DENTAL TRAUMA

Question 1

4 types of dental trauma

Answer 1

1. concussion
2. subluxation
3. avulsion
4. fracture

Question 2

Definition and treatment of concussion

Answer 2

minor injury to the tooth supporting structures without abnormal loosening
or displacement of the tooth.
no treatment required.

Question 3

Definition, treatment, disposition of Subluxation

Answer 3

traumatic injury that results in a tooth, that is, to varying degrees, loose in
the socket.
(1) Treatment
(a) Tooth subluxation should be treated with gentle manipulation of the tooth into its proper position.
(b) Splint if necessary.
(2) Disposition
(a) Refer to dental

Question 4

Definition, treatment, disposition of Avulsion

Answer 4

injury where the tooth has been removed from the socket and
necessitates immediate action.

(1) Treatment
(a) Rinse the tooth gently with saline. Do NOT scrub! Administer local anesthesia or a regional intraoral nerve block. Replace the tooth in the socket (Re-implantation
success rates decrease by 1% every minute the tooth is out of the socket).
Administer antibiotics. Splint tooth.
(b) If re-implantation is unsuccessful, place the tooth in an isotonic media such as
Hank’s solution, milk, saline, or saliva (the patient’s mouth)
(c) Immediately consult dental
(d) A partially avulsed tooth that is repositioned and stabilized quickly usually is permanently retained
(e) A completely avulsed tooth may be retained if replaced in the socket with minimal handling within 30 min to 1 hour

(2) Disposition
(a) Refer to dental

Question 5

Definition, treatment, disposition of Fractured Tooth

Answer 5

a portion of the tooth or bone has cracked or
separated from itself.
(1) Fractures are divided by depth into those that
(a) Affect only the enamel

(b) Expose the dentin

(c) Expose the pulp
(d) Include the root

(2) If the fracture involves only the enamel, patients notice rough or sharp edges but are
asymptomatic.

(a) Treatment involves smoothing the edges and improving appearance.

(3) If dentin is exposed but not the dental pulp, patients usually exhibit sensitivity to cold
air and water.

(a) Provide mild analgesic and referral to a dentist.

(b) Treatment consists of restoration of the tooth by a composite (white filling) or, if the
fracture is extensive, a dental crown, to cover the exposed dentin

(4) If the pulp is exposed (indicated by bleeding from the tooth) or if the tooth is mobile,
dental referral is urgent.

(a) Treatment usually involves a root canal

(5) Root fractures and alveolar fractures are not visible, but the tooth may be mobile.
Dental referral is also urgent for stabilization by bonding an orthodontic arch wire or polyethylene line onto several adjacent teeth.
(6) Mandible and Maxillary fractures may require extensive force. Therefore patients
should be evaluated for other facial fractures, C-spine, and traumatic brain injury.
(7) Mandible fractures may present with localized pain, malocclusion and mobility,
trismus, and mucosal lacerations. If teeth are separated or the TMJ is involved, it is
classified as an open fracture and requires more aggressive treatment.
(8) For a mandibular fracture:
(a) Tetanus prophylaxis to patients with open fractures with immunization <5 years
(b) PCN 2-4 million units IV, or clindamycin 600-800 mg IV, or erythromycin 500-
1000 mg IV
(c) Reposition/reduce jaw if dislocated.
(d) Local Anesthetic
(e) Re-approximate fracture.
(f) Immobilize jaw (Barton Bandage)
(9) Maxillary fractures will present with obvious facial trauma. Grasping the hard palate
and rocking maxilla may reveal midface instability. Patient may sense malocclusion,
and complain of diplopia. Fracture may involve sinuses and present with facial
emphysema. CSF may be present in rhinorrhea.
(a) Tetanus prophylaxis to patients with open fractures with immunization <5 years
(b) Analgesics
(c) PCN VK 500 mg qid
(d) Tx epistaxis if present
(e) Sudafed 60 mg tid