the latest on endodontics.
- Read the New Zealand Endodontic Journal online.
- Access to the [Dental Trauma Guide](https://dentaltraumaguide.org/)
- New Zealand Society of Endodontics members can also attend the Endodontic meetings of the International Federation of Endodontic Associations (IFEA) and other international Endodontic meetings at special rates.
- The New Zealand Society of Endodontics supports endodontic education and research in New Zealand through funding Research - Grants to Graduate Endodontic students as well as to its general members.
- Members rates for continued education courses
- Access to exclusive webinars and resources

Join NZSE

# Advertisements
If you are interested in advertising in this area please contact the [Secretary](mailto:secretary@nzse.org.nz)


Additional Information Sources

Links

Dental Trauma Day

Resources

### Welcome

The New Zealand Society of Endodontics is a not-for profit organisation with membership open to general dentists as well as dental specialists from all fields of dentistry both locally and internationally. With more than 300 members, the New Zealand Society of Endodontics is the largest society associated with the New Zealand Dental Association.

New Zealand Society of Endodontics was officially incorporated in July 1995 with the objects of promoting and advancing the study and practice of endodontics. The annual general meeting of the Society usually coincides with the annual conference of the New Zealand Dental Association, or alternatively scheduled on another date fixed by the committee and shall be convened by the Honorary Secretary or President of the Society.

The New Zealand Society of Endodontics aims to:
* Serve as a source of continuing education in the field of Endodontics for the society members and for the dental profession.
* Support research in the field of Endodontics.
* Support undergraduate elective period projects in Endodontics.
* Provide information to the New Zealand public about the field of Endodontics, general information about root canal treatment and management of traumatic injuries.

Join Us

About

# Contact Us

### President
Joanna Lowe\
[president@nzse.org.nz](mailto:president@nzse.org.nz)

### Secretary
Nick Tramoundanas\
[secretary@nzse.org.nz](mailto:secretary@nzse.org.nz)

### Treasurer
Theodore Kay\
[treasurer@nzse.org.nz](mailto:treasurer@nzse.org.nz)

### New Zealand Endodontic Journal Editor
Dikesh Parmar\
[journal@nzse.org.nz](mailto:journal@nzse.org.nz)