Traumatic dental injuries may result from injuries to the teeth or the soft tissues usually following- Fall sports road traffic accident and altercations
What is Trauma?
This may result from injuries to the teeth or the soft tissues usually following
1. Fall.
2. Sports.
3. Road traffic accident.
4. Altercations.
How does Truma involves soft tissue?
When it involves soft tissue it may be simply bruises or frank lacerations. When it is a bruise this can be handled by cleaning the wound by an antiseptic agent and dressing with sterile gauze or better still left dry.
An example of antiseptic agent are:
1. Iodine.
2. Eusol purit.
3. Dettol.
4. Methylated spirit or other antiseptic you know of which are commonly use in your local area or country ( visit your dentist for more details and description ).
If it is a laceration the wound may have to be sutured to controlled the bleeding and subsequently sutured. It is very important that the child should be given antitetanus serum 600,000 I.U after a test dose , then tetanus toxoids of 0.5 ml subcutaneous Stat. ( According to standard medical treatment )
Hard tissues
This may be the teeth or the bones of the face and jaw . Teeth can be further divided into four classes:
Class1:
Injuries without fracture of crown or root. If tooth is firm they may not present until there is apical periodontitis or abscess has developed. Absence of damage to crown is due to absorption of the force of the blow by supporting structures hence periodontal fibre may have been torn or apical vessels damage . Vitality test should be done .
If tooth is loosened ( Luxated or subluxated ) or displaced patient may present early. In this case the tooth should be manipulated back to position gently, then splinted to allow healing of pulp and surrounding structures. If pulp is dead a root canal treatment ( RCT) should be done.
Class II: Fractures of the crown
.
If this involves the enamel alone there will be know symptom. Tooth may be firm or loose.
If this involves the enamel alone there will be know symptom. Tooth may be firm or loose.
Treatment is for class 1 when it involves the dentin the patient complains of pain and sensitivity. In this case the exposed dentine should be covered by calcium hydroxide and cement and may be held in position by stainless steel crown.
Class lll: Exposure of pulp -
This also present with pain and chance of pulp survival is reduced with time lapse . If pulp is still alive the treatment is pulpotomy if pulp is dead RCT can be done and in open apex apexification is first done followed by RCT.
CLASS IV: Fracture of root -
When fracture line is in coronal half of root the treatment is usually extraction as there is risk of infection of fracture line and lack of support to the tooth . If the fracture line is below gingival crevice or in apical half there is chance of conserving the tooth by splinting, if pulp does not heal an RCT can be done and endodontic splint used.
CLASS V: Avulsion or complete displacement -
This is when the tooth is completely removed from the socket.
The Treatment is along 2 lines.
1. Space maintenance until the permanent succeeds
2. Re- implantation of the avulsed tooth. After re- implantation RCT may have to be carried out on the tooth.
It must be emphasized that in these cases a good history need to be taken and investigation by radiograph and vitality testing is essential for all the cases also a careful inspection of the socket for fragments is important.
This may lead to dilacerations I.e bending of the root of the developing tooth.
There may lead to tearing of the membrane and bleeding. These may be swelling of the membrane , partial extrusion of the tooth and acute periodontitis.
This may involve the dental alveolar bone 2 or more teeth in segment move in unison . This is usually treated by splinting to immobilize for at least 2 weeks for other bones of the face ideal treatment is reduction and immobilization of fragments for 6 weeks.
Class lll: Exposure of pulp -
This also present with pain and chance of pulp survival is reduced with time lapse . If pulp is still alive the treatment is pulpotomy if pulp is dead RCT can be done and in open apex apexification is first done followed by RCT.
CLASS IV: Fracture of root -
When fracture line is in coronal half of root the treatment is usually extraction as there is risk of infection of fracture line and lack of support to the tooth . If the fracture line is below gingival crevice or in apical half there is chance of conserving the tooth by splinting, if pulp does not heal an RCT can be done and endodontic splint used.
CLASS V: Avulsion or complete displacement -
This is when the tooth is completely removed from the socket.
The Treatment is along 2 lines.
1. Space maintenance until the permanent succeeds
2. Re- implantation of the avulsed tooth. After re- implantation RCT may have to be carried out on the tooth.
It must be emphasized that in these cases a good history need to be taken and investigation by radiograph and vitality testing is essential for all the cases also a careful inspection of the socket for fragments is important.
Other forms of injury
1. Injuries to the developing teeth:
This may lead to dilacerations I.e bending of the root of the developing tooth.
2. Injuries to the periodontal membrane:
There may lead to tearing of the membrane and bleeding. These may be swelling of the membrane , partial extrusion of the tooth and acute periodontitis.
3. Injuries to the bone:
This may involve the dental alveolar bone 2 or more teeth in segment move in unison . This is usually treated by splinting to immobilize for at least 2 weeks for other bones of the face ideal treatment is reduction and immobilization of fragments for 6 weeks.
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