dental trauma
Introduction
Introduction to dental trauma Dental trauma includes acute and chronic injury. Acute injury includes periodontal ligament injury, tooth dislocation, hard tissue damage and tooth fracture. Chronic injury includes tooth wear, bruxism, wedge-shaped defect, acid erosion, and cracked teeth. Acute tooth damage can occur alone or simultaneously, and can also cause damage to other parts of the body, such as lip, cheek, tongue, neck and nasal trauma; dental trauma involves a wide range of teeth, including the tooth itself (including Enamel, dentin, dental pulp trauma, as well as periodontal ligament, alveolar bone trauma, total dislocation of the teeth. The most common cause of permanent dentition trauma is falling, followed by traffic accidents, violence and sports. The nature, size, speed and direction of action of external forces create various types of damage. Direct external force causes anterior teeth injury if it falls; indirect external force, such as external force hitting the ankle (chin), the lower teeth violently hit the upper teeth, usually causing trauma to the premolars and molars; lighter external force only causes periodontal tissue The light injury, the heavier external force can tear all the periodontal ligament, the teeth are removed from the alveolar socket; the high-speed external force is easy to cause the crown to break, and the low-speed and high-strength external force is easy to cause periodontal tissue damage. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: endodontic pulpitis acute pulpitis chronic pulpitis
Cause
Cause of dental trauma
Mechanical external force (40%):
The most common cause of permanent dentition trauma is falling, followed by traffic accidents, violence and sports. The nature, size, speed and direction of action of external forces create various types of damage. Direct external force causes anterior teeth injury if it falls; indirect external force, such as external force hitting the ankle (chin), the lower teeth violently hit the upper teeth, usually causing trauma to the premolars and molars; lighter external force only causes periodontal tissue The light injury, the heavier external force can tear all the periodontal ligament, the teeth are removed from the alveolar socket; the high-speed external force is easy to cause the crown to break, and the low-speed and high-strength external force is easy to cause periodontal tissue damage.
The incidence of dental trauma in children is relatively large. This is because children are in the stage of physical, physiological and psychological growth and development, and they are more prone to dental trauma than adults, especially anterior teeth trauma.
Prevention
Dental trauma prevention
In sports such as football, basketball, rugby, handball, ice hockey, boxing, bicycles, motorcycles, and horseback riding, the use of protective trays, masks, and helmets can prevent dental trauma.
Complication
Traumatic trauma complications Complications pulpitis pulpitis acute pulpitis chronic pulpitis
1. Congestion of the pulp: Dental trauma, regardless of the severity of the injury, causes the degree of pulp congestion, and its recovery is closely related to the age of the patient. The recovery should be observed regularly.
2. Endodontic hemorrhage: The crown is pink, which can appear at the time of trauma, or it can appear after a certain period of time. The micro-bleeding of young permanent teeth may return to normal; the adult teeth are not easy to recover, and the yellow color varies from day to day. If the tooth has no other symptoms, it is not necessary to do root canal treatment.
3. The pulp temporarily loses its sensation: also known as endodontic shock. After tooth trauma, the pulp may lose its sensation and will not respond to the vitality test. After a period of time (1-13 months), the pulp vitality may slowly return to normal. This happens mostly in young permanent teeth. Therefore, the dental pulp vitality test after the tooth trauma does not respond, does not necessarily indicate the pulp necrosis, does not need to be treated immediately, should be observed regularly, the diagnosis is clear and then treated.
4. Endothelial necrosis: Dislocation, root fracture, tooth concussion and improperly treated crown fracture can cause pulp necrosis, and the incidence of embedded necrosis of pulp necrosis is as high as 96%. The incidence of dental pulp necrosis of the traumatic teeth with complete root development was significantly increased. Root canal treatment should be performed immediately after pulp necrosis occurs.
5. Calcium in the pulp: more common in the dislocation injury of young permanent teeth, the color of the tooth crown can be slightly darker, and the pulp activity is slow or non-responsive. X-ray films showed disappearance of the pulp cavity and root canal images. If no symptoms, no treatment.
6. Root resorption: Dislocation and root fracture of the traumatic teeth may occur outside the root and absorption. In the treatment of root canal, the inclusion of calcium hydroxide in the root canal prevents and stops the occurrence and progression of root resorption. Absorption of the teeth outside the root is accompanied by bone healing.
Symptom
Tooth trauma symptoms Common symptoms Denture pain Dental damage Toothache tooth dislocation
1. Tooth damage: including enamel, dentin, pulp damage.
2. Periodontal cerebral concussion injury.
3. Dislocation of the teeth: including subluxation, total dislocation, three kinds of teeth, a small part of the alveolar fracture, teeth embedded in the alveolar fossa, lip, cheek, tongue dislocation, loose teeth, post-dislocation complications:
1) pulp necrosis;
2) the medullary cavity is narrowed;
3) Absorption outside the root.
4. Tooth folding:
1) Crown folding: including complete and incomplete fracture.
2) Root fold: there is pain, looseness, bleeding in the sulcus.
3) Crown root fold: can affect the enamel, dentin, cementum, pulp exposed, very sensitive.
Examine
Dental trauma examination
Clinical examinations for patients with traumatic trauma include: soft tissue injury, tooth looseness examination, percussion examination, pulp vitality examination, and imaging examination.
1. For the examination of acute tooth injury, "A" is the main;
2. If there is any difficulty in diagnosis or differential diagnosis, you can add "B" item to check;
3. If you suspect tooth trauma and maxillary sinus penetrating or mandibular fracture, you can take a mandibular or maxillary sinus slice and if necessary, you can choose CT.
Diagnosis
Diagnosis and diagnosis of dental trauma
Dental trauma diagnosis
Most of the dental trauma is emergency department. The patient should first pay attention to the general condition of the patient, and find out whether there are major problems such as fractures and head injury in other parts. If there is life-threatening situation, rescue should be organized immediately. Dental trauma is also often accompanied by gingival tears and fractures of the alveolar process, which should be promptly diagnosed.
1. The tooth has a history of trauma.
2. Traumatic periodontitis, loose teeth, chewing pain, tooth elongation, hypersensitivity, spontaneous pain, cramps, tenderness.
3. Tooth folding:
1) Only small pieces of enamel are fractured and asymptomatic.
2) Most of the dentin is exposed, and the tenderness is sensitive. For example, when the pulp is worn, the pain is stimulated and the bleeding is detected.
4. Dislocation of the teeth: subluxation, total dislocation, three kinds of teeth in vitro, inserted into the alveolar fossa after dislocation of the teeth, and a small part of the fracture with the alveolar process.
5. Endothelial necrosis: no vitality, discoloration of teeth.
6. X-ray film to find the root fold and periodontal conditions, alveolar bone condition.
Combined with the medical history, the diagnosis can be confirmed without identification.
