The trauma to the facial aspect is displaced, fractured or lost teeth that can have impacted significantly on psychological, functional and aesthetic effects on a tooth. The role of dentists must collaborate to create the awareness about treatments and prevention of traumatic injuries to an oral and maxillofacial region.
It is the simple or complex branch of dentistry that encompasses, assessment, aetiology, management, epidemiology, prevention, may be interdisciplinary and multidisciplinary management which embraces sequelae of posttraumatic such as resorption of root and its treatment.
Classification of dental trauma:
Ellis Classification 1:
Class 4: Tooth becomes non-vital with or without loss of crown.
Class 5: Traumatically avulsed tooth
Causes of Dental Trauma:
At 2 or 3 years of age, The incidence of traumatic injuries to the primary teeth is seen during motor coordination is developing whereas traumatic injuries to permanent tooth occur later i.e secondary followed by violence, sports, road accidents, accidental falls, collisions etc:
Management of Dental trauma:
Examination of a patient:
- Clean the oral cavity with saline or water
- Take note of medical and dental history
- How/when/where did the injury happen or occur?
- Did the patient experience a period of unconsciousness?
- Is there any bite disturbances?
- Is there any teeth reaction to heat and or cold exposure?
- Examine the Lips, face and muscles of the oral cavity for lesions of soft tissue
- Palpate the signs of fractures and skeletal aspect of the facial region
- Inspect the region of dental trauma for abnormal responses to percussion, the mobility of tooth abnormality in tooth position
- Pulp testing
- Radiographic examination:
- Photographic documentation: Take a pre and post treatment photograph in order to assess the outcome of treatment, and also for the medicolegal purpose
Traumatic injuries of teeth:
- No mobility and displacement of the tooth
- Injury and inflamed PDL
- Tender tooth
Visual sign: Displacement of tooth
Percussion test: Tender on tapping or touch
Mobility test: No marked increased mobility.
Pulp sensibility test:
- Positive Result
- Important in assessing the risk of complication in healing
- Lessor lack of response to the test indicates an increased risk of pulp necrosis laterally.
Radiographic Findings: Nil
Instructions are given:
- One week soft diet
- Brush teeth using soft bristles
- To prevent plaque accumulation advised rinsing 0.1 % chlorohexidine mouthwash.
total separation, Supporting alveolus fractures may occur. It is similar to extrusion injuries.
Percussion test: Metallic sound is usually heard.
Mobility Test: Immobile tooth
Pulp Sensibility Test: Except for teeth with minor displacement gives a lack of response.This test is important in assessing the healing complication risk. In initial examination indicates positive result to a reduced risk of pulp necrosis in the later stage.
- Before repositioning, rinse the exposed part of root surface with saline.
- Apply local anaesthesia and reposition the tooth with digital pressure or forceps in order to disengage it from the socket of bone.
- Gently reposition it into original position, stabilise the tooth for 4 weeks using a flexible splint, due to associated fracture nearly 4 weeks is indicated.
Instruction is given:
- 1 week for soft food
- Use soft bristles for brushing the teeth
- In order to prevent plaque accumulation rinse with 0.1% chlorohexidine mouthwash.
Visual Sign: Loss of enamel seen
Mobility Test: Mobility is normal
Radiographic Findings: Loss of enamel is visible
Treatment: Restoration of a tooth with composite resin depending on the extent and also the location of the fracture. In case of a tooth, fragment treatment is bonding to the tooth is the treatment of choice.
Mobility Test: Mobility normal
Percussion test: Non-tender
Mobility test: Mobility normal
Radiographic findings: Tooth substance loss is visible
Treatment: To preserve pulp vitality for young patients with open apex by pulp capping or partial pulpotomy in order to secure development of the tooth. This treatment is also the treatment of choice for closed apices patients.
Calcium hydroxide compounds and MTA are used for such procedure. In older patients with closed apices and luxation injury with displacement, The treatment of choice is RCT.
Percussion Test: Tender is seen.
Mobility Test: Fragment of the coronal part is mobile.
Radiographic findings: Apical extension of fracture not visible usually.
- Removal of the fragment.
- Gingivectomy and removal of crown sometimes osteotomy.
- Extrusion of fragment apically orthodontically.
- Surgical extrusion
- Extraction in severe cases.
Percussion test: Tender on the tooth is seen on percussion.
Mobility test: Mobility of coronal fragment.
Radiographic findings: Fracture of apical extension usually not visible.
- Fragment removal and gingivectomy.
- Fragment orthodontic extrusion
- Surgical extrusion
- Extraction with severe cases.
Percussion test: Tender tooth
Mobility test: Coronal segment of the tooth mobility is seen.
- Before repositioning rinse exposed root surface with saline.In case of displacement reposition the coronal segment of the tooths soon as possible.
- Recheck it radiographically the correct position of the placed tooth.
- Stabilise the tooth with a flexible splint for 4 weeks.
- Stabilisation is beneficial for a longer period of time up to 4 months if the root fracture is near the cervical area of the tooth
- To determine pulpal status monitor healing for at least 1 year.
- In case of the fracture seen RCT of the coronal segment and also for the pulp necrosis indicated.
In determining the success of tooth replantation the paramount is extra-oral time 2. The common injuries are enamel and dentin fractures 3. Timely care is important because these are the situations of an inappropriate or inefficient case of emergency.
- Sasikala Pagadala1*, Deepti Chaitanya Tadikonda2 Pagadala S, Tadikonda DC. An overview of the classification of dental trauma IAIM, 2015; 2(9):157-164
- Ritu Namdev, Ayushi Jindal, Smriti Bhargava, Lokesh Bakshi, Reena Verma, and Disha Beniwal. Awareness of emergency management of dental trauma Contemp Clin Dent. 2014 Oct-Dec; 5(4): 507–513
- Jackson NG1, Waterhouse PJ, Maguire A. Management of dental trauma in primary care: a postal survey of general dental practitioners. Br Dent J. 2005 Mar 12;198(5):293-7;
DISCLAIMER : “Views expressed above are the author’s own.”