EFFECT OF TRAUMA ON DENTITION

what are common causes of trauma in the primary dentition (3)

• falls

• bumping into objects

• non-accidental

what are common causes of trauma in the secondary dentition (3)

• sport

• assault

• road traffic accidents (RTA)

primary dentition: which teeth are most commonly affected by trauma

maxillary central incisors

primary dentition: what is the prevalence of trauma

17-54%

primary dentition: are males or females more commonly affected

males = females

primary dentition: at which age is trauma most common

2-4 yrs

primary dentition: what type of trauma is most common

luxation: loosening of tooth involving tooth movement

• photo: lateral luxation

permanent dentition: which teeth are most commonly affected by trauma

maxillary central incisors

permanent dentition: what is the prevalence of trauma

prevalence of trauma in 12yo = 12% (UK)

permanent dentition: are males or females more commonly affected

males > females

• sports

• violence

• crime

permanent dentition: at which age is trauma most common

8-10 years (roots have not fully formed but incisors have erupted so if vitality is compromised then any root treatment is more complex)

permanent dentition: what type of trauma is most common

uncomplicated crown fracture

• uncomplicated = not involving pulp

who is the famous author who led the world in dental traumatology research

Andreasen

list the types of tooth fractures in order of increasing severity (6)

• enamel infraction

• enamel fracture

• uncomplicated enamel and dentine fracture

• complicated enamel and dentine fracture

• crown root fracture - difficult restoration

• root fracture - 3 types

diagram of tooth fractures

list the types of periodontal tissue injuries (6)

• concussion

• subluxation

• luxation

• avulsion

• intrusion

• extrusion

define the types of periodontal tissue injuries

• concussion: tooth accepts a blow, is not responsive to vitality testing

• subluxation: loosening of tooth without tooth movement (tooth remains in correct positioning)

• luxation: loosening of tooth involving tooth movement

• avulsion: tooth has been knocked out of mouth

• intrusion: tooth has been pushed inwards

• extrusion: tooth has been pulled outwards - almost knocked out

what type of periodontal tissue injury is this

labial luxation

what types of periodontal tissue injury is this

lateral luxation of 51 and avulsion of 52

what type of periodontal tissue injury is this

intrusion

what type of periodontal tissue injury is this

subluxation of 51 and 61

what type of periodontal tissue injury is this

extrusion

list the types of soft tissue injuries (3)

• laceration

• contusion

• abrasion

define the types of soft tissue injuries

• laceration: tear in the mucosa

  • usually caused by a sharp object

• contusion: bruise

  • usually caused by a blunt object

• abrasion: rubbing or scraping injury

  • e.g. face sliding along ground during a fall

what are long term effects of trauma to 1° teeth on 1° teeth (4)

• discolouration - can be permanent or can resolve (due to blood seeping into dentinal tubules)

• discolouration and infection

• resorption and early exfoliation - can happen faster if there is an infection

• delayed exfoliation

what are long term effects of trauma to 1° teeth on 2° teeth (3)

• enamel defects

• abnormal tooth/ root morphology

• delayed eruption

what type of periodontal tissue injury to 1° has the greatest effect on 2° teeth

intrusion

table showing type of injury to 1° and % of affected 2° as a consequence

what do these images show

• discolouration due to trauma

• no infection indicated in radiograph

what do these images show

• trauma to discoloured tooth with an abscess above

• red square = abscess in radiograph

what does this image show

• tooth has darkened

• non-vital tooth

• laceration of gingiva

• caries present where the root has been exposed

what is discolouration NOT an indication of

discolouration ≠ a non-vital tooth

what does this clinical image show

• delayed exfoliation

• retention of upper central incisors due to trauma

• upper lateral, lower central + lateral incisors are all 2°

what does this clinical image show

• delayed exfoliation

• retention of UL1 due to trauma

what is the solution to retained teeth due to trauma

• extract 1° so 2° can erupt

• find reason behind why permanent teeth have not erupted

what are other effects of 1° trauma (3)

• enamel opacity/ enamel hypoplasia

• dilaceration

• odontome

outline enamel opacity/ enamel hypoplasia

• enamel opacity: enamel is less translucent than normal - visible colour change

• enamel hypoplasia: thin/ missing enamel

images of enamel opacity and enamel hypoplasia

radiograph of enamel hypoplasia

outline dilaceration

• dilaceration: abnormal angulation/ bend in the root

outline odontome

• odontome: a benign tooth structure consisting of normal dental tissues that is not actually a tooth

how does the risk of severe damage change with age

• the risk of severe damage decreases with age because the older you are the more developed the 2° tooth is

• dependent on injury though

which periodontal tissue injury does this image show

avulsion: tooth has been knocked out of mouth

what are the consequences of trauma to 2° teeth

• pulp death » RCT

• inflammatory resorption

• replacement resorption - bone is laid down

• pulpal obliteration

• tooth fracture

what does the red arrow and bottom radiograph show

• red arrow = area of replacement resorption

• bottom radiograph = inflammatory resorption (dark area = no bone)

table showing type of injury to 2° and the % of affected 2° teeth as a consequence

what are some implications of dental trauma (4)

• pain

• distress

• costs to patients

  • money for treatment

  • time off school/ work

  • self-esteem

• costs to health service

how should an avulsed 2° be managed

emergency management of an avulsed 2° tooth

• check if there is another more urgent injury apart from avulsion e.g. head injury characterised by confusion, unconsciousness, nausea, vomiting

• tetanus vaccination needed

• clean dirt and debris on tooth carefully under running water - DO NOT REMOVE PERIODONTAL TISSUE

• re-implant tooth

OR

• store in milk until re-implanted

• if no milk, use water or get person to dribble over their tooth

• DO NOT LET TOOTH DRY OUT

what is the best treatment for dental trauma

PREVENTION!

e.g. wear gum shield during sports