Dental Trauma

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Basics

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
  • 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
  • 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

  • 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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Basics

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
  • 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
  • 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

  • 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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