Friday, May 11, 2012

The 'tooth' about dental injuries

Dislodged/Luxated Teeth
Intrusion: Tooth impacted into the alveolar socket
Extrusion: Tooth vertically dislodged from the socket

Lingual luxation: Displcement of the tooth towards the tongue
Labial luxation: Tooth is displaced toward the lips
Lateral luxations: occur within the plane of the tooth

Luxations of primary teeth are treated by extraction. Permanent teeth are immediately treated if malocclusion or significant mobility is present. It consists of repositioning and splinting.

Intrusion injuries are generally followed up by a dentist within 48 hours. Permanent teeth will generally re-erupt within 6 weeks. Intrusions <3mm have a good prognosis, those >6mm have a poor outcome secondary to inflammatory root resorption.

Avulsed teeth
teeth that have been knocked completely out of the socket. The best storage media in order of preference are milk, saliva, and saline. Hank's Solution (Save-a-Tooth) can preserve the fragile periodontal ligament for 24 hours. the major risk of not preserving a tooth is that it will dry out. Ideal re-implantation  with 90% survivability occurs within 90 minutes. Survival decreases 1% every minute thereafter, with very few teeth surviving after being out >2 hours.

Primary teeth should never be re-implanted, as there is a risk of interfering with the eruption of a permanent tooth, as well as ankylosis (fusion of the tooth with the alveolar bone) occurring.

Tooth Fractures
Class I:Chips or fractures in the outer enamel layer only
Class II: Fractures into the dentin layer
Class III: Fractures into the pulp of the tooth
Class IV: Fractures onto the root often vertical fractures

When to consult dentistry
  • Avulsed permanent teeth
  • Luxation injuries with malocculsion or significant mobility
  • Root fractures with crown displacement
  • Alveolar ridge fractures (socket)
Within 48 hours
  • Tooth fractures (Class II and III)
  • Tooth subluxation
  • Tooth intrusion
  • Luxation without malocclusion or significant mobility
Non-urgent follow-up (1 week)
  • Tooth concussion
  • Class I tooth fracture

1 comment:

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