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Dental Trauma Management

aDental Trauma refers to the accidental damage of dental structures and supporting structures such as the teeth, gums, jaw bone and surrounding structures through blunt dental trauma. Dental trauma can occur unexpectedly and without warning.  Occurring in both adults and children alike, with it occurring more commonly in the later. Dental traumas caused to primary “baby” teeth, often result in the removal of affected teeth, preserving the health of the underlying permanent teeth.  Damages to permanent teeth, however, often times involve more extensive treatment to restore form and function to the injured tooth.

Types of dental trauma

Dental trauma or injuries to the tooth can occur for various reasons, giving rise to complex dental conditions. Here we will discuss some of the common types of dental trauma that are experienced, ranging from tooth fracture, to luxation injuries and even avulsion of teeth.

Enamel Infraction

Enamel infraction refers to a crack in the enamel or the white tooth structure without the loss of tooth structure. There is only a partial or minor crack in a tooth and may require no treatment. In the event of larger infarctions, treatment may be required in the form of etching and sealing the crack with resin to prevent infraction lines from discoloring the tooth.

Enamel fracture

As the term suggests, enamel fracture involves the loss of tooth structure resulting from a fracture of part of the tooth. When dental trauma results in the loss to dental enamel,  it can be treated by either bonding the broken fragment back onto the tooth, or by restoration of the tooth with composite resin.

Enamel & Dentin fracture

This involves loss of tooth from a fracture of the enamel and dentin. Such damage does not extend up to the centrally located pulpal tissue. The treatment of this kind of fracture is similar to that of an enamel fracture. The broken fragment can either be bonded to the tooth or combined with restoration with composite resin filling material.  Depending upon the depth of the fracture, permanent medicament maybe required to provide protective dressing over the underlying pulpal tissue, to help assist in maintaining pulpal vitality.

Complex fracture of tooth

A complex fracture of the tooth means that all layers of the tooth are affected by the trauma, including   damage to the clinical crown, exposure of the underlying dentin and pulpal tissues. In this type of trauma, tooth structure is lost. Treatment modalities for such trauma can be complicated and time consuming depending upon the extent of dental injury. In certain circumstances, the tooth may even need to be removed.

Root fracture of tooth

Root fracture is defined as a dentin and cementum fracture that may extend to the dental pulp. In case of such a fracture, the crown of the tooth may remain intact because only the root is damaged. Treatment of such fractures largely depends upon the location and extent of the fracture.

Concussion

Concussive injuries happen when the supporting structures of a tooth are injured without unusual loosening or displacement of the tooth. There could be bleeding and inflammation around the tooth to suggest concussion. No tooth structure is lost, and no cracks or fractures have occurred to the tooth in this type of dental trauma. You may experience heightened sensitivity to hot and cold stimuli, and possible discomfort on biting. The treatment for such a trauma often involves monitoring of the tooth, avoiding things that illicit pain responses, and a temporary change in dietary habits to softer foods. By doing so, you will assist the body in engaging in repair and restoration of periodontal ligament and pulp tissue vitality.

Subluxation

In case of subluxation trauma, supporting structures are damaged with noticeable loosening of a tooth without any tooth displacement. The treatment of this is similar to that of a concussion dental injury, with possible additional management for tooth mobility.

Lateral Luxation

As the name would suggest, lateral luxation involves the displacement of the tooth and damage to supporting structures in any direction other than axially. Along with injury to the periodontal ligament, damage to the alveolar bone can also be seen in this type of dental trauma. For permanent teeth, this type of trauma often involves moving the tooth back to the correct alignment and splinting the tooth to sound adjacent teeth. Root Canal Therapy may be required in the future, depending upon the results of tooth sensibility tests. In the instance of such trauma to primary “ baby” teeth, the treatment of choice is often the removal of the affected tooth.

Intrusion

Dental intrusive injury refers to the apical displacement of a tooth into the alveolar bone. Compression of periodontal ligament, contusion of the cementum, and crushing fracture of the surround alveolar socket bone walls, are often all associated with this type of dental trauma. Endodontic treatment is one of the most common treatment modalities for trauma management.

Extrusion

Extrusion refers to partial displacement of the tooth from its socket. Damage to periodontal ligament leads to such injury. The alveolar socket bone remains unaffected as compared to intrusion. Treatment modalities may include the replanting of the tooth into the dental socket, the splinting of the tooth in the correct position and possible future endodontic treatment.

Avulsion

Avulsion is complete displacement of the tooth from the dental socket and often times out of the mouth. The dental socket, in this instance may either be empty or fill with coagulum. Re-plantation of the tooth and restoration of the periodontal ligament are some of the common procedures for the emergency management of such trauma. Splinting therapy and root canal therapy are indicated in this form of trauma, that may or may not be successful. Depending upon the circumstances of the dental trauma, extent of trauma, extra-oral management of the tooth, and the time the tooth spends outside the dental socket, the prognosis may range from guarded to poor.  In the later instance, the tooth may require future removal.

Communition of Mandibular/ Maxillary alveolar socket wall

This refers to the crushing of the alveolar socket along with an intrusive or lateral luxation of a connected tooth or teeth.

Fracture of Mandibular/ Maxillary socket wall

Such damage refers to fracture that is limited to the facial or lingual cortical bone.

Fracture of Mandibular/ Maxillary alveolar processes

Such fractures or injuries involve both labial and lingual cortical bone and may or may not involve the tooth socket.

Fracture of Mandible/ Maxilla

This kind of injury involves damage to the base of the mandible or maxilla along with the alveolar process and may or may not involve the alveolar socket.

Any kind of Mandibular/ Maxillary injury can be treated only after adequate radiographic examination and other diagnostic measures are performed to reveal the extent of the damage. Any of the above conditions are treated only after administration of local anesthesia followed by requisite endodontic and/ or periodontal treatment that could include extraction of non-restorable teeth and other restorative procedures.

Soft tissue laceration involving the lips and gingival tissue

Dental trauma may also include soft tissue lacerations which trauma injuries extending to the lips, gums, tongue or cheeks. Injuries in the roof of the mouth, back of the throat or tonsil may also result in damage leading to bleeding. Such injuries, if minor in nature, may be treated at home by firstly disinfecting the wound site, followed by the application of direct pressure and application of Vaseline to the soft tissues.  Hemostasis or the stopping of hemorrhaging is essential.  Over the counter pain medication may also be indicated for pain management. Larger soft tissue lacerations may require intervention through stitches, that aid in the healing process.  Contact our dental office in Brampton, we are always happy to help you.

How to prevent dental trauma?

The most common and effective way to prevent dental trauma, is the use of sports mouth guards during sports and other high risk physical activities, where there is heightened risk of dental injury. More awareness needs to be created about usage of mouth guards during such activities, as for the most part they are largely preventable. Regular use will also reduce the initial discomfort caused by them. Getting customized mouth guards is always a better option as they ensure a more complete fit. However, injuries can also be caused with mouth guards if they are not of the right fit. Here at Dentistry on Dusk, we can service your mouth guard needs.

Primary management of dental trauma

Dental trauma management greatly depends on the age of the patient. Trauma to baby teeth may require extraction treatments, whilst in the case of adults, more extensive treatment may be required to restore the damaged tooth. In the event of a dental trauma, the following are a few helpful hints from our dental team here at Dentistry on Dusk:

  • Make the patient comfortable and put him at ease
  • Find the displaced tooth, holding it by the crown ONLY, and gently remove any debris. Avoid using water to do this, as this will damage the living cells in the root of the tooth. The patient’s own saliva maybe a viable cleaning solution. Try to put it back to the socket if possible.
  • If you are unable to put the tooth back into the dental socket from which it was avulsed, store it in the correct medium for transportation to the dental office for emergency care and dental splinting treatment. DO NOT STORE IN WATER (this will kill the dental tooth cells that are needed to keep it alive). Acceptable transportation mediums include: Hanks Solutions, saline, cold milk or the child’s own saliva until you reach the dentist.
  • Ask the patient to bite on a gauze or piece of cloth to hold the tooth in place
  • Schedule an appointment with the dentist as soon as possible for immediate dental assistance

Call us at 905-453-7777 for all kinds of Dental Trauma Management