DENTAL
TRAUMA
See also Avulsed
teeth ('Tooth knocked out')
- Prognosis increases with good immediate treatment
- Avulsed teeth should be reimplanted immediately
- Crown # this will have dissipated most of the energy
of impact, therefore root # is less likely
- Take good notes for future reference and medico legal
purposes (often results from MVA, assault, accident)
ASSESSMENT
- Assess for other injuries - CHI, facial#/lacerations
- Tetanus status
- Assess location of tooth fragments - aspirated, embedded into lip,
impacted below gum surface
- Be alert to child abuse - esp. young children, injury inconsistent with parentis
history, delayed attendance, bruises of different ages, ear pinches, and frenal tears
(<1 year of age)
Examination
- Assess occlusion (get patient to bite together) if any teeth is displaced
- Gently wash away blood
- Assess for soft tissue lacerations, dento alveolar # and damage to teeth.
- Assess teeth mobility
Investigations
- OPG - root #, tooth fragment embedded in soft tissue
- +/- Facial views
- +/- CXR (aspirated fragments)
MANAGEMENT
See also Avulsed
teeth ('Tooth knocked-out')
See also Injuries
to primary teeth
See also Injuries
to permanent teeth
Aim
- Primary dentition preserve integrity of permanent successor
- Secondary dentition preserve intact dentition, maintain pulp vitality
Principles
- Eliminate pain - dental anaesthesia
- Protect pulp (never inject LA into pulp to relieve pain)
- Reduce teeth (with digital pressure under local anaesthesia)
- Splint mobile teeth (consult RAH oral-max-fax surgeon)
- Suture soft tissue laceration (vicryl 3.0)
- +/- Chlorohexidine mouth wash
- +/- Analgesics
- +/- Antibiotics
- +/- Tetanus
booster
- Soft diet
- Avoid hot/cold foods
Splinting techniques
Consult oral and maxillofacial surgeon (RAH)
Dr George Chu BDSc MBBS
Ed: Dr. Derek Louey MBBS FACEM