Dental Trauma 1

8/13/2019 Dental Trauma 1

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Dental trauma:epidemiology, etiology and classification

o The doctor was reading the slides most of the time, she justexplained some points, but didnt add anything.

o This lecture is an introduction and in the coming lectures we will talkabout each subject in details.

o Dr.arwa will give us a lecture about local anesthesia and another oneabout extraction in "preventive course" just for the first two weeks to

prepare us for the clinic.

Dental trauma: tooth fractures have been described as a significant

dental disease and are reported to be third most common cause of tooth

loss behind caries and periodontal disease ,,, here this definition is talking

about adultsbecause tooth loss in adults mostly due to caries, periodontal

disease and trauma. In children; periodontal disease is not that much

common so the main cause is caries and trauma is the second cause.

Epidemiology

Trauma frequencies will vary in different countries in varying age groups.

The frequencies differ among primary and permanent dentition.

Trauma frequencies in children in primary dentition:o In primary dentition almost one-third have suffered a

traumatic dental injury.

o Most often tooth luxation, luxation means the injury isdirected to the PDL. It is the most common because bone in

children is very loose and the crown-root ratio is small as roots

are shorter; so the tooth can be easily displaced. However; if

we compare them with permanent teeth, bone is harder and


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roots are longer so if there is a direct fall on the floor the

tooth is easy to be fractured.

o In Boys the incidence is much higher than girls. Trauma frequencies in children in permanent dentition:

o 20-30% have suffered dental injuries.o The typical injury is uncomplicated crown fracture.o Boys are almost one-third more frequently affected.

Trauma incidences in the primary dentition :o Annual trauma incidences: mean the number of new injuries suffered

during a year.

o Peak incidences in the primary dentition are found at 2-3yearsof agewhere motor coordination is developing and children start moving

around on their own, he bases on the chair and table and walk

around the house, in this stage the motor coordination is stimulated

and the weight of the head is larger than the body so this is causing

the child to fall on the ground causing trauma, which is the main

reason for trauma at this age.

Trauma incidence in the permanent dentition : Peak incidences for boys are found at 9-10 years where vigorous

playing and sports activities become more frequent.

Epidemiologic characteristics of dental trauma: Sex and age: in males more than females , in primary dentition

luxation more common than crown fracture. Etiology: leading cause in primary dentition is falls, while in

permanent dentition is sports and violence.

Seasonal variation: in Jordan the frequencies in summer aremore due to school holidays, children are going outside to play


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Prevalence of

etiologic factors:

Falls are the

highest then fights

& accidents and

then bicycle

&sports.

where they get injured. While in Switzerland its more in

winter because they have winter sports like skating, so injuries

may happen. In other words seasonal variation depends on

countries and cultures.

Type of injury: in primary teeth luxation, in permanent crownfracture.

Soft tissue injuries: the most popular, in 50% of trauma cases,it can be extra oral or intra oral

Place of injury: at home, school or playground. Location of injury: anterior teeth get traumatized more than

posteriors and in maxilla more than mandible; if the patient

have class III skeletal relation then the mandible will get

injured more.

Etiology:

Causes of trauma:

Iatrogenic injuries in newborns prolonged intubation inprematurely born infants, the tube sometimes

causes pressure on the tooth bud leading to

enamel hypoplasia. Falls in infancy due to lack of coordination Child physical abuse. Contact sports,bicycle injuries

,horseback riding.

Road traffic accidents/motor vehicleaccidents.

Assaults. Physical torture.


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Note in the prevalence table of etiologic factors (slide15) child abuse is 1%

and this doesnt mean it is low but its not reported ,we dont ha ve actual

number about child abuse.

In the chart (slide 16): bicycle ,falls and sports cause trauma in girls morethan boys ,while violence more in boys.

Remember this is not a general rule; it depends on the country and the year

of the study.

Predisposing factors to trauma : (they are not direct reasons butthey could predispose to trauma)

The incidence of trauma increased with increased overjet, protrusionof upper incisors and incompetent lips, if the patient falls on his face

he/she will be at risk of trauma.

Medical history: Epilepsy, mental retardation , Attention DeficitHyperactivity Disorder (ADHD) ,in ADHD the child is very hyperactive

but his attention is low .

Dental history: any dental condition which will weaken the Enameland Dentin structure may dispose them to trauma like amelogenesis

imperfecta (AI), dentinogenesis imperfecta (DI) and endo therapy,

which may weaken the root especially apexification in a young age,

because the root doesn't have much time to lay enough thickness of

dentine .

Low socio economic status and this is a debatable to some degree ,because the poor neighborhood have more fighting and violence,

but also in high SES have problems like drugs and violence ,so its

debatable and cultural . Lack of mouthguards and faceguards during playing


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Classification of dental injuries to teeth:

Proposed and modified by Andreasen and Andreasen based on WHOclassification in 1978. Andreasen is a dentist who has many

researches and puplication about trauma ,and he has a book named

(Atlas of dental trauma) which is very useful book if you want to read

it.

He classified trauma according to anatomic, therapeutic andprognostic factors.

Includes injuries to teeth, supporting tissues, gingival and oralmucosa.

Can be applied to both permanent and primary dentitions.Classification of dental injuries :

Injuries to the hard dental tissues and pulp . Injuries to the hard dental tissues , pulp and alveolar process . Injuries to the periodontal tissues . Injuries to the gingival or oral mucosa .

Injuries to the hard tissues & pulpEnamel infraction : incomplete fracture (crack) in enamel without loss

of tooth substance .

Enamel fracture : (uncomplicated crown fracture ) fracture with loss oftooth substance confined to enamel .

Enamel-dentine fracture: (uncomplicated crown fracture) a fracturewith loss of tooth substance confined to enamel and dentine but NOT

involving the pulp .

Complicated crown fracture: a fracture involving enamel , dentine andexposing the pulp .


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Injuries to the hard dental tissues ,pulp and alveolar process Crown- root fracture: fracture involving enamel , dentine and

cementum .it may or may not expose the pulp. Usually its

diagonal in direction .

Root fracture: fracture involving dentin, cementum and pulp,it could be apical ,in the middle or cervical .

fracture of the alveolar socket (Mx or Mn) : fracture of thealveolar process which involves the alveolar socket ,some

times this fracture occurs with luxation injury ,i.e. the tooth is

intact the crown goes palatally and the apex goes labially .

fracture of the alveolar process (Mx or Mn) : fracture of thealveolar process not the jaw bone, that may or may not involve

the alveolar socket .

Sometimes root fracture appears clinically only as

displacement of the root, thats why X-rays are very necessary

in management of trauma .later on you, will learn that each

type of trauma has different types of x-rays.

There is a website about guide lines of management of dental

trauma which always updates these guidelines, because you

have to refresh your informationwww.iadt-dentaltrauma.org

Injuries to the periodontal tissues:Concussion: injury to tooth-supporting structures without abnormal

loosening or displacement of the tooth, but with marked reaction to

percussion, clinically and in radiographs there are no changes only

the tooth becomes tender.Subluxation (loosening): injury to tooth supporting structures with

abnormal loosening, but without displacement of the tooth.

Extrusive luxation (partial avulsion): partial displacement of the

tooth out of its socket, we take a radiograph to make sure that there

is no root fracture.


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Lateral luxation:displacement of the tooth in a direction other than

axially. Clinically the crown goes palatally and the root goes labially ,

in the x-ray there is widening in the PDL space.

Intrusive luxation:displacement of the tooth into the alveolar bone.

Accompanied by comminution or fracture of the alveolar socket.

Avulsion (Exarticulation):complete displacement of the tooth out of

its socket.

Injuries to the gingival or oral mucosa:Laceration of gingival or oral mucosa: a shallow or deep wound in

the mucosa resulting from a tear, usually produced by a sharp object.

Contusion of gingival or oral mucosa: a bruise usually produced by

impact with a blunt object and not accompanied by a break in the

mucosa, usually causing submucosal hemorrhage.

Abrasion of gingival or oral mucosa: a superficial wound produced

by rubbing or scraping of the mucosa, leaving a raw, bleeding

surface.

The doctor showed us some pictures about the previous cases which

are in the slides please refer to them.

The end


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Dental Trauma 1

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