Trauma Tooth-day!

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I know lame pun... But today lets talk dental trauma. Why? Because while we don't see it often it is ALWAYS on boards and inservice, so lets review the simple stuff we need to know. ( Highlighted stuff is the most commonly seen exam questions!)

A tooth:
  • Pulp- vascular, that makes it red/pink colored. If exposed can be painful
  • Dentin- Makes up the bulk of the tooth, yellow colored
  • Enamel- Outer visible layer, white colored (mostly)
Primary teeth- 20 teeth by age 3, lettered not numbered, don't worry about that..
Permanent teeth- 32 in total and should be there between 6-13 years old
Traumatic Injuries:
  • Fracture/Ellis Classification: Remember anatomy from above and think white/yellow/red!
    • Type 1: Supportive care ie pain control soft diet, refer to dentist
    • Type 2: Risk of pulpal necrosis, treat with sealant such as calcium hydroxide and 24 hrs follow up!
    • Type 3: Consider urgent dental consult, pain control and if no dental available at minimum cover with calcium hydroxide and if available glass ionomer. Pt needs URGENT follow up as high risk of abscess and pulp necrosis
  • Luxation:
    • Partial displacement from socket and can involve periodontal ligament and alveolar bone
    • TRX: Dental consult for splinting!
  • Intrusion:
    • Apical displacement into bone- tooth will look shorter or missing
    • GET XRAY!
      • If >3mm tooth needs to be repositioned by DENTAL!
  • Avulsion:
    • Time is tooth- each minute out viability decrease by 1%!!!
      • Best survival if implanted within 15-30min
      • Don't worry if pt is less than 6yrs old
    • Handle only the crown, rinse with sterile saline or tap water for max 10s
      • Irrigate the socket and remove any accumulated clot
      • Place in socket and splint while waiting for URGERY dental consultation
    • If unable to re-implant place in patients mouth- saliva is a great medium = Hanks solution > Milk > Saline. NEVER TAP WATER and DON'T LET THE TOOTH DRY OUT
  • Alveolar Fracture:
    • Consider if multiple teeth are dislocated or are loose on palpation
    • Get CT face, urgent dental consult and DON'T implant any loose teeth.
SOURCES: EMDocs, Uptodate, Tintinallis
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