Dental Injuries Overview

Dental Injuries - Etiology

• Direct trauma often results from collisions in contact sports.
• Mouthpieces are crucial to prevent dental injuries.
• Most common during the first 12 years of life, with traumatic dental injuries being prevalent.

Medical History for Dental Injuries

• Important to note the circumstances surrounding the injury, including time and location.
• Assess the patient's overall health and any medications taken.
• Symptoms suggesting more severe injuries must be documented.
• Previous management actions taken prior to clinic visit should be recorded.
• Proper storage methods for avulsed teeth need to be established.

Examination Principles

• Begin examination externally, progressing inward.
• Look for missing tooth fragments or prosthetic components to assess inhalation risk.
• Evaluate pulp exposure, noting size and location.

Types of Fractures

• Blow to the chin can lead to crown-root fractures in molars and premolars.
• Teeth displacement and avulsion assessed through visual examination, occlusion checks, and radiographs.

Complications with Primary Teeth

• Displaced primary teeth can hinder the development of permanent successors.
• Palpation from a vestibular approach can help identify displacement issues.

Occlusion Changes

• Jaw fractures or alveolar process fractures can impact occlusion.
• Alveolar fractures show mobility in adjacent teeth when tested.

Mobility and Radiographic Examination

• Radiographic examination is needed to differentiate between luxation injuries and root fractures.
• Various imaging techniques include dental films, panoramic imaging, CT scans, and cone-beam CT.

Dental Injury Classifications

• Classifications for injuries are available in specific pediatric resources.

Treatment of Dental Fractures

• Infraction usually requires no treatment.
• Uncomplicated fractures can be treated with smoothing and composite restoration.
• Complicated fractures involve pulpotomy, pulp extirpation, or apexification based on the condition of the pulp and root apex.

Management of Various Dental Conditions

• Uncomplicated crown-root fractures require removal of coronal fragments and restoration.
• Complicated crown-root fractures necessitate extraction if non-restorable, or either pulp extirpation or superficial pulp amputation if restorability is uncertain.
• Root fractures require repositioning and splinting; root canal treatments are delayed to allow for potential pulp healing.
• Concussions require no treatment; subluxations use flexible splints for comfort.

Treatment for Displacement and Avulsion

• Lateral luxation involves manual repositioning and splinting for four weeks; monitor pulpal health.
• Extrusion should be manually repositioned and stabilized as well.
• Intrusion treatment varies based on root formation; spontaneous re-eruption is encouraged in incomplete roots, while completed roots typically necessitate orthodontic treatment or surgery.
• Immediate avulsion management includes reassurance, tooth cleaning, and replantation if possible, or proper storage in milk or saline.

Clinic Procedures for Avulsed Teeth

• After replanting an avulsed permanent tooth, clean the area, and apply a splint.
• If avulsed outside the socket with prolonged dry time, consider root canal treatment, and monitor for root resorption.
• For primary teeth, treatment differs; they should not be replanted, especially if impacting permanent tooth development.

Complications Post-Injury

• Pulpar complications include canal obliteration, necrosis, and internal root resorption.
• Periodontal complications can lead to infection-related resorption or dentoalveolar ankylosis.