What is Traumatic Dental Injury?
Traumatic dental injuries (TDI) or tooth trauma has a global prevalence of 10-15%. These can occur alone or associated with facial or bodily injuries. It exhibits two peaks of incidence in boys at 1-3 and 10-12 years and one peak in girls at 1-3 years of age. The age of 2-3 years is the period of acquisition of walking skills with lesser control on motor coordination which makes these children more vulnerable to falls and injury to front teeth. The higher incidence of trauma to permanent teeth in boys is related to their increased indulgence in contact sports and adventure activities. There have been multiple causes of dental trauma: falls, sports injuries, fights, road traffic accidents, animal injuries etc. Proclined upper front teeth and problems related to abnormality in gait or motor coordination makes children more susceptible to dental trauma. Since most of injuries occur in play grounds; parents, school teachers and common people must be made aware of emergency measures to be taken in event of dental trauma.
Types of Dental Trauma
Traumatic dental injuries are best classified with their description.
Injury to hard tooth tissue are
- Visible part of tooth/ Crown fracture
- Fracture at the gum line/ Crown root fracture,
- Root fracture
- Concussion (severe pain with no mobility and bleeding),
- Subluxation (pain and bleeding from gum),
- Tooth moved inside bone/ Intrusive Luxation
- Tooth hanging out of socket/ Extrusive Luxation
- Tooth moved in a direction other than axial/ Lateral Luxation
- Avulsion (complete dysjunction of tooth from its socket).
Complicated Crown Fracture
A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp. There is normal mobility and percussion test is not tender. If tenderness is observed, evaluate for possible luxation or root fracture injury. Exposed pulp sensitive to stimuli.
- Endodontic treatment and restoration with a post retained crown
- In patients with mature apical development, root canal treatment is usually the treatment of choice, although pulp capping or partial pulpotomy also may be selected.
- if the exposed dentin is within 0.5mm of the pulp (pink, no bleeding) place calcium hydroxide base and cover with a material such as a glass ionomer.
- If tooth fragment is available, it can be bonded to the tooth.
What can you do ?
The children with high risk due to proclined teeth or other conditions can be identified and treated for the condition. Counselling for trauma prevention using mouth guards and helmets can be done. In event of dental trauma, identification of type of injury and taking the patient to dental surgeon at the earliest, can lead to a significant reduction of complications and improvement in prognosis. If a tooth has been knocked out, the best management is to replant it in the socket after gently cleaning with saline as early as possible. In case this is not possible, tooth should be stored in cold milk and brought to dental surgeon immediately. Most of traumatic dental injuries can be effectively restored to normal form and structure. It is important to recognise them and report to dentist.
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