Dental Trauma

Definition
Dental trauma is injury to the mouth, including teeth, lips, gums, tongue, and
jawbones. The most common dental trauma is a broken or lost tooth.
Tooth has the outer hard enamel and the dentine is the part of a tooth between the
enamel and the pulp. The pulp is the living centre of the tooth and is made up of
delicate blood vessels, nerve tissue and cells.
If you sustain any dental injuries, seek a dentist's advice immediately. If you have the
fractured piece of tooth with you, bring it along to the dentist. It is sometimes
possible to put it back.
Description
Dental trauma may be inflicted in a number of ways: contact sports, motor vehicle
accidents, fights, falls, eating hard foods, drinking hot liquids, and other such
mishaps. As oral tissues are highly sensitive, injuries to the mouth are typically very
painful. Dental trauma should receive prompt treatment from a dentist.
Types of dental trauma
a. Fracture
1. Superficial fracture means the fracture is confined only to the enamel, the
hard outer covering of the crown of the tooth. This is usually not serious
unless the fracture leaves the tooth with a sharp edge. Even then, the sharp
edge can be filed down easily.
2. Serious fracture: If your tooth becomes sensitive to touch, heat or cold, the
fracture may be more serious. It may have exposed the inner, more sensitive
parts of the tooth such as the dentine and the pulp. This can increase the risk
of bacterial infections.


b. Displacement
A more severe knock may displace the tooth so that it may sink deeper into the socket
or hang loosely out of it. The tooth may be displaced to the side. If the blow is very
severe, it may knock the tooth out completely or fracture the supporting bone.
In most cases of tooth displacement, the delicate blood vessels supplying the pulp are
damaged and the tooth will require a root canal treatment.
Causes and symptoms
Soft tissue injuries, such as a "fat lip," a burned tongue, or a cut inside the cheek, are
characterized by pain, redness, and swelling with or without bleeding. A broken tooth
often has a sharp edge that may cut the tongue and cheek. Depending on the position
of the fracture, the tooth may or may not cause toothache pain. When a tooth is
knocked out (evulsed), the socket is swollen, painful, and bloody. A jawbone may be
broken if the upper and lower teeth no longer fit together properly (malocclusion), or
if the jaws have pain with limited ability to open and close (mobility), especially
around the temporomandibular joint (TMJ).
Diagnosis
Dental trauma is readily apparent upon examination. Dental x rays may be taken to
determine the extent of the damage to broken teeth. More comprehensive x rays are
needed to diagnose a broken jaw.
Treatment
If your tooth has been knocked out, forced out of position, loosened or fractured, you
should get to the dentist as soon as you can. Getting to a dentist within 30 minutes
can make the difference between saving or losing a tooth.

If your tooth has been knocked out, you should:
a. Find the tooth, and if you can, re-plant it immediately. If a baby tooth has been
knocked out, it may not be replanted. You may try to replace the tooth in the socket,
and keep it down by biting on gauze. This will protect the periodontal ligament fibres
surrounding the tooth.
(A note of caution: Always handle the tooth by the crown; do not touch the root, that
is, the part of the tooth below the gum. Touching the root can damage cells necessary
for bone re-attachment. If there is any dirt on the tooth, do not try to scrape the tooth
to remove it. Rinse gently with water).
b. Apply a cold compress to your cheek to relieve any pain or swelling.
c. Rush to your dentist immediately so that the tooth can be re-planted. Remember that
the longer you wait, the less likely it is for your tooth to be re-planted successfully.
d. If the tooth cannot be replaced and you have to bring the tooth to a dentist, make sure
it does not dry out. To keep it moist, you can put it in special solutions which are
available from pharmacies, or you can put it in a container with a small amount of
cold milk, or even your own saliva.
If your tooth is broken, you should:
a. Clean the broken tooth and find the broken bit (for the adult tooth only).
b. Wash any dirt and debris from the injured area and apply a cold compress on the
cheek if there is any swelling.
c. Rush to your dentist immediately. Minor fractures can be easily filled in but if there is
damage to the enamel, dentine or pulp, the tooth may be restored with a full
permanent crown. If the trauma is too severe, the tooth may have no chance of
recovery.


If your tooth is pushed out of position, you should:
a. Try to put it back to its normal position using very light finger pressure. Do not force
the tooth.
b. Bite down to keep the tooth from moving.
c. Rush to the dentist immediately. The dentist may splint the tooth in place to the two
healthy teeth next to it.
If you have cut your lips, gums, or tongue, you should:
a. Rinse with cold water to remove any dirt.
b. Apply cold compresses to the cut area to stop bleeding.
c. Go to a hospital emergency department if the bleeding does not stop, as you may
need stitches.
Prognosis
When dental trauma receives timely attention and proper treatment, the prognosis for
healing is good. As with other types of trauma, infection may be a complication, but a
course of antibiotics is generally effective.
Prevention
Most dental trauma is preventable. Car seat belts should always be worn, and young
children should be secured in appropriate car seats. Homes should be monitored for
potential tripping and slipping hazards. Child-proofing measures should be taken,
especially for toddlers. In addition to placing gates across stairs and padding sharp
table edges, electrical cords should be tucked away. Young children may receive
severe oral burns from gnawing on live power cords.
Everyone who participates in contact sports should wear a mouthguard to avoid
dental trauma. Athletes in football, ice hockey, wrestling, and boxing commonly wear
mouthguards. The mandatory use of mouthguards in football prevents about 200,000
oral injuries annually. Mouthguards should also be worn along with helmets in
noncontact sports such as skate-boarding, in-line skating, and bicycling. An athlete
who does not wear a mouthguard is 60 times more likely to sustain dental trauma
than one who does. Any activity involving speed, an increased chance of falling, and
potential contact with a hard piece of equipment has the likelihood of dental trauma
that may be prevented or substantially reduced in severity with the use of
mouthguards.
Case
To present the case of a 17-year-old male soccer goalkeeper who sustained
maxillofacial fractures and dental trauma after being struck in the face by an
opponent's knee.
Background:
Because of the nature of the sport and a lack of protective headgear, soccer
players are at risk for sustaining maxillofacial trauma. Facial injuries can complicate
the routine management of on-field medical emergencies often encountered by
certified athletic trainers. The appropriate management of maxillofacial trauma on the
playing field may help to reduce both the immediate and long-term morbidity and
mortality associated with these injuries.
Differential Diagnosis:
Lacerated superior labial artery, lacerated upper lip, dental fractures,
maxillofacial fractures, orbital blowout fracture, closed head injury, cervical spine
injury, cerebrovascular accident.
Treatment:
The athlete received immediate on-field medical care and was subsequently
transported to the hospital, where diagnostic testing was performed and further
treatment was provided. Hospital inpatient management included dental and plastic
surgery. After discharge from the hospital, the athlete underwent several additional
dental procedures, including gingival surgery and nonsurgical endodontic treatments.
The fractures were followed closely to assure that adequate healing had occurred. The
athlete did not return to soccer.
Conclusions:
It is sometimes necessary to consider nonstandard methods of airway
management in order to first address heavy bleeding that may be associated with
facial trauma. Achieving hemostasis is essential in order to prevent potentially life-
threatening complications related to hemorrhage, such as airway obstruction and
hypovolemic shock.
Orthodontic
Orthodontics is a specialization within the field of dentistry that requires
additional training and certification. Orthodontic treatment involves correcting
malocclusion, which is the misalignment of a bite or incorrect spacing between
teeth. This is usually accomplished through the use of orthodontic braces or clear
aligners such as Invisalign. The cost of orthodontics can vary depending on the
materials used, the treatment plan, and even location. Get more information by
talking to an Invisalign Provider near you.
BENEFITS OF ORTHODONTIC TREATMENT
Straighter teeth give you more than a great smilethey also help to
reduce your risk for tooth decay and gum disease. If left untreated by a dentist,
tooth decay and gum disease can cause mouth sores, tender or bleeding gums,
bad breath and possible tooth loss. Orthodontic treatment with Invisalign can
assist with straight teeth, helping you to avoid problems such as an improper
bite, difficulty speaking or chewing, and jaw problems.
Case
This boy was first seen at age 11,7 years and the family were advised to wait for half
a year until the late mixed dentition, because nine primary teeth were present, most of
which were close to being shed. He was seen again at age 11,11 years with a class II
division 1 malocclusion on a slightly low-angle pattern, with MM angle of 24 degrees
but had a wits value of 4 mm, indicating mild class II bases. The family was
originally from Jakarta, but living in London.
Dentally, the patient showed an uncrowded Class II division 1 malocclusion with an
overjet of 11,5 mm, and an upper midline diastema of 1,5 mm, with a minor left-side
crossbite. Upper incisors were very proclined. It was felt that cooperation would be
good in he case, as the family were concerned about the lack of facial harmony and
anxious for this to be improved. This case almost fully met the recommended case
selection criteria.
The first Andresen was contructed using a wax bite with the mandible protruded
approximately 8 mm and with above average 6 mm of opening at the incisors, to
encourage an increase in lower face height. It was fitted at age 12,1 years and was
worn for 10 months. The bow was passive and positioned half way up the labial
surface of the upper incisors. The lower molars and second premolars were free to
erupt. The original treatment planning was for a second Andresen appliance to be
used, but this was not required, as it proved possible to reduce the overjet fully using
the original one, after a slightly slow start.
The overjet was reduced from 11,5 mm to 3,5 mm using only the one Andresen
appliance for 10 months. The molar and premolars were in Class I relationship with
the upper incisors under lip control, and the patient was reminded of the need to
maintain a lip seal. Understandably, patients sometimes ask to cease treatment at this
stage!
Full-size metal upper and lower fixed appliances were placed at age 12,11 years. The
opening archwires were 014 round steel and these wer replaced by upper and lower
018 round steel wires at the first adjustment isit at age 13 years. At this stage light
Class II elastics were being worn during sleeping hours to hooks bent into the upper
archwire, but Kobayashi hooks or other methods could have been used for the
elastics. Very light elastic chain was being used to close space in the lower arch
mesial to first premolars, and the brackets of these teeth were tied to prevent
rotations. Passive elastic chain was in place across the upper incisors
At age 13,1 years a normal upper steel rectangular 019/025 working wire was placed,
with a 020 round wire in the lower, and light Class II elastics were continued at night.
The upper wire was expanded to correct the slight left-side crossbite. At age 13,3
years lower canine brackets were repositioned more mesially and the lower arch was
realigned. A lower rectangular steel 019/1025 working wire was in place from age
13,5 years until the fixed appliances were removed at age 13,7 years.
At the end of treatment at age 13,7 years the patient had much improved facial
harmony and this had been the main reason for seeking treatment. Interestingly, the
three-quarter smile view suggests slight retronathism, which supports the view that
headgear is generally not beneficial in this type of case.
A tooth positioner was used for 4 weeks before proceeding into normal retention at
age 13,8 years, leaving a pleasing Class I dentition. The minus 7 degrees of upper
canine torque seems to work well in individuals with broad dental arches of this type,
but zero torque canine brackets can be considered for cases with narrower arches.
Cephalometrically the measurements were close to ideal.







Daftar Pustaka
http://www.aso.org.au/docs/Orthodontists/What_is_an_orthodontist.htm
http://www.invisalign.com/orthodontic-treatment
http://mylifemysmile.org/why-orthodontic-treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1150225/
http://m.hpb.gov.sg/mobile/dc-article/372
http://nyp.org/health/dental-trauma.html
http://www.dentalarticles.com/xml/skeletal_malocclusion.php
Bennett, John. 2006. Orthodontic Management of Uncrowded Class II Devision One
Malocclusion in Children.