Tree vs teeth: Bark proves worse for his bite

Lughaidh, 11, was driv­ing a go-kart when it smashed into a tree and lost an adult front tooth. Luck­ily, it was re­cov­ered but the chain of events will prove costly, writes his mum,

Irish Examiner - Feelgood - - Feature - Cather­ine Shana­han

MARCH 27, 2017. A date, to my shame, not for­ever etched in mem­ory, but at least re­triev­able by email.

In con­duct­ing re­search for this ar­ti­cle, I came across the fol­low­ing, sent to a girl­friend tasked with or­gan­is­ing a mu­tu­ally ben­e­fi­cial week­end away: “Lughaidh smashed into a tree to­day in a go-kart. Knocked out a front tooth, bruised ster­num, to­tally trau­ma­tised (us both). Spent the bones of an hour in the den­tist’s try­ing to stop the bleed­ing and re-in­sert the tooth. Trip to spe­cial­ist on the cards.

“Yes, I need a week­end away.”

Four-and-a-half months af­ter Tooth­gate, an event that trau­ma­tised the house­hold and sent my son and his cen­tral in­cisor on their sep­a­rate ways, I vis­ited the scene of the crime for the first time. My 11-year-old took me through the high­speed im­pact that ul­ti­mately de­stroyed his per­fect smile.

He had called for his cousin who lives ad­ja­cent to the green area near our home. His cousin was al­ready down the green with a friend and they were rid­ing around on a dou­ble-seater go-kart.

For rea­sons un­sub­stan­ti­ated, Lughaidh ended up in the driver’s seat at the top of a steep grassy hill where per­haps the thin­ner air con­trib­uted to a se­ri­ous er­ror of judge­ment.

The go-kart took off — in­ves­ti­ga­tions failed to es­tab­lish if this was with or with­out the driver’s bless­ing — hit a dip half­way down, front wheels shot into the air, con­trol over go-kart was neu­tralised, and in the split sec­ond when the wheels hit the ground back on the level, there was no time to re­gain con­trol and the tree that had been di­rectly in the go-kart’s path from the get- go was sud­denly RIGHT THERE.

“Mum it was go­ing SSOOOOOO FASSSSSSSST. was NOTH­ING I could do. We smashed into the tree and the kart jerked for­ward and I jerked for­ward and it was SO SCARY,” said Lughaidh.

It was so scary that his eyes welled up while re­count­ing the tale. Not scary enough to stop him do­ing it, though.

The af­ter­math of the ac­ci­dent wasn’t pretty. The tree lost a slice of bark. Lughaidh lost an adult front tooth. My poor fa­ther, who was mind­ing my chil­dren, nearly lost his mind. A fraught phone call sum­monsed me home from work to tend to a son cov­ered in blood and sob­bing and bliss­fully un­aware that he had nar­rowly cheated death.

The story al­most had an up­side. A woman whose sis­ter is a den­tist wit­nessed the trauma. She ex­plained to my fa­ther that if they could find the tooth ASAP and put it in milk, there might be a chance of sav­ing it. The cousin/go-kart copi­lot ran back to the park and mirac­u­lously re­trieved the tooth — al­beit with a piece miss­ing. It was placed in milk and whizzed, along with Lughaidh, to the den­tist.

Hi­lary Ho­gan, of Ballinlough Den­tal Care, Cork City, did all he could to save the tooth. He man­aged to rein­sert it amid ex­ten­sive bleed­ing. He sub­se­quently splinted it and re­ferred us on to a spe­cial­ist, en­dodon­tist Michael Hart­nett. (En­dodon­tists spe­cialise in main­tain­ing teeth through en­dodon­tic ther­apy — pro­ce­dures in­volv­ing the soft in­ner tis­sue of the teeth, called the pulp.)

Michael, who set up up the first prac­tice lim­ited to en­dodon­tics in Cork in 1995 (now the mul­ti­dis­ci­plinary spe­cial­ist Cler­mont clinic in Dou­glas) worked his magic, re­in­stated the tooth, filled it, and re­stored Lughaidh’s in­cisor.

How­ever, as we nei­ther knew nor ad­hered to the pro­to­cols nec­es­sary to save a tooth by pre­vent­ing the root from dy­ing (the rea­son for this ar­ti­cle), Lughaidh will need an im­plant at a later stage. In the mean­time, Michael will mon­i­tor his tooth and make the necessThere ary ad­just­ments as his face de­vel­ops and changes.

He ex­plains that Lughaidh’s tooth “will ap­pear shorter than the ad­ja­cent teeth as the knocked-out tooth be­comes fixed in po­si­tion” (called anky­lo­sis — where the root of the tooth be­comes re­placed with bone). This im­pedes nor­mal de­vel­op­ment of the alve­o­lar process (bone) in the area of the knocked-out tooth.

Cor­rec­tive ac­tion will in­clude re­mov­ing the crown of

the tooth, leav­ing the root be­low gum level (deco­ro­na­tion).

“This hap­pens around the time of Lughaidh’s growth spurt or when there is ap­prox­i­mately a 1mm-2mm dif­fer­ence in height be­tween the teeth,” says Michael.

This will al­low nor­mal de­vel­op­ment of the alve­o­lar process/bone in the area of the knocked out tooth.

An or­thodon­tic ap­pli­ance can then be placed to re­place the miss­ing tooth.

Over time, Lughaidh will have to be re­ferred to an or­tho­don­tist, fol­lowed by a pe­ri­odon­tist and pro­thodon­tist (don’t ask), at which point I may be bank­rupt. For­tu­nately, the ex­penses to date have been cov­ered by school in­sur­ance.

The moral of this story is be pre­pared for the mo­ment you find your­self scrab­bling in the dirt in search of a tooth un­ex­pect­edly sent fly­ing — and take out school in­sur­ance.

If they could find the tooth ASAP and put it in milk, there might be a chance of sav­ing it. The cousin/go-kart co-pi­lot ran back to the park and re­trieved the tooth — al­beit with a piece miss­ing

Pic­ture: De­nis Mini­hane

CLOSE CALL: Lughaidh Smyth­willeven­tu­ally have to get a tooth im­plant af­ter los­ing a front tooth in an ac­ci­dent when his go-kart hit this tree.

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