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16.11 Traumatic Dental Injuries

Table of Contents

It may result in loosening, displacement and or loss of teeth, fracture of teeth and or bone, lacerations and bleeding. The commonest causes are falls (in sports and play) at home or school and motor accidents. Most affected are upper incisors.

Diagnostic Criteria

Type Presentation
Tooth concussion Is an injury to supporting tissues of tooth, without displacement
Sublaxation Is the partial displacement, but is commonly used to describe loosening of a tooth without displacement
Intrusion Is the displacement of tooth into its socket often accompanied by fracture of alveolar bone
Luxation Is the displacement of tooth laterally, labially or palatally.
Avulsion Is the complete loss of tooth from the socket

Soft tissue Injuries

Abrasion: where friction between an object and the surface of the soft tissue causes a wound. This wound is usually superficial, denudes the epithelium, and occasionally involves deeper layers.

Contusion/Bruising: indicates that some amount of tissue disruption has occurred within the tissues, which resulted in subcutaneous or sub mucosal hemorrhage without a break in the soft tissue surface.

Laceration: is a tear in the epithelial and sub epithelial tissues. It is perhaps the most frequent type of soft tissue injury, is caused most commonly by a sharp object

Non-Pharmacological Treatment

  • Check for facial fractures and trauma to other sites, rule out evidence of head injury (amnesia, loss of consciousness, neurological signs)
  • Intra-oral examination: Look for soft-tissue lacerations, dentoalveolar fractures and damage to teeth
  • Check for tooth fragments which may be displaced in soft tissues
  • Examine traumatized teeth for mobility and check mobility
  • X-rays: (periapical x-ray) especially for suspected root fracture, and OPG xray for suspected alveolar bone fracture and jaw fracture
  • Suture for any soft tissue wounds
  • Extraction is treatment of choice for significantly traumatized primary/deciduous teeth with mobility and or displacement.
  • Refer to a dentist, where available orthodontics or endodontic specialist depending on the need of advanced treatment

Note: Give tetanus toxoid (0.5% IU) if patient has not received vaccination in the previous 10 years.

Referral: to oral and maxillofacial surgeon for patients with complicated maxillofacial injuries

Pharmacological Treatment

Pain control by analgesics

A: Paracetamol (PO) 1g 8 hourly for 3 days

OR

C: Diclofenac (PO) 50 mg 8 hourly for 3 days

OR

A: Ibuprofen (PO) 400 mg 8 hourly for 3 days

Prophylactic antibiotics are indicated in cases of suspected contamination or extensive damage

A: Amoxicillin (PO) 500 mg 8 hourly for 5 days6

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