Dental Trauma to Teeth

emergency-dentistry

Dental Trauma to Teeth

Description Clinical status Treatment – permanent tooth Deciduous tooth

Concussion

Injury to tooth supporting structures with no displacement of tooth Visually no displacement of tooth, TTP, no mobility, usually a positive vitality test and no abnormalities radiographically No immediate treatment required. Monitor pulpal condition for a year Same treatment as permanent teeth

Sublaxation

Injury to tooth supporting structures with loosening of the tooth however with no displacement Tender to percussion and increased mobility but no displacement of tooth as injury limited to the tooth supporting structures. Bleeding at gingival crevice No immediate treatment required. Monitor pulpal condition for a year Same treatment as permanent teeth

Extrusion

Loosening and partial displacement of the tooth out of its socket. Alveolar bone is still intact however may result in a partial or total separation of periodontal ligament Tooth appears elongated, TTP, excessively mobile, vitality testing inconclusive Reposition tooth back into tooth socket after surface has been cleaned with saline. Splint is applied and to be monitored after two weeks for further treatment. Root canal treatment where signs of pulpal necrosis Extract tooth. If minimal extrusion then leave and monitor

Lateral Luxation

Displacement of tooth in a lateral position – labially, lingually, distally or mesially. Most seen case is crown towards the palate with the apex going labially. Sensitivity to touch is present as well as sulcular bleeding Tooth displaced usually at a palatal/ lingual or labial direction, sensitive to touch, sulcular bleeding, tooth locked into bone. Radiographically the tooth shows a widened periodontal ligament space Tooth is repositioned into its original location and is splinted for 4 weeks If crown displaced towards the palate and is not in traumatic occlusion then no treatment is required as apex of the tooth is away from the developing tooth germ. If apex of tooth is displaced towards the palate and making contact with the tooth germ then tooth is extracted

Intrusive Luxation

Displacement of tooth into the alveolar bone (pushed into the socket) causing fracture of the alveolar bone. It is the most damaging injury to the tooth and supporting tissues as ankylosis and pulp necrosis can occur. In severe cases, 100% of the crown is not visible Tooth displaced axially into alveolar bone, no mobility, negative to vitality testing. Periodontal ligament space may be absent radiographically Depending on severity of displacement, tooth may be left to allow for spontaneous eruption. If severe then orthodontic reposition or surgical repositioning is needed. Root canal treatment after 12 weeks Tooth is extracted if apex of the root is in the developing tooth bud

Avulsion

Tooth is completely displaced out of the socket. Desiccation of periodontal ligament can not occure, as well as pulpal necrosis if no immediate action is taken place Tooth is absent from socket Depends on the maturity of the tooth, how the tooth was stored and patient cooperation. If tooth has been kept in favourable conditions and periodontal ligament is not necrotic, then tooth is replanted Tooth is not replanted to avoid damage to developing tooth germ