Managing dental trauma in the emergency

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.

Dental trauma:

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 1: Fracture of enamel involving little or no dentin. Class 2: Fracture of enamel and dentin but no pulp Class 3: Fracture of enamel, dentin and pulp. Class 4: Tooth becomes non-vital with or without loss of crown. Class 5: Traumatically avulsed tooth Class 6: Fracture of a tooth with or without crown fracture. Class 7: Displacement of a tooth without fracture of crown or root Class 8: Fracture of crown en masse and its replacement. Class 9: Fracture of deciduous teeth

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:

1. Clean the oral cavity with saline or water
2. Take note of medical and dental history
3. Questionnaire:
4. How/when/where did the injury happen or occur?
5. Did the patient experience a period of unconsciousness?
6. Is there any bite disturbances?
7. Is there any teeth reaction to heat and or cold exposure?

Clinical examination:

1. Examine the Lips, face and muscles of the oral cavity for lesions of soft tissue
2. Palpate the signs of fractures and skeletal aspect of the facial region
3. Inspect the region of dental trauma for abnormal responses to percussion, the mobility of tooth abnormality in tooth position
4. Pulp testing
5. Radiographic examination:
6. Occlusal
7. Periapical
8. Panoramic
9. 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:

1. Concussion
2. Luxation
3. Fracture

Concussion:

1. No mobility and displacement of the tooth
2. Injury and inflamed PDL
3. Tender tooth

Visual sign: Displacement of tooth Percussion test: Tender on tapping or touch Mobility test: No marked increased mobility.

Pulp sensibility test:

1. Positive Result
2. Important in assessing the risk of complication in healing
3. Lessor lack of response to the test indicates an increased risk of pulp necrosis laterally.

Radiographic Findings: Nil

Radiographs:

1. Occlusal
2. Periapical

Instructions are given:

1. One week soft diet
2. Brush teeth using soft bristles
3. To prevent plaque accumulation advised rinsing 0.1 % chlorohexidine mouthwash.

Luxation:

Displaced tooth in labial, lingual or labial direction, Periodontal ligament partial or total separation, Supporting alveolus fractures may occur. It is similar to extrusion injuries. Visual sign: Displaced usually in labial, palatal or lingual direction. 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. Radiographic Findings: Widened periapical ligament is seen on occlusal exposure. Radiograph: periapical, occlusal

Treatment:

1. Before repositioning, rinse the exposed part of root surface with saline.
2. Apply local anaesthesia and reposition the tooth with digital pressure or forceps in order to disengage it from the socket of bone.
3. 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. 1 week for soft food
2. Use soft bristles for brushing the teeth
3. In order to prevent plaque accumulation rinse with 0.1% chlorohexidine mouthwash.

Enamel fracture:

It is confined to enamel with loss of tooth fracture Visual Sign: Loss of enamel seen Percussion Test: Non-tender, in case of tenderness, evaluate tooth for a possible root fracture injury or for a Luxation. Mobility Test: Mobility is normal Radiographic Findings: Loss of enamel is visible Radiograph: Periapical and occlusal. 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.