Trauma

Primary Tooth Trauma 1) Labial Frenum tear Bleeding ++ Pressure over tear to stop bleeding. O>en looks worse than it is! Rarely needs sCtches. 2) Concussion injury Tooth may turn darken. Watch for abscess formaCon. 3) LuxaCon ReposiCon tooth ASAP ! 4) Intrusion Allow to re-erupt. 5) Avulsion Locate tooth. Do NOT replant a baby tooth.

Concussion An injury to the tooth-supporCng structures without increased mobility or displacement of the tooth, but with pain to percussion.

Concussion - Treatment Guidelines Treatment: Monitor pulpal condition for at least 1 year. Patient instructions: Soft food for 1 week. Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris. Follow-up: Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year.

Colour Change DiscolouraCon = bruising Does not indicate need for pulpal therapy May lighten over Cme Approximately 1/3 will require further treatment 74% remain asymptomaCc and 48% remain discoloured Holan G Dent Traumatol. 2004 Oct;20(5):276-87.Development of clinical and radiographic signs associated with dark discolored primary incisors following trauma8c injuries: a prospec8ve controlled study.

SubluxaCon An injury to the tooth supporCng structures resulCng in increased mobility, but without displacement of the tooth. Bleeding from the gingival sulcus conrms the diagnosis.

Subluxation - Treatment Guidelines Treatment: A flexible splint to stabilize the tooth for patient comfort can be used for up to 2 weeks. Patient instructions: Soft food for 1 week. Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris. Follow-up: Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year. Action related to endodontic treatment may be taken after 2-3 months.

Extrusion ParCal displacement of the tooth out of its socket. An injury to the tooth characterized by parCal or total separaCon of the periodontal ligament resulCng in loosening and displacement of the tooth.

Extrusion - Treatment Guidelines Treatment: The exposed root surface of the displaced tooth is cleansed with saline before repositioning. Reposition the tooth by gently re-inserting it into the tooth socket with axial digital pressure (local anesthesia is usually not necessary). Stabilize the tooth for 2 weeks using a flexible splint. Monitoring the pulpal condition is essential to diagnose associated root resorption. Patient instructions: Soft food for 1 week. Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris. Follow-up: Clinical and radiographic control and splint removal after 2 weeks. Clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, and 1 year.

Lateral luxaCon Displacement of the tooth other than axially. Displacement is usually accompanied by comminu6on or fracture of either the labial or the palatal/lingual alveolar bone. Lateral luxa6on injuries, similar to extrusion injuries, are characterized by par6al or total separa6on of the periodontal ligament. However, lateral luxa6ons are complicated by fracture of either the labial or the palatal/ lingual alveolar bone and a compression zone in the cervical and some6mes the apical area. If both sides of the alveolar socket have been fractured, the injury should be classied as an alveolar fracture (alveolar fractures rarely aect only a single tooth). In most cases of lateral luxa6on the apex of the tooth has been forced into the bone by the displacement, and the tooth is frequently non-mobile.

Lateral LuxaCon No collision with permanent tooth bud

Lateral LuxaCon Collision with permanent tooth bud

Lateral luxation - Treatment Guidelines Same as for extrusion.

Intrusion - Intrusive luxaCon Displacement of the tooth into the alveolar bone. This injury is accompanied by comminu6on or fracture of the alveolar socket.

Intrusion - Treatment Guidelines Spontaneous eruption This is the treatment of choice for deciduous/primary teeth and for permanent teeth with incomplete root formation. This treatment has been shown to lead to significantly fewer healing complications than orthodontic and surgical repositioning.

Intrusion Treatment Choice Spontaneous eruption This is the treatment of choice for deciduous/primary teeth and for permanent teeth with incomplete root formation. This treatment has been shown to lead to significantly fewer healing complications than orthodontic and surgical repositioning. Orthodontic repositioning This treatment may be preferred for patients coming in for delayed treatment. This treatment method enables repair of marginal bone in the socket along with the slow repositioning of the tooth. Surgical repositioning This treatment technique is preferable in the acute phase. Intrusion with major dislocation of the tooth (approximately more than half a crown length) may be an indication for surgical repositioning.

Intrusion - Treatment Guidelines Factors determining treatment choice are stages of root development, age and intrusion level OPEN APEX (6-11 years) Allow for spontaneous repositioning CLOSED APEX (12-17 years) AND less than 7 mm intrusion. Allow for spontaneous eruption CLOSED APEX (12-17 years) AND more than 7 mm intrusion. Orthodontic or Surgical repositioning CLOSED APEX (more than 17 years) orthodontic or surgical repositioning.

Avulsion The tooth is completely displaced out of its socket. Clinically the socket is found empty or lled with a coagulum.

Primary Avulsion Treatment Guidelines NO TREATMENT DO NOT REIMPLANT THE TOOTH

Avulsion Permanent Tooth Replant the tooth with gentle pressure. Suture gingival laceraCons if present. Verify normal posiCon of the replanted tooth clinically and radiographically. Stabilize the tooth for 4 weeks using a exible splint. A/B Tetanus ?? PaCent instrucCons: So> food for up to 2 weeks. Brush teeth with a so> toothbrush a>er each meal. Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week. Follow-up: Radiographic control

Avulsion - First aid for avulsed permanent teeth www.iadt- dentaltrauma.org

Enamel infracCon. An incomplete fracture (crack) of the enamel without loss of tooth structure

Enamel Fracture A fracture conned to the enamel with loss of tooth structure.

Enamel-dentin fracture A fracture confined to enamel and dentin with loss of tooth structure, but not involving the pulp.

Enamel-dentin-pulp fracture (Complicated crown fracture) A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp.

Crown-root fracture without pulp involvement A fracture involving enamel, dentin and cementum with loss of tooth structure, but not involving the pulp.

Crown root fracture with pulp involvement A fracture involving enamel, dentin, and cementum with loss of tooth structure, and involving the pulp.

Root fracture A fracture confined to the root of the tooth involving cementum, dentin, and the pulp. Root fractures can be further classified by whether the coronal fragment is displaced (see luxation injuries).

Root fracture Primary Tooth ExtracCon: removal of root fragment if visible only.

Root fracture - Treatment Guidelines Permanent Tooth Treatment: Rinse exposed root surface with saline before reposiConing. If displaced, reposiCon the coronal segment of the tooth as soon as possible. Check that correct posiCon has been reached radiographically. Stabilize the tooth with a exible splint for 4 weeks. Cervical fractures stabilizaCon is indicated for a longer period of Cme (up to 4 months). Monitor healing for at least 1 year to determine pulpal status. If pulp necrosis develops, then root canal treatment of the coronal tooth segment to the fracture line is indicated. PaCent instrucCons: So> food for 1 week. Good healing following an injury to the teeth and oral Cssues depends, in part, on good oral hygiene. Brushing with a so> brush and rinsing with chlorhexidine 0.1 % is benecial to prevent accumulaCon of plaque and debris.

Alveolar fracture A fracture of the alveolar process; may or may not involve the alveolar socket. Teeth associated with alveolar fractures are characterized by mobility of the alveolar process; several teeth typically will move as a unit when mobility is checked. Occlusal interference is often present.

Alveolar fractures - Treatment Guidelines Treatment: reposiConing using forceps of the displaced segment. Stabilize the segment with exible splinCng for 4 weeks PaCent instrucCons: So> food for 1 week. Good healing following an injury to the teeth and oral Cssues depends, in part, on good oral hygiene. Brushing with a so> brush and rinsing with chlorhexidine 0.1 % is benecial to prevent accumulaCon of plaque and debris. Follow-up: Splint removal and clinical and radiographic control a>er 4 weeks. Clinical and radiographic control a>er 6-8 weeks, 4 months, 6 months, 1 year and yearly for 5 years

PERMANENT TOOTH TRAUMA PREVENTION Wear a sports mouthguard for any contact sport. Concussion radiograph LuxaCon radiograph and reposiCon Fractured radiograph and if the fractured piece is located it can be bonded back on Avulsion - locate the tooth. REPLANT IMMEDIATELY --- DO NOT TOUCH THE ROOT !! Handle the tooth by the crown part and insert it back into the socket ASAP! Radiograph a>er replantaCon.

Trauma Pathnder Tooth is not Displaced No displacement Not loose No displacement Loose

Not tender to percussion

Tender to percussion

SUBLUXATION

No fracture

Fracture

CONCUSSION

NO TRAUMA

Fracture above gingival margin

Fracture below gingival margin

CROWN FRACTURE

CROWN ROOT FRACTURE

Trauma Pathnder Tooth is Displaced Displaced Completely displaced

No mobility

Mobility

Single mobile tooth

Several mobile teeth moving as a unit

No sign of root fracture

X-ray shows sign of root fracture

INTRUSION

LATERAL LUXATION

EXTRUSION

ROOT FRACTURE

ALVEOLAR FRACTURE

AVULSION