Dentoalveolar Trauma PDF
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Uploaded by Deleted User
2024
Matthew Faigan
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Summary
This document provides treatment guidelines for dentoalveolar trauma, focusing on the management of different types of injuries involving teeth. It explores the epidemiology, classifications, and radiographic examination methods. The document is structured into sections discussing various aspects of dentoalveolar trauma, including its consequences and the importance of preserving both primary and permanent teeth. It also covers the role of antibiotics and splinting in trauma treatment.
Full Transcript
Dentoalveolar Trauma MATTHEW FAIGAN PGY4 OMFS SEPTEMBER 18, 2024 Introduction - Epidemiology Traumatic dental injuries (TDIs) of permanent teeth occur most frequently in children and teenagers where tooth loss has life-long consequences Unique management compared to adults due to...
Dentoalveolar Trauma MATTHEW FAIGAN PGY4 OMFS SEPTEMBER 18, 2024 Introduction - Epidemiology Traumatic dental injuries (TDIs) of permanent teeth occur most frequently in children and teenagers where tooth loss has life-long consequences Unique management compared to adults due to immature teeth and facial growth Dental injuries comprises 5% of all traumatic injuries 25% of all school children experience dental trauma and 33% of adults have experienced trauma to the permanent dentition, with the majority of the injuries occurring before age 19 Luxation injuries are the most common TDIs in the primary dentition (softer bone), whereas crown fractures are more commonly reported for the permanent teeth. Dental trauma may be accompanied by facial fractures and soft tissue lacerations Introduction Consequences of trauma to primary / immature dentition: Tooth malformation Impacted teeth Eruption disturbances Damage to underlying permanent tooth Introduction – 2020 Guidelines The International Association of Dental Traumatology (IADT) has developed guidelines as a consensus statement These updates of the International Association of Dental Traumatology's (IADT) Guidelines include a comprehensive review of the cur- rent dental literature using EMBASE, MEDLINE, PUBMED, Scopus, and Cochrane Databases for Systematic Reviews searches from 1996 to 2019 and a search of the journal Dental Traumatology from 2000 to 2019 Classifications Andreasen Classification Ellis Classification Fractures & Luxations Radiographic Examination You need justification for taking a radiograph, i.e. it would provide information that will influence your treatment plan Initial radiographs are important as baselines for comparison at follow up Maxillary central incisors are the most frequently injured. Example series: 1. PA of the midline to show the two maxillary central incisors. 2. PA of the maxillary left and right lateral incisors (should also show the b/l canine and central incisor). 3. Maxillary occlusal radiograph. 4. At least one parallel periapical radiograph of the lower incisors centered on the two mandibular centrals. Use your clinical judgement… Other radiographs may be indicated if there are specific obvious injuries Consider 3D imaging (CBCT) if available and likely to change management (alveolar fx?) In general: You will make your diagnosis based on history, signs and symptoms, clinical and radiographic exam Each diagnosis has a unique treatment, prognosis, and follow up plan The goal is to preserve tooth and alveolar bone structure, form and function Ideally, pulp is preserved, especially in primary dentition, to preserve future root development The details for each scenario are in the following tables Primary dentition Primary dentition Avulsion of Permanent Teeth Replantation is, in most situations, the treatment of choice but cannot always be carried out immediately Contraindications: Do not re-implant primary teeth (will become ankylosed and prevent eruption of permanent tooth) Severe caries or periodontal disease, an uncooperative patient, severe cognitive impairment requiring sedation, severe medical conditions such as immunosuppression, and severe cardiac conditions FIRST AID FOR AVULSED TEETH AT THE PLACE OF ACCIDENT Instructions to patient: Pick up tooth by crown (don’t touch root) If dirty rinse in milk, saline, or patient’s saliva Place back in original position Bite on gauze If immediate re-implantation not possible, place in storage medium to avoid dehydration of root surface (happens in minutes…) In descending order of preference: Milk → Hank’s Blanaced Salt Solution → Saliva → saline Water is a poor medium (hypoosmolar) but better than leaving the tooth to air-dry See dental professional as soon as possible Treatment Guidelines for Avulsed Permanent Teeth Choice of treatment depends on: 1. Maturity of root (open vs closed apex) 2. The condition of the PDL cells, which depends on the time out of mouth and storage medium 1. After extra-alveolar dry time of 30 min, most PDL cells are non-viable. Therefore, find out how long before attempting to re-implant. Still attempt, but will guide prognosis. Three groups 1. The PDL cells are most likely viable. The tooth has been replanted immediately or within a very short time (about 15 minutes) at the place of accident. 2. The PDL cells may be viable but compromised. The tooth has been kept in a storage medium (eg, milk, HBSS (Save-a-Tooth or similar product), saliva, or saline, and the total extra-oral dry time has been
