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Management of trauma to the teeth and supporting structures

الكلية كلية طب الاسنان     القسم التقويم والاطفال وطب الاسنان الوقائي     المرحلة 5
أستاذ المادة حسن فليح فرحان السلطاني       6/3/2011 8:42:27 PM

Lec. 12                                 Pediatric Dentistry                                    Dr. Hassan Wateefi
                                                                               
Management of trauma to the teeth and supporting structures
Definitions:
Trauma defines as a physical injury or wound caused by an external force which may cause death or permanent disability.
Dental trauma is an injury to the mouth, including teeth, lips, gum and tongue and the most common dental trauma is a broken or lost tooth.
      Traumatic  dental  injury  is  consider  to  be  one of the serious dental accidents affecting children and  young adults. It is a public health problem in all societies that reaches a large number of people.
Trauma with accompanying fracture of a permanent incisor is a tragic experience for the young patient and is a problem whose management requires experience, judgment, and skill perhaps unequaled by any other portion of the dentist s practice.

Epidemiology:
The prevalence of dental trauma in various epidemiological studies has been found to differ considerably, depending upon:
1. The trauma classification.
2. The dentition studied.
3. The geographical and behavioral differences between study locations and countries.

Classification of Traumatic Dental Injuries:
Many studies had been conducted around the world concerning traumatic dental injury and its classification. The most important classifications are:                            
1. Ellis classifications.
2. WHO classifications.
3. Garcia-Godoy classifications.

Ellis classifications (1961):
1. Class I: Enamel fracture.
2. Class II: Enamel and dentine fracture.
3. Class III: Enamel and dentine fracture with pulp exposure.
4. Class IV: Root fracture.
5. Class V: Tooth luxaton.
6. Class VI: Tooth avulsion.


Descriptive Classification of Dental Trauma: include
A- Injuries to the tooth may involve:
Crown:
1. Crack or craze of enamel without loss of tooth structure.
2. Fracture of the crown involving enamel, dentine and pulp (horizontal or vertical).
3.  Fracture of the crown and root involving cementum and may or may not have pulpal involvement.
Root:
1. Apical 1/3 fracture (Horizontal or oblique).
2. Middle 1/3 fracture (Horizontal or oblique).
3. Coronal 1/3 fracture (Horizontal or oblique).
Involving the whole tooth:
1. Concussion: injury to the tooth and supporting structure without loosening but the tooth tender to percussion.
2. Subluxation:  loosening of the tooth but without displacement.
3. Displacement (luxation):
• Intrusion: displacement of a tooth in an apical direction (into the socket) and the tooth appear shorter than the adjacent teeth.
• Extrusion: displacement of a tooth in a coronal direction (out of the socket) and the tooth appear longer than the adjacent teeth.
• Labial/ lingual/ palatal luxation: displacement of tooth in labial or lingual direction.
• Lateral luxation: displacement of tooth in a mesial or distal direction. 
4- Avulsion: loss of tooth from its socket.
 

Injuries to the supporting bone
1. Fracture of alveolar socket due to tooth intrusion.
2. Socket wall fracture (labial or lingual fracture).
3. Fracture of alveolar process.
4. Fracture of maxilla.
5. Fracture of mandible.
Soft tissues injuries:
1. Contusion.
2. Abrasion.
3. Laceration.
4. Deep puncture wound.
5. Wide loss of tissue.


Etiology of dental trauma.
May be categorized into:
1. Domestic violence, child abuse and neglect.
2. Sporting activities like football and contact sports especially rugby, hockey, judo and karates.
3. Other causes like struck by an object, falls, collision, assaults, motor vehicle accidents, RTA, fights, eating hard foods and other such mishap in children and adolescents.
Mechanism of trauma occurrence: Injuries to the teeth can be due to:
A- Direct trauma          B- Indirect trauma.
1- Direct trauma produce:
•  Platal or lingual movement of tooth with palatal fracture of alevolar bone.
•  Platal or lingual movement of tooth with buccal fracture of alevolar bone.
•  Extrusion.
2- Indirect trauma produce:
•  Labial movement of tooth with fracture of the labial alveolar bone.
•  Labial movement of tooth with fracture of palatal or lingual alveolar bone.
•  Intrusion.

Risk Factors or predisposing factors:
     Several factors play a role in predisposing children to dental trauma, the frequency of which varies considerably.
1- Age Variation: The most accident-prone times are between 2 and 4 years for the primary dentition when the child is learning to walk; this is due to lack of experience in walking and disorientation of muscles. At age of 7-10 years the prevalence of traumatic dental injuries increase in the permanent dentition because the child have more energetic action, more self dependent in addition to increase in vigorous outdoor activities.
2- Gender Variation:
In general, males were affected almost twice as females in both the primary and permanent dentitions, this is due to:
• Males tend to be more active and participate in strenuous activities with higher trauma risk, such as contact sports and more aggressive types of playing.
• Females tend to be more mature in their behavior and may be more concerned about their physical appearance and esthetics which is possibly reflects the play characteristics of females toward more stability and calmness than males.
• The awareness of malocclusion and demand for treatment is more for females than males. 
3- Lip Condition:
Adequate lip coverage makes a natural barrier against trauma to the teeth, while inadequate lip coverage being an important predisposing factor for dental trauma.
4- Types of Occlusion:
Traumatic dental injuries increased in class II malocclusion particularly  division 1 because of, in cases with normal occlusion, the energy of the trauma is decreased by the larger contact area, the incisal contact of the upper and lower teeth. While in cases with class II malocclusion, the lack of incisal contact and the location of this contact in the cervical part of the upper incisors, all increases the risk of being traumatized in children with class II malocclusion.
5- Increased over jet.
6- Increased overbite.
7- Anterior open bite.
8- Anterior cross bite.
9- Displacement and rotation.
10- Other Risk factors:
• Socioeconomic status
• Overweight
• Parents level of education
• Place of trauma occurrence
• Mechanical factors: The severity of injury depend on:
(1) Energy of impact (2) Resilience of impacting object (3) Shape of impacting object (4) Angle of direction of the impacting force.

Reaction of tooth to trauma:
1. Pulp hyperemia.
2. Internal hemorrhage.
3. Calcified metamorphosis of the pulp (Progressive canal calcification).
4. Internal resorption.
5. Peripheral (external) root resorption.
6. Pulp necrosis.
7. Ankylosis.


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .