| Dental trauma |
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Injuries of the attachment Apparatus
(Gums, periodontal Ligament, cemental Layer, Alveolus)
ConcussionAn injury involving no displacement, mobility, or sensitivity to percussion.
Treatment:The occlusion must be checked and adjusted if necessary. Tooth must be observed. Schedule radiographic follow-up!
Subluxation
An injury involving sensitivity to percussion, increased mobility, and no displacement.
Therapie:see Concussion !
Extrusive Luxation
An injury involving displacement in a coronal direction.
Treatment:Treatment involves quick repositioning of the tooth into its original position. Immobilization for 2 to 3 weeks with a semirigid splint! Follow-up treatment (sensitivity testing, x-rays).
Laterale Luxation
An injury involving displacement labially, lingually, distally, or incisally.
Treatment:Quick, careful repositioning of the tooth into its original position. Immobilisation for 2 to 3 weeks with a semirigid splint! Follow-up treatment in the first few weeks (3 weeks after the injury) and months (after 3, 6, and 12 months), followed by annual follow-up treatments for at least 5 years (sensitivity testing, x-rays, mobility, sensitivity to percussion or palpation) which is very important because of the danger of pulp necrosis and root resorptions (internal or external).
Intrusive Luxation
An injury involving displacement in an apical direction into the aveolus.
Treatment:Wait, if tooth reerupts spontaneously and establishes its original position. If reeruption stops before normal occlusion is attained, orthodontic movement should be initiated quickly before the tooth is ankylosed in position. If an orthodontic appliance can be attached to the tooth, orthodontic repositioning for 3 to 4 weeks is favored.
In most cases, the movement into the socket results in extensive attachment damage, with resultant dentoalveolar ankylosis and replacement resorption is almost a certainty. In addition, pulp necrosis is extremely common, so that inflammatory roort resorption will result if timely and adequate endodontic treatment is not performed. Regular follow-up treatment during the first few weeks (3 weeks after the injury) and months (after 3, 6, and 12 months), followed by annual follow-up treatment for at least 5 years is important.
Avulsion – Knocked out tooth
Complete displacement of the tooth out of its socket.
Important for the prognosis is the time that the tooth is outside of the mouth!!!
Treatment:
Of utmost importance is the prevention of drying, which causes loss of normal physiologic metabolism of the periodontal ligament cells. Every effort should be made to replant the tooth within the first 15 to 20 minutes.
If doubt exists that the tooth can be replanted adequately, the tooth should quickly be stored in an appropriate medium until the patient can get to the dental office for replantation. Suggested storage media include:
| • | Cell culture media in specialized transport containers (»Hanks Balanced Salt Solution«), in which 70% of the cells survive after 24 hours. |
| • | Vestibule of the mouth. Be careful kids don’t swallow the tooth! |
| • | Milk |
| • | Water |
Go to the dentist’s (best endodontist’s) office as soon as possible!!!
If no replantation has occured, replantation at the office (tooth that has been outside of the mouth for an hour needs to beconditioned first)
Semirigid fixation (physiologic) for 7 to 10 days
Check for occlusal interferences
The administration of systemic antibiotics (penicillin V potassium, 500 mg, 4x daily or equivalent child dose or alternative antibiotic for 7 days)
Talk to your local doctor about tetanus booster
Eat soft food rich in proteins and drink a lot of fluids
Be careful when chewing!
With immature teeth, wait for possible revasularization of the pulp
With mature teeth, start endodontic tratment after one week and fill root canal with calcium hydrixide
Make the definitive root canal filling after 6 to 24 months with guttapercha
Follow-up twice a year for 5 years and yearly for as long as possible
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