Out of the Deep End

by James Findlay, DDS

Water Park Opening on Saturday! The town’s kids were sweating and lined up for hours to visit the newest summer attraction. Saturday evening my emergency phone line sharply announced the first casualty of the high-speed superdrop slide. One of my young female patients, age 11, had catapulted off the lip of the drop-off and smashed her face into “the roof” of the tunnel encasing the slide. Her anxious dad was on the phone to tell me that she had lost her two permanent front teeth. Horrified, I instructed him to bring her down to my office immediately.

At the office, I quickly assessed the young lady. She was such a delightful girl, it was doubly appalling to see her potentially marred for life by what was supposed to be the highlight of her summer fun. And to add insult to injury, the teeth were cleanly avulsed but were not recovered due to their loss on the slide, which emptied into a huge central pool. I couldn’t do much but radiograph the sockets to check for root fragments and dress the wounds.

Despite that, I insisted to her dad that those teeth must be present in what should essentially be a closed water system. He returned to the pool and a hasty search was conducted. Talk about looking for a needle in a haystack! No fresh incisors were discovered.

The next day, the water park opened for business as usual. Adamant that the teeth still were present in the pool or in its treatment system, I decided to consult directly with the new owner. I urged him to check the filtration screens, which he apparently had already done once before.

Nothing turned up, and he basically shrugged and said that accidents happen. Thinking of that little girl, and also understanding that the teeth were being preserved in a hydrated and chlorinated system made me persist. That evening I went back to the pool and met with the management staff. I began to explain the legal implications of such a permanent injury. We reached an understanding to redouble our efforts. They agreed to close the water park down while they scoured the pool’s depths with snorkel gear.

The next morning I received a call from my little patient’s father. The teeth had been found. They would pick them up and drive straight to my office. When the teeth arrived they were in a vial of pool water, shreds of periodontal ligaments still attached.

Now the tricky part! I bonded orthodontic brackets onto the avulsed centrals while the local anaesthetic went to work. She was a brave little trooper. I debrided and curetted the sockets. Carefully I re-implanted the teeth and placed brackets on adjacent permanent lateral incisors and primary cuspids. I explained the risks and pitfalls of avulsed teeth including root resorption, anlylosis and need for endodontic therapy and close monitoring. With her new front teeth back in place, we had one happy little girl again.

The teeth had been avulsed 48 hours and I held out only marginal hope for their success. Over the course of the next few weeks, calcium hydroxide was placed in each canal and the orthodontic wire was removed as the teeth showed some stability. In total, we replaced the calcium hydroxide dressings four times over a nine-month period.

The roots showed some mild resorption tendencies but overall I was impressed with their integrity. We completed conventional root fill procedures one year later.

My little patient grew older and the need for orthodontic repositioning of her maxillary anterior segment was required to improve some alignment and crowding problems. Despite further warnings of the risk in orthodontically moving these two weak teeth, the patient and family chose to proceed.

At the time of this writing our patient is 16-years-of-age and in retention phase. The smile is intact and in good harmony with her face. Her front teeth may never be “out of the woods” but at least we were able to get them “out of the deep end.”

Postscript: The waterslide park remained open for only one month. In that brief span, four separate injuries occurred on the same dangerous slide and the owners were forced to shut down when insurers declined further coverage. It has yet to reopen.

Dr. James Findlay is a 1977 graduate of UBC. He has been in private practice in Maple Ridge and Langley, BC for 24 years.

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