Tooth Trauma: Classification And Other Forms Of Injuries

Tooth trauma result from injuries to the teeth or the soft tissues usually following, Fall, Sports, Road traffic accident and Altercations.

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How does tooth trauma involve soft tissue?

When tooth trauma involves soft tissue it may be simply bruises or frank lacerations. When it is a bruise this can be handled by cleaning the wound by an antiseptic agent and dressing in sterile gauze or better still left dry.

An example of an antiseptic agent is:

1. Iodine.

2. Eusol purit.

3. Dettol.

4. Methylated spirit or other antiseptics you know of which are commonly used in your local area or country (visit your dentist for more details and description).

If it is a laceration tooth trauma the wound may have to be sutured to controlled the bleeding and subsequently sutured.

It is very important that the person should be given antitetanus serum 600,000 I.U after a test dose, then tetanus toxoids of 0.5 ml subcutaneous Stat. ( According to standard medical treatment ) Hard Tissues

This may be the teeth or the bones of the face and jaw. Teeth can be further divided into four classes:

tooth trauma classification

Class1: Injuries without fracture of crown or root.
Class II: Fractures of the crown
Class lll: Exposure of pulp
CLASS V: Avulsion or complete displacement

Class1: Injuries without fracture of crown or root. If a tooth is a firm they may not present until there is apical periodontitis or abscess has developed. Absence of damage to the crown is due to absorption of the force of the blow by supporting structures hence periodontal fibre may have been torn or apical vessels damage .Vitality test should be done.

If a tooth is loosened ( Luxated or subluxated ) or a displaced patient may present early. In this case, the tooth should be manipulated back to position gently, then splinted to allow healing of pulp and surrounding structures. If the pulp is dead a root canal treatment ( RCT) should be done.

Class II: Fractures of the crown

If this involves the enamel alone there will know symptom. A tooth may be firm or loose. Treatment is for class 1 when it involves the dentin the patient complains of pain and sensitivity. In this case, the exposed dentine should be covered by calcium hydroxide and cement and may be held in position by stainless steel crown.

Class lll: Exposure of pulp - This also presents with Tooth pain and chance of pulp survival is reduced with time lapse. If the pulp is still alive the treatment is pulpotomy if the pulp is dead RCT can be done and in open apex, apexification is first done followed by RCT.

CLASS IV: Fracture of root - When fracture line is in coronal half of root the treatment is usually extraction as there is a risk of infection of fracture line and lack of support to the tooth. If the fracture line is below gingival crevice or in apical half there is a chance of conserving the tooth by splinting, if pulp does not heal an RCT can be done and endodontic splint used.

CLASS V: Avulsion or complete displacement - This is when the tooth is completely removed from the socket.

The Treatment is along 2 lines.
1. Space maintenance until the permanent succeeds
2. Re- implantation of the avulsed tooth. After re- implantation RCT may have to be carried out on the tooth.
It must be emphasized that in these cases a good history need to be taken and investigation by radiograph and vitality testing is essential for all the cases also a careful inspection of the socket for fragments is important.

Other forms of tooth trauma

Injuries to the developing teeth:This may lead to dilacerations I.e bending of the root of the developing tooth.
Injuries to the periodontal membrane: There may lead to tearing of the membrane and bleeding. These may be swelling of the membrane, partial extrusion of the tooth and acute periodontitis.
Injuries to the bone: This may involve the dental alveolar bone 2 or more teeth in segment move in unison. This is usually treated by splinting to immobilize for at least 2 weeks for other bones of the face ideal treatment is reduction and immobilization of fragments for 6 weeks.

Reference

American Association of Endodontists (AAE)