Prevention of Traumatic Dental Injuries-1

Mariam Rafiq 2008D006Saher Ahmed 2008D007Salma Meher 2008D017

Traumatic Dental injuries

• A minor broken tooth (fracture) involves chipping of the enamel only.

• A deeper fracture can involve both the enamel and the dentin of a tooth.

• Death of pulp tissue can lead to serious tooth infection and abscess.

There is high frequency of injuries to anterior teeth among those taking part in contact sports.eg.football , boxing , wrestling.

•Any dental injury, even if apparently mild, requires examination by a dentist immediately.

•Sometimes, neighboring teeth suffer an additional, unnoticed injury that will only be detected by a thorough dental exam

•A serious fracture that exposes both the dentin and the pulp tissue should be treated promptly

• The most important variable affecting the success of reimplantation of a tooth that is knocked out is the amount of time that the tooth is out of its socket.

• Care should be taken to handle the knocked-out tooth only by its crown and not by its root.

• Prevention of dental injuries involves aligning protruding front teeth by dental braces and using face masks and mouthguards while participating in sports

•Most chipped or fractured tooth crowns can be repaired either by reattaching the broken piece or by placing a tooth-colored filling.

• If a significant portion of the tooth crown is broken off, an artificial crown or "cap" may be needed to restore the tooth.

•Injuries in the back teeth often include fractured cusps, cracked teeth, and the more serious split tooth. If cracks extend into the root, root canal treatment and a full coverage crown may be needed to restore function to the tooth.

• Split teeth may require extraction.

Dislodged (Luxated) Teeth

•During an injury, a tooth may be pushed sideways, out of, or into its socket.

• Your dentist will reposition and stabilize your tooth.

• Root canal treatment is usually needed for permanent teeth that have been dislodged and should be started a few days following the injury.

•Children between seven and 12 years old may not need root canal treatment, since their teeth are still developing.•For those patients, your dentist will monitor the healing carefully and intervene immediately if any unfavorable changes appear.

•If a tooth is completely knocked out of your mouth, time is of the essence.

•The tooth should be handled very gently, avoiding touching the root surface itself.

• If it is dirty, quickly and gently rinse it in water.

• Do not use soap or any other cleaning agent, and never scrape or brush the tooth.

• If possible, the tooth should be placed back into its socket as soon as possible.

•The less time the tooth is out of its socket, the better the chance for saving it.

• Once the tooth has been put back in its socket, your dentist will evaluate it and will check for any other dental and facial injuries.

• If the tooth has not been placed back into its socket, your dentist will clean it carefully and replace it.

• A stabilizing splint will be placed for a few weeks.

• Depending on the stage of root development, your dentist may start root canal treatment a week or two later.

•A traumatic injury to the tooth may also result in a horizontal root fracture.

• The location of the fracture determines the long-term health of the tooth.

• If the fracture is close to the root tip, the chances for success are much better.

• The closer the fracture is to the gum line, the poorer the long-term success rate.

•Sometimes, stabilization with a splint is required for a period of time

•Resorption occurs when your body, through its own defense mechanisms, begins to reject your own tooth in response to the traumatic injury.

• Following the injury, you should return to your dentist to have the tooth examined and/or treated at regular intervals to ensure that root resorption is not occurring and that surrounding tissues continue to heal.

•With any traumatic dental injury, time is of the essence. Contact your dentist immediately.

•Chipped primary (baby) teeth can be aesthetically restored.

• Dislodged primary teeth can, in rare cases, be repositioned.

• However, primary teeth that have been knocked out typically should not be replanted.

•This is because the replantation of a knocked-out primary tooth may cause further and permanent damage to the underlying permanent tooth that is growing inside the bone

•Children's permanent teeth that are not fully developed at the time of the injury need special attention and careful follow up, but not all of them will need root canal treatment.

• In an immature permanent tooth, the blood supply to the tooth and the presence of stem cells in the region may enable your dentist to stimulate continued root growth.

• Children with proclined teeth are particularly susceptible to trauma.

• Early orthodontic therapy is an important preventive measure in order to reduce excessive overjet and maxillary protrusion.

• Moving the teeth into a more favorable alignment considerably reduces the likelihood of injury.

• The dentist should determine whether any of his patient is likely to be involved in sport activity likely to result in trauma to face or jaws.

• Assess any protection that can be given.

• In some sports, use of mouth protectors is obligatory.

E.g. Football helmet, Face mask used in boxing.

Disadvantage: They provide little protection from

blows which cause fracture of teeth or jaws.

Requirements:- Retentive.- Comfortable.- Provide ease of speech.- Ease of breathing.- Protect the teeth and soft tissues.- They should be made of materials

which can be easily washed, cleaned and disinfected.

Design:1- Cover occlusal surface of teeth.

2- Extend distally to the maxillary tuberosity.

3- Avoid palatal bulk in order not to interfere with speech or breathing.

4- The flanges must be 3 mm short of mucobuccal fold for retention and in the same time doesn’t impinge on frenum attachment.

Mouth protectors or mouth guards:

• Several varieties of mouth protectors are available.• They should be comfortable to wear• Protect the teeth and gingivae• Should not affect breathing or speech.• Three sizes of mouth protector are usually

considered.

Types of mouth (intra-Oral) Protectors

1- Stock (prefabricated) mouth protector.2- Mouth formed protectors.3- Custom made protectors.

1- Stock (prefabricated) vinyl protector:

• They are usually supplied in three different sizes: small, medium and large.

• The appropriate size is chosen for the individual and trimmed as necessary to fit on the upper jaw some remolding in the mouth is possible by prior immersion in the water.

• These protectors are generally considered to be unsatisfactory because they are loose & thus are not tolerated.

• Not proper coverage of vulnerable areas.

2- Mouth formed protectors:• These are usually supplied in

a kit containing a plastic shell, which is matched to the upper arch and trimmed where necessary.

• The fitting surface is filled with mixed soft acrylic and put to place on the maxillary teeth where the material is allowed to set while the teeth are gently closed together.

• Further trimming of the margins is carried out after that.

2- Mouth formed protectors: Advantages:1- Reasonably quick to construct.2- Less expensive.3- Could be used for fluoride application.

Disadvantages:1- Excess bulk. 2- Less comfort. 3- Interferes with speech.4- Difficult to adjust.5- Repeated tear.

3- Custom made protectors:

• This is made of acrylic resin material on a stone cast of the maxillary arch of the individual.

• When taking impressions, all removable appliances should be removed from the mouth.

3- Custom made protectors:

* Advantages:1- Lack of excessive bulk.2- Careful Coverage of vulnerable areas.3- Do not encroach on the free way space

occlusally.

* Disadvantages:1- Expensive.2- Time consuming.

3- Custom made protectors:

Technique:1- Take an upper alginate impression.

2- Mould the vinyl material to the model, trim then smooth the margins.

3- Try in the mouth and adjust if necessary.

The American Dental Association's recommendspreventive measures for avoiding a dental trauma: • Yearly dental exams (including x rays).

• Teeth should be brushed and flossed thoroughly at least once a day.

• A mouth guard and helmet should be worn while playing all contact sports (football, soccer, hockey, baseball, boxing, basketball).

• A seatbelt should always be worn when in a moving vehicle.

• Foreign objects (pencils, fingernails, pens) should be kept out of the mouth.

References

• Internet • Classification of dental injuries by

• Andreasen JO

– Application of the international classification of diseases to dentistry (geneva: WHO )