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Dental trauma:epidemiology, etiology and classification
o The doctor was reading the slides most of the time, she justexplained some points, but didnt add anything.
o This lecture is an introduction and in the coming lectures we will talkabout each subject in details.
o Dr.arwa will give us a lecture about local anesthesia and another oneabout extraction in "preventive course" just for the first two weeks to
prepare us for the clinic.
Dental trauma: tooth fractures have been described as a significant
dental disease and are reported to be third most common cause of tooth
loss behind caries and periodontal disease ,,, here this definition is talking
about adultsbecause tooth loss in adults mostly due to caries, periodontal
disease and trauma. In children; periodontal disease is not that much
common so the main cause is caries and trauma is the second cause.
Epidemiology
Trauma frequencies will vary in different countries in varying age groups.
The frequencies differ among primary and permanent dentition.
Trauma frequencies in children in primary dentition:o In primary dentition almost one-third have suffered a
traumatic dental injury.
o Most often tooth luxation, luxation means the injury isdirected to the PDL. It is the most common because bone in
children is very loose and the crown-root ratio is small as roots
are shorter; so the tooth can be easily displaced. However; if
we compare them with permanent teeth, bone is harder and
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roots are longer so if there is a direct fall on the floor the
tooth is easy to be fractured.
o In Boys the incidence is much higher than girls. Trauma frequencies in children in permanent dentition:
o 20-30% have suffered dental injuries.o The typical injury is uncomplicated crown fracture.o Boys are almost one-third more frequently affected.
Trauma incidences in the primary dentition :o Annual trauma incidences: mean the number of new injuries suffered
during a year.
o Peak incidences in the primary dentition are found at 2-3yearsof agewhere motor coordination is developing and children start moving
around on their own, he bases on the chair and table and walk
around the house, in this stage the motor coordination is stimulated
and the weight of the head is larger than the body so this is causing
the child to fall on the ground causing trauma, which is the main
reason for trauma at this age.
Trauma incidence in the permanent dentition : Peak incidences for boys are found at 9-10 years where vigorous
playing and sports activities become more frequent.
Epidemiologic characteristics of dental trauma: Sex and age: in males more than females , in primary dentition
luxation more common than crown fracture. Etiology: leading cause in primary dentition is falls, while in
permanent dentition is sports and violence.
Seasonal variation: in Jordan the frequencies in summer aremore due to school holidays, children are going outside to play
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Prevalence of
etiologic factors:
Falls are the
highest then fights
& accidents and
then bicycle
&sports.
where they get injured. While in Switzerland its more in
winter because they have winter sports like skating, so injuries
may happen. In other words seasonal variation depends on
countries and cultures.
Type of injury: in primary teeth luxation, in permanent crownfracture.
Soft tissue injuries: the most popular, in 50% of trauma cases,it can be extra oral or intra oral
Place of injury: at home, school or playground. Location of injury: anterior teeth get traumatized more than
posteriors and in maxilla more than mandible; if the patient
have class III skeletal relation then the mandible will get
injured more.
Etiology:
Causes of trauma:
Iatrogenic injuries in newborns prolonged intubation inprematurely born infants, the tube sometimes
causes pressure on the tooth bud leading to
enamel hypoplasia. Falls in infancy due to lack of coordination Child physical abuse. Contact sports,bicycle injuries
,horseback riding.
Road traffic accidents/motor vehicleaccidents.
Assaults. Physical torture.
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Note in the prevalence table of etiologic factors (slide15) child abuse is 1%
and this doesnt mean it is low but its not reported ,we dont ha ve actual
number about child abuse.
In the chart (slide 16): bicycle ,falls and sports cause trauma in girls morethan boys ,while violence more in boys.
Remember this is not a general rule; it depends on the country and the year
of the study.
Predisposing factors to trauma : (they are not direct reasons butthey could predispose to trauma)
The incidence of trauma increased with increased overjet, protrusionof upper incisors and incompetent lips, if the patient falls on his face
he/she will be at risk of trauma.
Medical history: Epilepsy, mental retardation , Attention DeficitHyperactivity Disorder (ADHD) ,in ADHD the child is very hyperactive
but his attention is low .
Dental history: any dental condition which will weaken the Enameland Dentin structure may dispose them to trauma like amelogenesis
imperfecta (AI), dentinogenesis imperfecta (DI) and endo therapy,
which may weaken the root especially apexification in a young age,
because the root doesn't have much time to lay enough thickness of
dentine .
Low socio economic status and this is a debatable to some degree ,because the poor neighborhood have more fighting and violence,
but also in high SES have problems like drugs and violence ,so its
debatable and cultural . Lack of mouthguards and faceguards during playing
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Classification of dental injuries to teeth:
Proposed and modified by Andreasen and Andreasen based on WHOclassification in 1978. Andreasen is a dentist who has many
researches and puplication about trauma ,and he has a book named
(Atlas of dental trauma) which is very useful book if you want to read
it.
He classified trauma according to anatomic, therapeutic andprognostic factors.
Includes injuries to teeth, supporting tissues, gingival and oralmucosa.
Can be applied to both permanent and primary dentitions.Classification of dental injuries :
Injuries to the hard dental tissues and pulp . Injuries to the hard dental tissues , pulp and alveolar process . Injuries to the periodontal tissues . Injuries to the gingival or oral mucosa .
Injuries to the hard tissues & pulpEnamel infraction : incomplete fracture (crack) in enamel without loss
of tooth substance .
Enamel fracture : (uncomplicated crown fracture ) fracture with loss oftooth substance confined to enamel .
Enamel-dentine fracture: (uncomplicated crown fracture) a fracturewith loss of tooth substance confined to enamel and dentine but NOT
involving the pulp .
Complicated crown fracture: a fracture involving enamel , dentine andexposing the pulp .
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Injuries to the hard dental tissues ,pulp and alveolar process Crown- root fracture: fracture involving enamel , dentine and
cementum .it may or may not expose the pulp. Usually its
diagonal in direction .
Root fracture: fracture involving dentin, cementum and pulp,it could be apical ,in the middle or cervical .
fracture of the alveolar socket (Mx or Mn) : fracture of thealveolar process which involves the alveolar socket ,some
times this fracture occurs with luxation injury ,i.e. the tooth is
intact the crown goes palatally and the apex goes labially .
fracture of the alveolar process (Mx or Mn) : fracture of thealveolar process not the jaw bone, that may or may not involve
the alveolar socket .
Sometimes root fracture appears clinically only as
displacement of the root, thats why X-rays are very necessary
in management of trauma .later on you, will learn that each
type of trauma has different types of x-rays.
There is a website about guide lines of management of dental
trauma which always updates these guidelines, because you
have to refresh your informationwww.iadt-dentaltrauma.org
Injuries to the periodontal tissues:Concussion: injury to tooth-supporting structures without abnormal
loosening or displacement of the tooth, but with marked reaction to
percussion, clinically and in radiographs there are no changes only
the tooth becomes tender.Subluxation (loosening): injury to tooth supporting structures with
abnormal loosening, but without displacement of the tooth.
Extrusive luxation (partial avulsion): partial displacement of the
tooth out of its socket, we take a radiograph to make sure that there
is no root fracture.
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Lateral luxation:displacement of the tooth in a direction other than
axially. Clinically the crown goes palatally and the root goes labially ,
in the x-ray there is widening in the PDL space.
Intrusive luxation:displacement of the tooth into the alveolar bone.
Accompanied by comminution or fracture of the alveolar socket.
Avulsion (Exarticulation):complete displacement of the tooth out of
its socket.
Injuries to the gingival or oral mucosa:Laceration of gingival or oral mucosa: a shallow or deep wound in
the mucosa resulting from a tear, usually produced by a sharp object.
Contusion of gingival or oral mucosa: a bruise usually produced by
impact with a blunt object and not accompanied by a break in the
mucosa, usually causing submucosal hemorrhage.
Abrasion of gingival or oral mucosa: a superficial wound produced
by rubbing or scraping of the mucosa, leaving a raw, bleeding
surface.
The doctor showed us some pictures about the previous cases which
are in the slides please refer to them.
The end
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