A traumatic dental injury represents acute transmission of energy to the tooth and supporting structures, which can result in fracture and displacement of the tooth and injury to the supporting gums and bone. The most common injuries are due to falls, followed by traffic accidents, acts of violence and sports.
The tooth consists of 3 layers, the enamel, the dentine and the pulp. The pulp contains the nerves and blood vessels of the tooth which supplies sensation and nutrients to it. The dentine layer contains millions of dentinal tubules which course throughout its thickness. Within these tubules are nerves which provides sensation to the tooth. The outer enamel is essentially a dead calcified layer whose function is to protect the tooth.
This involves only the first layer of the tooth and is easily treated by a tooth coloured restoration to restore esthetics. Unless there is concomitant displacement of the tooth, the outcome is good and complications are unlikely.
In this sort of injury, the pulp, dentine and surrounding tissues are all affected. Treatment involves splinting of about 6 weeks following repositioning of the tooth to its original position.
Exposed dentinal tubules permit bacteria and their toxins to enter the pulp and result in pulpal inflammation. Treatment consists of protecting the pulp from external insults and restoring function and esthetics. It is usual to review the tooth 2 months after injury to assess pulp status. The risk of pulpal complications is minimal, and root canal therapy is unlikely.
The pulp presents as a bright red appearance and the exposed pulp allows bacteria to penetrate it. In case the pulp exposure is small and the area is clean, then medicated cements can be placed over the exposed pulp to allow the pulp tissue to heal. Larger pulp exposures may require partial pulpotomy procedures where a part of the pulp tissue is removed and medicated dressings are placed over the remaining pulp for healing. Some complicated fractures may require comprehensive endodontic treatment.
Teeth that are traumatized can be displaced from their position. This displacement can be in any direction depending upon the type and direction of trauma. The displacement can be into the bone (i.e. the tooth is driven into the bone) or can be displaced partially out of the socket. In some instances, teeth can also be displaced out of their sockets. Such displaced teeth may have to be repositioned in the socket and splinted for a specified period of time. These teeth may also require endodontic therapy.
Yes, if the tooth is intact it can be placed back into the socket. However, the outcome of the treatment depends on how quickly the tooth is put back in its place. Prolonged time out of the mouth and drying of the tooth will have poor prognosis. Until a dentist is approached the tooth should be carried in the patient's mouth or externally in a cup of milk or normal saline. The tooth should never be allowed to dry. In these emergencies the success of treatment depends on how quickly the tooth is put back inside. So it is advisable to contact your dentist immediately.
About 90% retention is achieved if the tooth is replanted within 30 minutes of the accident. This success drops to 65% if the tooth is replanted 90 minutes after the injury.
Splinting is a procedure where the teeth are supported in its position for a period of time. This is done to teeth that are traumatized or teeth whose supporting structures are affected by disease, which prevents them from supporting the teeth. Splinting involves binding a group of teeth together so that the biting forces are shared by a large number of teeth instead of being born by the affected tooth.
Injuries involving the facial skeleton and commonly results in fractures. In most cases, treatment will entail hospitalization and a general anesthetic procedure to approximate the bone fragments together. The bone pieces are usually held together by plates during the initial healing period.
This patient suffered fractures of the upper jaw bone, lower jaw bone and nasal bone as a result of a road traffic accident.