What Are Traumatic Dental Injuries?
Dental trauma involves injuries to the gums, teeth, soft tissues, and jaw bones. These injuries mainly occur due to falls, accidents, and sports-related injuries. Various types of dental injuries occur due to trauma, these include
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Cracked or fractured teeth
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Chipped teeth.
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Tooth avulsion.
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Luxation or dislodged teeth.
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Lacerations or cuts in the soft tissues.
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Intrusion or impaction of teeth into the socket.
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Dislodged or broken jaw.
Symptoms of Traumatic Dental Injuries:
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Jaw pain.
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Toothache.
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Swelling.
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Discolored teeth.
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Bleeding from the oral or mouth region.
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Loose tooth.
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Occlusion or dental bite-related issues. It affects the way teeth fit together while chewing.
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Difficulty in opening mouth and chewing.
What Are the Guidelines for the Management of Acute Traumatic Dental Injuries?
The guidelines that are to be met by general dentists, endodontists, pediatric dentists, or oral and maxillofacial surgeons across the world before treating dental injuries are as follows:
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Physical Examination and Eliciting of Patient History:
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This is the most vital step for treating any traumatic dental injury or a patient who reports to the dental clinic or hospital setting with injuries to the oral cavity or orofacial regions.
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Before even planning treatment in such trauma cases, the dentist must cross-check the given below circumstances written in a consent form that needs to be obtained by the patient or the family members of the patient ideally.
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The Patient’s Name, Age, and Gender:
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This should further include the weight of an individual in the case of pediatric patients, the address or the guardian's address, and the contact numbers of the patient or the guardian.
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Any notable symptoms of the central nervous system (CNS) should be checked by the dentist. This is to ensure that the patient is in stable mental health and has an awareness even after the accident.
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History of General Health:
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The dentist should ensure that the three W’s must be enquired from the patient affected by trauma or the family member or person who reports to the dental clinic with the injured patient.
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These questions are crucial to diagnosis and treatment planning. These three W’s as per the guidelines are ‘when’, ‘where’, and ‘how’ did the injury possibly occur and if only the dental or orofacial regions are affected or the injury has occurred elsewhere in the body also.
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Past Dental History: Including the details of the last visit to the dentist or any possible dental history should be recorded by the pediatric dentist, maxillofacial surgeon, or endodontist before assessment of traumatic injuries. This past dental history must include the following:
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Possible disturbances in the occlusion or the dental bite (closing of teeth in the mouth).
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Tooth sensitivity reactions, such as any instance of thermal changes or sensitivity to sour or sweet taste.
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Soreness or sensitivity of the teeth while eating or chewing or by touching it or upon percussion (tapping with hand, finger, or a small instrument) by the dentist.
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Whether the patient is suffering from intermittent or spontaneous pain in the affected tooth or teeth.
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The possibilities should be checked regarding the access to the tooth for checking signs of concussion (brain injury), bleeding, or hemorrhage, if any.
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History should be elicited whether the symptoms are acute or chronic (may be delayed slightly from a few minutes to hours in some cases).
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Physical examination to check whether there is a loss of consciousness, difficulty in speech or slurred speech, feelings of nausea or vomiting, or fluid leakage from the ear or nose region. If there is a blurring in vision or any signs of pupillary dilation or uneven pupils.
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Eliciting the History of Dental Trauma:
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Knowing about the mechanism and the exact location of the injury, bleeding points must be checked.
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Any previous dental trauma or history of similar incidents or accidents should be elicited from the patient or their family members.
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Dental Examination:
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Clinical examination should comprise the evaluation parameters of visual inspection, palpation, electric pulp testing (pulp sensibility test), infrared thermography, and thermal testing.
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The extent of tooth injury and lacerations (skin wounds) should be assessed, to confirm whether there is any displacement in the teeth’s position or of the jaw because of the impact of trauma.
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The appearance of the tooth enamel tissue should be checked for any discoloration of the tooth. The tooth may appear purple, blue, gray, and yellow because of the traumatic impact.
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Tooth mobility due to trauma or injury should also be checked.
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Pulp testing through clinical percussion, electric pulp testing (EPT), and thermal tests.
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In case the traumatized tooth is immature, as in the case of permanent teeth in young adults, EPT tests may not be needed.
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Palpation of the gingival and the surrounding soft tissue of teeth must be thoroughly recorded by the dentist. These recordings would help the dentist note possible improvements in the gingival or soft tissue’s health in the follow-up or appointment.
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Dental Intraoral Photographs and Radiographs: The American Association of Endodontists (AAE) recommended guidelines, the intraoral photographs taken by the dentist in the clinic can help in coordinating pre-operatively and post-operatively, the differences notably in the patients affected by traumatic injuries. The following radiographic modalities would be useful in assessing the situation of the tooth, the fracture lines, and the extent of injury that would help the dentist diagnose and treatment plan correctly.
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Occlusal Radiography.
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Periapical radiographs should be taken from different lateral angulations.
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CBCT (cone-beam computed tomography) may be needed to visualize the accurate fracture lines or in case of more serious traumatic injuries.
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Assessing the Types of Dental Trauma or Injuries to the Enamel:
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Enamel fracture or fracture of the outer covering of the tooth.
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Enamel-dentin (lies underneath the enamel of the tooth) fracture.
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Enamel infractions.
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Enamel-dentin-pulp fracture.
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Crown-root fracture without pulp tissue involvement.
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Crown-root fracture with pulp tissue involvement.
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Assessment of Trauma Based on Injury to the Periodontal Tissue:
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Concussion injury.
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Retained root fractures.
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Subluxation (complete or partial dislocation of the tooth) injury.
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Intrusive luxation (dislocation of the tooth towards the axial side into the alveolar bone) or central dislocation of the affected tooth.
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Extrusive luxation or partial avulsion of the tooth.
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Lateral luxation.
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Types of Dental Trauma Based on the Gingival or Oral Mucosal Affliction:
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Gingival or oral mucosal abrasion injuries.
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Gingival or oral mucosal laceration injuries.
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Gingival or oral mucosal contusion (injured skin or tissues with damaged capillaries) injuries.
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Type of Dental Trauma Assessment to the Supporting Bone:
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Exarticulation or complete avulsion of the tooth from the bone.
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Comminution injury to the alveolar socket.
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Alveolar socket wall fractures.
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Fracture of the alveolar process or bone.
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Maxillary or mandibular (upper jaw or lower jaw) fractures.
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Conclusion
The management of any painful swollen or inflammatory dental injuries that are caused by trauma in young patients such as in children, young adults, or in adults and geriatric cases can be challenging to the dentist or maxillofacial surgeon. Hence, it is ideal for a dental surgeon to plan and improvise treatment plans such as behavior management, restorative procedures, fracture surgery, fixation technique, or splints based upon eliciting proper examination, medical, dental, and past trauma history from the patient. Eliciting a proper history alongside dental and medical examination would prove to be the most useful in the accurate diagnosis of dental injuries and in treating them as well. Clinical, radiographic, and three monthly evaluations would be useful at the dental clinic to monitor the health of the impacted teeth.
