Dental Trauma

what is luxation injury

displacement of a tooth due to traumatic forces (sports injury)

most common injury in primary teeth

why does trauma to permanent teeth matter

commonly causes pulpal necrosis resulting in long term restorative problems

when are the peak times for dental trauma to occur

2-4 - learning to walk and are small, height of a table

8-10 - riding bikes skateboards etc

14-16 - contact sports like hockey etc

how do we prevent dental trauma

difficult

incidence increases with increased overjet so have ortho tx

can make or advise to buy mouthguards

how do we manage dental

trauma

proper diagnosis tx planning and follow ups

quicker the tx the more likely to aid pulpal recovery

what do we do first

check for head injury - also dizzyness nauseousness etc

assess facial/dental injury

where does

story fit/where are the bits

do emergency tx first to stabilise injuries

clean up pt

review and treat or refer to specialist

document everything

what does distal bleeding of the eye corner mean

potential cheeckbone fracture

what do we tell pts not to do and why when potential facial fractures

blow their nose to stop infection / swelling in and around the eye

what types of injuries occur from a blow to the teeth

crown/root fracture =

due to the impact of something hard ie road a golfclub etc

injuries to the socket =

tooth is intact but displaced within the socket

due to impact of something soft ie elbow or fist

what do we do immediatley with dental injuries

bacteria can invade pulp quickly so we cover asap

aids revascularity but vitality of tooth needs monitored

cover exposed dentine with calcium hydroxide

why are dento-alveolar (socket) injuries bad

cos movement of the tooth with likely sever all blood vessels into the pulp via apical foramen so pulp becomes necrotic

what are the types of dental trauma

luxation

avulsion

crown fracture

root fracture

what is luxation

Displacement of the tooth in the alveolar bone

subdivuded into;

concussion

sublaxation

intrusive luxation

extrusive and lateral luxation

this happens because alveolar bone is less calcified and has decresed elasticity so tjat trauma to primary is lilely to cause displacemnt or evulsion

what is concussion

is an injury to the tooth without displacement or mobility of the tooth

occurs when minor damage to pdl so increase of bacterual injury - OH needs to be stressed

what is subluxation

tooth is mobile but not displaced

occurs when minor damage to pdl so increase of bacterual injury - OH needs to be stressed

what are the clinical signs of concussion/sublaxation and why

TTP

haemorrhage and oedema in PDL but gingival bleeding only happerns if sublaxated

what do we do if there is mobility

if there is mobility dont check TTP and vitality check the teeth 1 week

how do we manage concussion/sublaxation

PA

soft diet for a week

advice to parents possible sequelae

follow up

check imms status ie tetanus

what is intrusive luxation

most common upper primary incisors

usually palatal and superior displacement of the crown

is usually not issue to permanent tooth

how do we manage intrusive luxation

crown visible with minor alveolar damage - usually just leave it as it will probs re erupt

whole tooth intruded - needs extracted as its likely of damaging perm follicle

if alveolar bone and ginviae inboled probs extraction but is pt dependant

what is extrusive and lateral luxation

extrusive - tooth moved out the socket due to pdl

lateral - direction thats not straight up or down

tx dependant on mobility and extent of displacement

if excessive mobility then extract

what is avulsion

tooth completelt knocked out the socket

primary avulsion shouldnt be replanted cos of lack of pt cooperation and damage to perm follicle with blood clot

if it already is replanted by parent and is viable then leave it

how do we manage avulsion of permanent tooth

replant immeditatly

pdl is viable only 30 mins

store in milk or isotonic saline or saliva

dont rinse or scrub it

wrap in clingilm to not dry out pdl

90mins and its only 10% chnace

ask child to bite in clean cloth until tx

how do we fix primary incisors

not pulp - smooth with disc and restore with GI or comp

complicated crown/root - more likely pulp and below gingival margin

can get pulpal plyp after injuty

how do we manage fractures of primary incisors

frgaments should be removed

remaining tooth can be extracted at a later date

small pieces of root remaining in socket after a fracture cn be left

root fracture - if signs of pulpal necrosis, excessive mobility sinus etc remove coronal portion and the root will resorb

minimal fracture just smooth it and no tx needed

what is sequalae after trauma to primary teeth

all traumatised teeth rewuire follow up

difficult to predict prognosis esp w perm teeth so guarded prognosis

reassure pt and parents

discuss w pts possible options

how do we initially manage permanent fractures

initial manegment matters

time is of essence

ensure injury is stable and reduce infecton risk

how do we treat permanent fractures

uncomplicated - treat crown fracture close to pulp, if no ine available treat with comp bandage

if pulp is involved, refer to be seen same day

what possible damage can occur to primary and perm teeth after trauma

necrosis of the pulp and grey discolouration and abcess formation like me

internal resorption of the primary tooth

ankylosis of the primary tooth

MIH of successor teeth

dilaceration of perm tooth germ