Dom and I are final year medical students with the University of Newcastle. We have spent the last month on placement with Dr Phil Chapman working in Busselton ED and in our time off scoped out the local surf. What this meant was hours of traipsing up and down Caves Rd, a 100ish km stretch of road connecting Cape Naturaliste and Cape Leeuwin. This road sports 150 odd Surf Breaks beneath Limestone Cliffs on one side and an assortment of Vineyards and Breweries on the other.
As a novice surfer following my more experienced companion, I was led into some heavy surf. Especially when joined by our big wave charging supervisor. Our trip featured some heavy lefts onto the rock shelf that WA is famous for, including Main Break Prevelly, Big Rock and Gallows. Notable waves included the A-frame Shorey at Injidup where I found my feet and the long rock shelf at Yallingup where I didn’t get to my feet at all.
Surprisingly then it wasn’t me that ended up with the most notable injury of the trip. Dom, on his birthday no less, while surfing the rock shelf left of Gallows, copped a lipping wave to his back creating an intense tooth clash as his jaw made friends with his rail. His upper teeth clashed down behind his lower incisors destroying the cement in his metal retainer. There was no trauma to the soft tissue of his mouth, but the force had chipped his upper teeth and caused a grade 2 luxation of his lower incisors
We were lucky enough to see the one endodontist in the south-west. She was worried that the disruption to the ligaments in the lower teeth would cause damage to the neurovascular supply of his teeth. She tested the sensation to cold of the teeth and found that one tooth had particularly reduced sensation. This is a non-specific sign for nerve injury in the tooth, at this point, it is not known if the tooth will regain feeling. If the tooth does have a severely disrupted neurovascular supply, it needs a root canal operation to prevent an avascular necrosis which predisposes to a dental abscess and increasingly nasty sequelae.
Especially in the case of tooth trauma in younger patients, it can be preferable to wait to see if the tooth will regain sensation because there is still a chance. Post root canal surgery the preferred option is to implant a tooth in the bone which requires complete ossification of the growth plate, in males that’s approximately 26 for the jaw.
In patients with a collision of teeth as the mechanism of injury, there is a commonly associated fracture to the TMJ which can be determined by palpation, which should be exquisitely tender.
In the case of an unstable tooth, especially with the possibility of neurovascular compromise, it is important to splint the tooth in place. This prevents the risk of further damage and dramatically reduces the pain of the injury. Splinting in a first aid setting can be achieved with a paper clip or aluminium foil placed behind the posterior aspect of the tooth. For surfers who are concerned about the prospect of losing teeth entirely, a tooth nutrient solution can be added to your first aid kit. This can extend the lifespan of a tooth considerably, and does not have the refrigeration requirements of milk, a common alternative.