DENTAL
DENTAL TRAUMA
PromptManagement of traumatic dental fracture
ResponseAssess for other injuries - oral mucosa, other teeth
Look for missing tooth fragment (? embedded in soft tissue/aspirated) - consider XR
Analgesia
ADT
Antibiotics - controversial
Reimplanting avulsed tooth (if permanent) + external fixing. Do not reimplant baby (Deciduous) tooth
Refer to dentist
Parental reassurance
Look for missing tooth fragment (? embedded in soft tissue/aspirated) - consider XR
Analgesia
ADT
Antibiotics - controversial
Reimplanting avulsed tooth (if permanent) + external fixing. Do not reimplant baby (Deciduous) tooth
Refer to dentist
Parental reassurance
Prompt
ResponseComplete avulsion of 1.1 and laceration to gum with disruption of alveolar ligament
Complete avulsion of 2.1
Extrusive subluxation of 2.2
Complete avulsion of 2.1
Extrusive subluxation of 2.2
Prompt
ResponseLeft lateral incisor injury (tooth 22)
Extrusive luxation (partially extruded from socket), displaced posteriorly
also has an uncomplicated crown fracture with dentine visible (no pulp) [Ellis Class II]
Extrusive luxation (partially extruded from socket), displaced posteriorly
also has an uncomplicated crown fracture with dentine visible (no pulp) [Ellis Class II]
PromptGoals of treatment for dental injury
ResponseStabilise the teeth (prevent aspiration risk)
Approximate anatomical position to prevent further ligament injury/aid healing
Provide advice on definitive management with Dentist
Exclude associated injuries
Analgesia
Approximate anatomical position to prevent further ligament injury/aid healing
Provide advice on definitive management with Dentist
Exclude associated injuries
Analgesia
PromptED management of above injury
ResponseIdeally need OPG to assess fracture of alveolar bone
Local anaesthetic block, analgesia
Reinsert tooth into normal position (mould alveolar bone if needed, check occlusion)
Splint to adjacent teeth with Glass Ionomer Cement (GIC). If no GIC available need alternate splint – e.g. “blue tac” and a mouth guard
Cover exposed fracture surface (dentine) with GIC
If no GIC available needs relatively urgent (< 24h) f/u with dentist
Will need splinting for 2-4 weeks
Local anaesthetic block, analgesia
Reinsert tooth into normal position (mould alveolar bone if needed, check occlusion)
Splint to adjacent teeth with Glass Ionomer Cement (GIC). If no GIC available need alternate splint – e.g. “blue tac” and a mouth guard
Cover exposed fracture surface (dentine) with GIC
If no GIC available needs relatively urgent (< 24h) f/u with dentist
Will need splinting for 2-4 weeks
PromptComplications of tooth injury
ResponsePulpitis/Dental abscess
Pulp necrosis
Ankylosis
Root resorption
Need for root canal therapy
Tooth colour change
Pulp necrosis
Ankylosis
Root resorption
Need for root canal therapy
Tooth colour change
Prompt
ResponseSubluxed 1:1 (R upper 1st incisor)
Extruded or Lateral luxation 2:1 (Lt upper 1st incisor)
Lip contusion
Alveolar Fracture
Extruded or Lateral luxation 2:1 (Lt upper 1st incisor)
Lip contusion
Alveolar Fracture
Prompt
ResponseRight maxillary tooth (1,1) – intrusion luxation Left maxillary tooth (2,1) – horizontal fracture involving pulp
Mgmt
Repositioning and splinting of tooth 1,1
Calcium hydroxide to cap tooth 2,1
Urgent dental or max/fax referral
Update ADT if not completed
Antibiotics – amoxicillin/clavulanate
Mgmt
Repositioning and splinting of tooth 1,1
Calcium hydroxide to cap tooth 2,1
Urgent dental or max/fax referral
Update ADT if not completed
Antibiotics – amoxicillin/clavulanate