Trauma

Trauma: Dental trauma refers to injury to the teeth and/or peridontium  (Gum, PDL, Alveolar bone) and near by soft  tissues-  Lips, Tongue .

Etiology:

1)    Automobile injury/RTA.

2)    Sports related.

3)    Falling while running/fall from height.

4)    Tube well injury(in rural areas).

5)    Acts of  violence(blow during fight).

6)    Epilepsy.

7)    Drug abuse.

Incidence :

Most dental injuries occur during 1st two decades of life ages 8-12 yrs. Frequent dental injuries occur ages 2-3  years.  Boys  tends more than girls.  Maxillary  anterior > than mandibular.

Clasification  :  There are too many types like…

1.     Ingle’s classification

2.     Andreasen classification

3.     Elli’s & Davey’s classification

4.     Garcia & Godoy classification

I want to tell/ highlight WHO classification(1978)

1.     Enamel fracture.

2.     Crown fracture involving enamel, dentin without pulp.

3.     Crown fracture with pulp involvement.

4.     Root fracture.

5.     Crown-root fracture.

6.     Luxation.

7.     Intrusion /Extrusion.

8.     Avulsion.

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Trauma Pathfinder

                  Intrusion

 

Fig:Luxation

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Examination of Traumatic Injuries

Examination of Traumatic Injuries…

Dental History:

1.          Time & place of injuries ( when & where ).

2.          Details about history ( how )

3.          Number of lost teeth/fragment.

4.          Previous history of trauma.

5.          Headache, vomiting, bleeding  from ear/nose

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Medical history

                   Medical history:

      Congenital heart disease.

      Bleeding disorder.

      DM.

      Epilepsy.

      Current medication.

      Tetanus.

      Allergic reaction to any medication.

                   Clinical examination:

   Extra-oral:

             Swelling , Laceration, Haemorrhage , TMJ.

   Intra-oral:

.  Injury to alveolar bone & supporting structure.

.  Occlusal abnormality.

.  Fracture crown.

.  Mobility.

                        .  Discoloration of tooth.

.  Reaction to sensitivity (vital test).

.  Pocket depth( Around injured tooth).

Avulsion: It is defined as complete displacement of the tooth out of the socket.

v    Incedence:  0.5-16% in permanent dentition.

          7-13% in primary dentition.

v   General prognosis:

            Prognosis of permanent dentition is primarily depend upon formation of root development( open/close) & extra oral dry time. The tooth has best prognosis of replanted immediately . If the tooth is not replanted within 5 minutes, it should be preserved in a medium that helps to maintain the vitality of periodontal ligament & fiber.

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Important medium inorder to preference-

Important medium inorder to preference-

ü      Viaspan TM.

ü      Hanks Balanced.

ü      Salt solution- NaCl, KCl, Glucose, CaCl2, MgCl2,  NaHCO3, Na(PO)4

ü      Cold milk.

ü      Coconut water.

ü      Eagle’s medium.

ü      Best buccal vestibule of own mouth.

>Primary tooth should not be replanted.

>Permanent tooth should not be replanted.

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Health

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Treatment

Treatment:

Treatment should be three (03) situation occurs-

ü     Some one may telephone for advice about avulsed tooth ( immediate)-

ü     Clean the socket first with water spray or normal saline and never hold root surface of the tooth.

ü     Immediately replanted the tooth, apply flexible splint for upto two (02) weeks.

ü     In case of open apex – Allow for possible re-vascularization.

ü     In case of close apex- Initiate RCT 7-10 days after replantation and place (CaOH)2 , as ICM.

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Conservative Management of Traumatized Anterior

Patient came < 60 mins with tooth kept in storage medium-

In case of OPEN apex….

Clean the socket first with water spray or normal saline and never hold root surface of the tooth.

Sock the tooth in Doxyclycline for 5 minutes.

Then re-planted the tooth with slight digital pressure.

Apply flexible splint for 2 weeks

appexification is recomanded.

In case of CLOSE apex…

RCT.

Patient came > 60 mins with tooth not kept in storage medium-

Debribe with soft pumice pro , gauge, gentle scaling , 3% citric acid for 5 minutes,  2% NaF for 5-20 mins/ cover the root with Emdogain before replantation.

Adjuvente therapy-  Antibiotic & Analgesics.

                           Tetanus prophylaxis.

Patient advice- Soft diet upto 02 weeks,

                   Gentle tooth brushing.

                   M/w:-  1% twice daily for 1 week.

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PRINCIPLES OF RATIONAL ANTIBIOTIC USE

* Microorganisms-suspected etiologic agent and patterns of local antimicrobial susceptibility

* Host factors-age, pregnancy, concomitant disease (s), host defense mechanism

* Site of infection, severity of infection

* Drug factors and previous antibiotics, etc.

* Appropriate specimens for Gram staining,

 culture and sensitivity test

should be taken prior to antibiotic treatment

Prevention of irrational prescribing

*To prevent irrational prescribing the following measures should be taken- a) making correct diagnosis; b) limiting the number of drugs; c) encouraging the availability of essential drugs; d) providing adequate training, drug information and Standard treatment guideline (STG) to the prescribers through continuing education, incorporating the concept of essential drugs; e) teaching of rational prescribing into the curricula of medicine, pharmacy, dentistry and nursing; and f) finally providing effective public education of the consumers and on public.

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Bilateral Ornital Fracture

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