Dental Trauma

Dental TraumaThe most common mechanism of dental injury is trauma from falls and sporting injuries; altercations and motor vehicle accidents account for most of the rest.

Approximately 70% of all dental injuries involve central incisors of the upper jaw.

Management of dental injuries depends on the age of the patient and the extent of tooth and surrounding bone involvement. Dental injury is often accompanied by injuries to adjacent areas and structures.

Usually, clinical assessment and radiographic evaluation (eg, tooth radiographs, panoramic radiography) are the most helpful measures for determining the severity of the injury, but computed tomography (CBCT) of the head, neck, and maxillofacial bones may be warranted.

Treatment of dental trauma varies, depending on the particular injury found (eg, fracture, avulsion, or luxation).

Arrangements should be made for prompt follow up with a dentist or an oral and maxillofacial surgeon.

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Dental Trauma

Tooth fracture

Tooth fractures can be superficial crown fractures (tooth chipping) or can involve complete crown or root fracture.

In cases of crown or root fracture, the tooth nerve is always involved and is at risk. Root fractures account for 5% of all dental injuries.

In either of these cases, the patients needs to be seen by dentist as soon as possible who will after clinical examination and initial investigations determine the need for treatment or referral to an Oral and Maxillofacial Surgeon.

Dental Trauma 

Dental avulsion

Dental avulsion occurs when a tooth is completely displaced from its socket. An adult tooth that is avulsed should be reimplanted in its socket as soon as possible to optimize the long-term viability of the tooth.

During reimplantation, the tooth should be handled by the crown only, and all loose dirt and debris should be gently rinsed away with normal saline or tap water. These measures will minimize damage to the ligament cells around the root of the tooth, which are crucial for  successful reimplantation.

If the tooth cannot be reimplanted, it should be placed in a protective solution, such as milk, or saline. These solutions help protect, hydrate, and nourish the periodontal ligament cells in the root of the tooth, thereby facilitating successful reimplantation at a later time.

The tooth should never be allowed to dry - this approach helps reduce root resorption and increases the success rate of reimplantation. 

Once the tooth is reimplanted, splint may be applied to the avulsed tooth on an urgent basis, preferably by a dentist or an oral and maxillofacial surgeon.

In the treatment of children with dental avulsions, it is vital to remember that primary teeth are never reimplanted, because reimplantation of a deciduous tooth can cause harm to the developing permanent tooth.

Tooth displacement injury (luxation)

There are different types of luxation, ranging form a very mild concussion of the tooth with minimal consequences to the severe injury to tooth, nerve and blood supply and also to surrounding bone.

The need for treatment will be determined after clinical examination and X-rays help determine the severity of injury.

Treatment can consist of a soft diet only, administration of nonsteroidal anti- inflammatory drugs (NSAIDs) and follow up or referral to an Oral and Maxillofacial Surgeon for identification of any further damage that may have been missed on initial examination.

In case of more severe trauma, treatment may require repositioning the tooth and immobilization with a splint.

In general, however, luxation often is a more significant injury than concussion and is more often associated with pulpal necrosis (death of the tooth nerve requiring root canal treatment).

If the fracture of the alveolar bone surrounding the tooth is suspected, an oral and maxillofacial surgeon must see the patient.

 

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