A toothache is usually a result of tooth decay or an infection.A toothache is often caused by poor dental hygiene.The pain around the tooth may be caused or triggered by: Tooth decay Abscessed tooth (which is a collection of infected martial resulting in a

bacterial infection in the centre of the tooth) Injury to the jaw and mouth Infected gums Tooth fracture Damaged Filling Repetitive motion such as chewing

or grinding teeth [4]

A tooth fracture is a crack in the tooth but the tooth structure still remains intact. [6] A tooth fracture can occur doing the following activities: Playing a contact sport such as Rugby League or Boxing Chewing on something hard Tooth cavities that have weakened the tooth

Their are many different types of tooth fractures which are: Minor cracks Chips Cusp fractures Serious Fractures Cracked tooth Vertical fractures or split root Decay induced fracture [5]

A knocked out tooth is caused by heavy physical contact to an individuals mouth which due to the impact causes the tooth to fall out.Examples of situations in which teeth can be knocked out are: Falls Assaults Contact sports such as Rugby league and Boxing Multiple traumas such as a car accident

It is important to note that you need to act urgently if one of your adult teeth get knocked out because you risk losing the tooth if it is out of your mouth for approximately two hours.It is not a concern if a baby tooth is knocked unless the some part of the tooth remains in the gum (broken tooth). [7]

Current primary management techniques for a toothache is:1. Take some medicine such as paracetamol or paracetamol plus codeine

to relieve pain temporarily2. Obtain dental or medical advice if pain persists [4]

Current primary management techniques for a Broken tooth is:1. Recover broken tooth fragments

If break was relatively clean the dentist may be able to cement the tooth together as a temporary measure.

2. Rinse your Mouth out well with warm water as well as any tooth fragments you may have recovered to clean them Do not scrub tooth fragments just rinse them [8]

3. Control any bleeding as fast as possible Apply a piece of gauze to the area for ten minutes or until the tooth stops bleeding

4. Apply an ice pack to the cheek or lip over the broken tooth This helps to reduce pain and swelling

5. Obtain dental or medical advice Take the patient to the nearest doctor or dentist for treatment If you can’t access any medical help then cover the broken surface of the tooth with

dental cement which can be purchased at the local chemist Take some paracetamol or paracetamol plus codeine for temporary pain relief [5]

Their is no way to treat a fractured tooth at homeYou need to obtain medical or dental advice as soon as possible for treatment.To prevent any further damage to the tooth avoid eating:

Hard foods like biscuits and apples Eat soft foods like jelly Avoid foods and drink that are very cold and extremely hot such as a

hot chocolate and ice cream that is likely to cause pain due to tooth sensitivity if nerves are exposed [5]

Current primary management techniques for a knocked out or Avulsed tooth is:

1. Asses the victim and the injury Check the tooth socket for any bleeding

2. Control any bleeding as fast as possible Apply firm pressure to the tooth socket Ask the victim to hold firmly a sterile dressing or clean tissue into a pad over the bleeding area for ten

minutes or until bleeding stops

3. Recover the tooth and if dirty clean it in some milk Don’t allow the tooth to dry out keep it moist Handle the tooth by its crown not by the root [10] Never scrub the tooth, just rinse it [8]

4. Ask the victim to suck the tooth socket dry and place the tooth in the socket to keep the tooth roots alive If victim doesn't co-operate with the placement of the tooth in the socket, try to keep the tooth moist

and clean by keeping it completely covered in milk for 1-2 seconds wrap it in plastic to keep it moist and transport it to the doctor

5. Use a splint such as a folded piece of Aluminium foil to keep the tooth in place and ask the victim to bite down firmly on the splint to keep the tooth root in contact with Jaw tissue.

6. Obtain medical or dental advice If tooth cannot be found still obtain immediate dental treatment [10]

The current primary management techniques for a loosened tooth is:

1. Avoid Eating hard foods that could damage the tooth/teeth and make it looser. Try eating foods like jelly or cup of soups till the tooth/teeth are treated

2. Obtain dental or medical advice to treat the loose tooth/teeth. [9]

‘Aussies advised to learn “first aid for teeth” (last updated 11th August 2003) http://www.mydr.com.au/default.asp?article=4048 retrieved 9/8/08 [1]

  ‘First aid for teeth’ (last updated unknown)

http://www.ada.org.au/ods/media/documents/DAM2004/Parents%20Page/061104%20Approved%20FIRST%20AID%20FOR%20TEETH.pdf retrieved 9/8/08 [2]

  ‘Tooth Injury’ (last updated August 2003)

http://www.lpch.org/healthLibrary/ParentCareTopics/MouthTeethThroatSymptoms/ToothInjury.html retrieved 9/8/08 [3]   ‘Dental Health: Toothache’ (last updated 2008) http://www.webmd.com/oral-health/toothaches retrieved 9/8/08 [4]   ‘Fractured and Broken Teeth’ (last updated 2005) http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthBasics/

EmergenciesInjuries/DentalEmergencies/FracturedandBrokenTeeth.cvsp retrieved 9/8/08 [5]   ‘Fractures Question and Answers’ (last updated 2008) http://www.locateadoc.com/questions.cfm/649 retrieved 9/8/08 [6]   ‘knocked out tooth’ (last updated September 2005) http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?

p=243&np=292&id=2353 retrieved 9/8/08 [7]   ‘Knocked out tooth’ (last updated 2007) http://kidshealth.org/parent/firstaid_safe/sheets/tooth_sheet.html retrieved 9/8/08 [8]   ‘Loose Teeth’ (last updated 2004) http://www.simplyteeth.com/category/sections/adult/aboutteeth/looseteeth.asp?

category=adultList&section=99&page=40 retrieved 9/8/08 [9]   Tyler. E “First aid emergency handbook” pg 52 ‘Mouth and tooth injuries’: Tyrell’s building Consultancy [10]   ‘Broken or Knocked out Teeth Symptoms’ (last updated 2008)

http://www.emedicinehealth.com/broken_or_knocked-out_teeth/page3_em.htm retrieved 9/8/08 [11]