Dental Trauma
DefinitionDental trauma is injury to the mouth, including teeth, lips, gums, tongue, and jawbones. The most common dental traumais a broken or lost tooth.
Epidemiology: Dental trauma in children is common. At 5 years of age 31-40% of boys and 16 – 30% of girls and at 12 years of age 13 – 33 % of boys and 4 – 19 % of girls will have suffered some dental trauma. The majority of dental injuries in the primary and permanent dentition involve the anterior teeth, especially the maxillary central incisors. Many factors affect the severity of trauma; researches showed that there was relation between the severity of trauma and the protrusion of maxillary incisors and the amount of lip coverage.
Etiology
Children are most accident prone between 2 and 4 years for the primary dentition and between 7 and 10 years for the permanent dentition. Coordination and judgement are incompletely developed in children with primary dentition, and the majority of injuries are due to:
falls in and around the home as the child becomes more adventurous and explores his/her surroundings. In the permanent dentition most injuries are caused by falls and collisions while playing and running, although bicycles are a common accessory. The place of injury varies in different countries according to local customs, but accidents in the school playground remain common.
Sports injuries usually occur in the teenage years and are commonly associated with contact sports.
Injuries due to road traffic accidents and assaults are most commonly associated with the late teenage years and adulthood.
Accidental injuries can be the result of either direct or indirect trauma. Direct trauma occurs when the tooth itself is struck. Indirect trauma is seen when the lower dental arch is forcefully closed against the upper, for example by a blow to the chin. Direct trauma implies injuries to the anterior region, while indirect trauma favours crown or crown-root fractures in the premolar and molar regions as well as the possibility of jaw fractures in the condylar regions and symphysis. The factors that influence the outcome or type of injury are a combination of energy impact, the resilience of the impacting object, the shape of the impacting object, and the angle of direction of the impacting force.
Increased overjet with protrusion of upper incisors and insufficient lip closure are significant predisposing factors to traumatic dental injuries. Injuries are almost twice as frequent among children with protruding incisors, and the number of teeth affected in a particular incident for an individual patient also increase.
Dental trauma may be inflicted in a number of ways: fights, eating hardfoods, drinking hot liquids, and other such mishaps. As oral tissues are highly sensitive, injuries to the mouth are typicallyvery painful. Dental trauma should receive promt treatment from a dentist.
Classification of dental trauma
Injuries to hard dental tissues and pulp
Enamel infraction: Incomplete fracture(crack) of enamel without loss of tooth substance.
Enamel fracture: loss of tooth substance confined to enamel.
Enamel-dentine fracture: loss of tooth substance confined to enamel and dentine not involving the pulp.
Complicated crown fracture: fracture of enamel , dentine exposing the pulp.
Uncomplicated crown-root fracture: fracture of enamel , dentine and cement but not exposing the pulp.
complicated crown-root fracture: fracture of enamel , dentine and cement exposing the pulp.
Root fracture: fracture of dentine and cement and the pulp. can be sub-classified into apical, middle and coronal (gingival ) part.
Injuries to the periodontal tissues
Concusion: no abnormal loosening or displacement but marked reaction to percussion.
Subluxation (loosening): abnormal loosening but no displacement.
Extrusive luxation ( partial avulsion):partial displacement of tooth from socket.
Lateral luxation: displacement other than axially with comminution or fracture of alverolar socket.
Intrusive luxation: displacement into alveolar bone with comminution or fracture of alverolar socket.
Avulsion: complete displacement of tooth from socket.
Injuries to supporting bone
Comminution of mandibular or maxillary alveolar socket wall: crushing and compression of alveolar socket. found in intrusive and lateral luxation injuries.
Fract ure of mandibular or maxillary alveolar socket wall: fracture confined to facial or lingual / palatel socket wall.
Fracture of mandibular or maxillary alveolar process: fracture of alveolar process which may or may not involve the tooth socket.
Fracture of mandible or maxilla: may or may not involve the alveolar socket.
Injuries to gingiva or oral mucosa
Laceration of gingiva or oral mucosa: wound in the mucosa resulting from a tear.
Contusion of gingiva or oral mucosa: bruise not accompanied by a break in the mucosa. Usually causes sub mucosal hemorrhage.
abrasion of gingiva or oral mucosa: superficial wound produced by rubbing or scraping the mucosal surface.