Dental Trauma Management

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.