Dental Trauma
Basics
Description
Description
- Primary teeth: 20 total
- Eruption begins between 6–10 mo of age and concludes by 30 mo
- Eruption is symmetric bilaterally
- Permanent teeth: 32 total
- Begin to erupt at age 5–6
- Number from 1–32 starting with upper right third molar (1) to upper left third molar (16) and lower left third molar (17) to lower right third molar (32)
- Better and easier to describe the involved tooth anatomically by name
- Naming from medial to lateral: central incisor, lateral incisor, canine, 2 premolars, and 3 molars
- 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 by the depth of injury or by 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 pale yellow compared to whiter enamel
- Not tender
- May be sensitive to heat, cold, or air
- 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)
- Injury classification:
- Concussed teeth:
- Tooth neither loose nor displaced
- Sensitivity with chewing or percussion
- Subluxed teeth:
- Tooth is loose but not displaced
- Bleeding from gingival sulcus may be present
- Sensitivity with chewing or percussion
- Periodontal ligament (PDL) is damaged
- Concussed teeth:
- Luxation injuries:
- Tooth is mobile and displaced in any direction
- Involves the supporting structures including the PDL and alveolar bone
- Intrusive luxation:
- Tooth is driven axially into socket
- Alveolar socket fractured
- PDL compressed
- Lateral luxation:
- Nonaxial displacement of the tooth
- PDL damaged
- Associated with potential alveolar socket fracture
- Extrusive luxation:
- Tooth appears elongated and is excessively mobile
- Partial central dislocation from socket
- PDL damaged
- Tooth is mobile and displaced in any direction
- Avulsed tooth:
- True dental emergency
- Total displacement from socket
- PDL severed
- 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
Etiology
- Nearly 50% of children sustain a dental injury
- Age periods of greatest predilection:
- Toddlers (falls and nonaccidental trauma)
- 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/nonaccidental trauma
- 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
Schaider, Jeffrey J., et al., editors. "Dental Trauma." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307554/all/Dental_Trauma.
Dental Trauma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307554/all/Dental_Trauma. Accessed November 3, 2024.
Dental Trauma. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307554/all/Dental_Trauma
Dental Trauma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307554/all/Dental_Trauma.
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