Dental Trauma Introduction PDF

Dental Trauma Introduction Dr. Afraa Salah Al-Obaidi  trauma dost have 1 picture or 1 theme Dr. Afraa Salah Al-Obaidi  It is well known that the majority of dental injuries occur in children. 83% of all individuals with acute dental trauma were you...

Dental Trauma Introduction Dr. Afraa Salah Al-Obaidi  trauma dost have 1 picture or 1 theme Dr. Afraa Salah Al-Obaidi  It is well known that the majority of dental injuries occur in children. 83% of all individuals with acute dental trauma were younger than 15 years of age. mostly for adult trauma happen due to accident Injuries to primary or permanent teeth can appear rather severe, particularly when associated with trauma to supporting tissues.can affect both primary gingiva , mucosa , cheeck and permanent The situation is distressing for both the child and parents. difficult condition for the patient It is important that the dentist and the other members of the dental team are well prepared to meet the many complex and challenging problems in the care of dental emergencies. all the dentists GP, need to be ready and well prepared to deal with the situation one of the most important factor is to consider the age , why ? because sometimes the same trauma happen for a child when he is 8 years old , and for another child SAME trauma but the age is 10 yrs. should i consider the age as clinical factor ? yes , Dr. Afraa Salah Al-Obaidi  Epidemiology primary higher 30% of children had suffered traumatic dental injuries in the primary dentition 22% of children had suffered traumatic dental injuries in the permanent dentition Boys appear to sustain injuries to boys affected by trauma twice the girls permanent teeth twice as often as girls. Dental injuries usually affect one or two of the anterior teeth, and especially the 1 or 2 anterior teeth and mainly central incisors maxillary central incisors. very rare to see the trauma affected canine Dr. Afraa Salah Al-Obaidi  Epidemiology The incidence of injuries to primary teeth increases from 1 year of age, and most traumas involve children younger than 4 years of age. In the permanent dentition, the most accident- prone time is between 8 and 10 years of age. the incidence of the injury for the primary - it start from age 1 year, and increase to the age of 4 Dr. Afraa Salah Al-Obaidi  Epidemiology Many studies showed that 30% of children had suffered traumatic dental injuries in the primary dentition and 22% in the permanent dentition. The incidence of injuries to primary teeth increases from 1 year of age, and most traumas involve children younger than 4 years of age. In the permanent dentition, the most accident-prone time is between 8 and 10 years of age. Boys appear to sustain injuries to permanent teeth twice as often as girls. Even in preschool children, trauma in boys is reported to outnumber cases in girls. Dental injuries usually affect one or two of the anterior teeth, and especially the maxillary central incisors. Dr. Afraa Salah Al-Obaidi by the age of 1 the baby start to walk , that's means he will fall down from time to time , because the body , the bone , the muscles they are not stable at the same time at the age 1 he will receive help from the parents start from age of 1 but it is the minimum , because it is increasing Etiology why it is increasing? BY the age of 2 the child start to have a confidence in his walk , so most of the parents will not give help so less at age 1 , increasing at age 4 1- In a young child learning to walk and to run, muscle coordination and judgment are incompletely developed and falling injuries frequently occur. 2- Trauma to the orofacial area may also be part of child physical abuse. not only physical condition , also exposed to physical abuse so 2 sources for seeking the trauma of the primary , either injuries walking steps or child abuse Dr. Afraa Salah Al-Obaidi A Norwegian study of children aged from 7 to 18 years reported that: 48% of all dental traumas occurred during school hours and means that schools are not well prepared to do emergency 52% during leisure time. treatment for dental traumas, so have to take care Nearly half of the leisure-time injuries occurred when children were playing. 10% happened in traffic, and ½ of these were bicycle accidents. 25% occurred while partying or visiting friends. teenagers In contrast to common belief, only 8% of all injuries were sports related. Finally, in the age group 16–18 years, 23% of all orofacial injuries resulted from violence. Dr. Afraa Salah Al-Obaidi why the lateral incisor 6 and 5 because if some one need to fight the other , in the right hand , so will hit on the left side 5% 34% 34% 6% 3% 6% 3% 6% no find any reading for the canine , only in severe car accident Dr. Afraa Salah Al-Obaidi  Correct treatment depends on History Examination Radiograph Dr. Afraa Salah Al-Obaidi  all the details about the child and the accident ( the trauma) if we have root fracture.... History what i need to ask to check for the history ??? When the patient is received for treatment, the first step is to get an initial impression of the extent of the injury. Has a tooth been knocked out? Is the patient’s general condition affected? Is there a need for immediate medical care? If not, The following questions should be asked to end up with a correct diagnosis, and allow treatment planning: Dr. Afraa Salah Al-Obaidi  History what i need to ask to check for the history ??? will affect the diagnosis and treatment, either the tooth will be vital , or non vital according to when i recive the patient , and saw the patient after the truama When did the injury occur? The time interval between injury and treatment can influence both the treatment procedure and the expected outcome. For example optimal repositioning of an extruded permanent tooth is difficult if treatment is delayed. The time factor is also very critical for the prognosis of replanted teeth. what is the difference between this and this? 8 yrs open apex 10 yrs - closed apex the root will be closed after 3 years after the eruption so when the tooth erupt by 7 , by 10 will be closed Dr. Afraa Salah Al-Obaidi  History is it in house , school?? because i may need to give him tetanus prophylaxis Where did the injury occur? This information is important for insurance and social security purposes. The place of accident also provides information on the need for tetanus prophylaxis in some cases. so the place , the time and how ? Dr. Afraa Salah Al-Obaidi History i need to know how , because it is very important for me to put question mark ?? if trauma with extra oral sign , bruising, bleeding or something, have to make a report for the police How did the injury occur? is it accident , fighting , any abuse The nature of the blow may provide clues as to the type of injury to be expected. For example, when a blow hits the chin, the mandibular arch is forced against the maxillary arch, with jaw fracture or crown-root fracture in the premolar or molar regions as possible resulting injuries. Dr. Afraa Salah Al-Obaidi History Was there a period of unconsciousness? If so, for how long? Is there headache? Amnesia? Nausea? Vomiting? Excitation or difficulties in focusing the eyes? These are all signs of brain concussion and require medical attention. Dr. Afraa Salah Al-Obaidi  History Is there any disturbance in the bite? Disturbance in the occlusion can imply luxation injury, alveolar fracture, jaw fracture, or luxation or fracture of the temporomandibular joint. Limitations of mandibular movement or mandibular deviation on opening or closing the mouth indicate that the jaw might be fractured. check if there is any malocclusion ? is there any deviation when closes -maybe have fracture is there any sound in the TMJ after the trauma limitation of the opening , maybe there is a problem in the muscles Dr. Afraa Salah Al-Obaidi History you cant give any medication , unless you are taking the medical history may have heart diseases , anemia, allergy Medical history A short medical history should reveal possible allergies, blood disorders, and other information about conditions that could interfere with treatment. Dr. Afraa Salah Al-Obaidi Examination any swelling , any bruises , Extraoral Examination Note is taken of swelling, bruises, or lacerations to the face and lips. ifmissing you have a trauma of the central , and one tooth , they founded it is embedded inside the lip Deep lip wounds are examined closely with respect to tooth fragments or other foreign bodies. fracture piece impedded in the llip Dr. Afraa Salah Al-Obaidi  Examination Intraoral Examination The examination must be systematic and include the recording of: 1. Swelling, laceration, and hemorrhage of the oral mucosa and gingiva. 2. Abnormalities in occlusion. 3. Missing, displaced or loosened teeth, fractured crowns, or cracks in the enamel. if there is missing teeth maybe not the traumatized tooth maybe the adjacent one It is important to examine all teeth within a traumatized area and, in close bite situations, also teeth in the opposite jaw. we can see the crack only if we put a light immediately, will find lines, the treatment : complete the crown with composite restoration, but the patient still has pain during cold and hot , because the crack need time for closing the spacing dentinal tubules start to close Dr. Afraa Salah Al-Obaidi  Examination Intraoral Examination Particular note is taken of the following factors: Displacement: when the child receive trauma, the tooth change the axis , when there is displacement means that we have trauma to PDL , maybe there is no fracture - but there is displacement The direction as well as the extent (in millimeters) of displacement should be recorded. Minor displacement can be difficult to detect. In such cases it is helpful to examine the occlusion as well as radiographs taken at various angulations. Mobility: for every traumatic case The degree of mobility is assessed in both a horizontal and vertical direction, keeping in mind that immature permanent teeth and primary teeth undergoing root resorption have quite extensive physiologic mobility. When several teeth move together, a fracture of the alveolar process is suspected. either immature permanently or the primary there is root resorption Dr. Afraa Salah Al-Obaidi  Examination Intraoral Examination with the end of the mirror , tap gently Reaction to percussion: The handle of a mouth mirror is tapped gently against the teeth in both a horizontal and vertical direction. Tenderness to percussion indicates damage to the periodontal ligament. A high metallic tone implies that the injured tooth is locked in bone. Color of the tooth: Discoloration may appear almost immediately after the injury. Follow up needed. related to non - vital tooth Dr. Afraa Salah Al-Obaidi  Examination Intraoral Examination Reaction to sensibility tests: It is usually not possible to obtain reliable information from a young, frightened child. However, in the permanent dentition electrometric sensibility testing should be performed whenever possible. It gives important information about the neurovascular supply to the pulp, and provides a baseline value for comparison at follow-up examination. The contralateral uninjured tooth or another comparable tooth serves as a control. The most reliable response is obtained when the electrode is placed upon the incisal edge. It is important to explain the purpose of the test and the type of reaction to be expected. To avoid painful stimulation of the tooth, the rheostat should always be increased slowly. Dr. Afraa Salah Al-Obaidi To be continued Dr. Afraa Salah Al-Obaidi