Dental Trauma is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Primary teeth:
    • Eruption begins between 6–10 mo of age and concludes by 30 mo
    • Eruption is bilaterally symmetric
    • 20 total teeth
  • Permanent teeth:
    • Begin to erupt at age 6
    • 32 total (4 central and 4 lateral incisors, 4 canines, 8 premolars, 12 molars)
    • Number from 1–32 starting with upper right 3rd molar (1) to upper left 3rd molar (16) and lower left 3rd molar (17) to lower right 3rd molar (32)
    • Better and often easier to describe the involved tooth anatomically
  • Most commonly injured teeth:
    • Maxillary central incisors, maxillary lateral incisors, and the mandibular incisors
  • Tooth fractures:
    • Fractures of the crown are classified as uncomplicated (involve only the enamel or both the enamel and dentin) or complicated (involves the neurovascular pulp)
    • Fractures can be classified using the Ellis classification system
    • Class I fracture (uncomplicated fracture):
      • Involves only the superficial enamel
      • Fracture line appears chalky white
      • Painless to temperature, air, percussion
    • Class II facture (uncomplicated fracture):
      • Involves enamel and dentin
      • Fracture line will appear ivory or pale yellow compared to whiter enamel
      • May be sensitive to heat, cold, or air
      • Not tender
    • Class III fracture (complicated fracture):
      • True dental emergency
      • Involves enamel, dentin, and pulp
      • Pulp has pinkish, red, fleshy hue
      • Frank bleeding or a pink blush after wiping tooth surface indicates pulp violation
      • May be exquisitely painful or desensitized (with associated neurovascular disruption)
  • Luxation injuries
    • Involve the supporting structures
      • Includes the periodontal ligament (PDL) and alveolar bone
  • Several types of injuries exist:
    • Concussed teeth:
      • Tooth neither loose nor displaced
      • Sensitivity with chewing or percussion
    • Subluxed teeth:
      • Tooth is loose but not displaced
      • Bleeding from gingival sulcus
      • Sensitivity with chewing or percussion
      • PDL is damaged
    • Intrusion:
      • Tooth is driven into socket
      • Alveolar socket fractured
      • PDL compressed
    • Avulsed tooth:
      • Total displacement from alveolar ridge
      • PDL severed
    • Extrusion:
      • Partial central dislocation from socket
      • PDL damaged
    • Lateral luxation:
      • Nonaxial displacement of the tooth
      • PDL damaged
      • Associated with alveolar socket fracture
  • Alveolar bone fractures:
    • Fractures of tooth-bearing portions of mandible or maxilla
    • Bite malocclusion, painful bite, tooth mobility en bloc
    • Diagnosed clinically or radiographically

Etiology

  • Nearly 50% of children sustain a dental injury
  • Age periods of greatest predilection:
    • Toddlers (falls and child abuse)
    • School-aged children and preteens (falls, bicycle, and playground accidents)
    • Adolescents (athletics, altercations, MVCs)
      • Mouth guard use greatly reduces sport-associated dental injury
  • Assault, domestic violence, or multiple trauma
  • Motor vehicle, motorcycle, bicycle accidents
  • Child abuse
    • Frequently associated with orofacial injury
  • Laryngoscopy
  • Certain predisposing anatomic factors increase risk:
    • Anterior overbite >4 mm increases risk for traumatic injury 2–3 times
    • Short or incompetent upper lip, mouth breathing, physical disabilities, use of fixed orthodontic appliances

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Citation

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TY - ELEC T1 - Dental Trauma ID - 307554 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307554/all/Dental_Trauma ER -