Recent studies indicate that 25% of Americans
between the ages of 6 and 50 years have experienced traumatic injury to
permanent teeth. Ninety percent of traumatized teeth involve the upper incisors.
The focus of contemporary treatment of dental traumatic injuries is conservative
management of the affected tissues to maximize their excellent healing potential
in children. The most important element in this process is the reduction of the
time interval between the traumatic episode and the dental treatment. Dental
treatment should therefore be sought immediately. It is for this reason that
public information on dental trauma management is so critical, particularly in
the following three areas.
Coronal Fractures -- Broken Crowns of Teeth
The predominant treatment goal in tooth crown fractures includes
protecting the underlying pulp (nerve tissue) within the tooth from bacterial
contamination and infection. Additional goals include keeping the adjacent teeth
from moving into the space created by the missing tooth portion and restoring
the esthetic appearance and function of the traumatized tooth.
Dental treatment of crown fractures involves the following steps. The
affected teeth and surrounding soft tissues are cleansed with an antibacterial
mouthwash and the exposed dental hard tissues are protected with either an
applied protective medicament or an adhesive resin material. These measures
provide a seal against bacterial penetration into the porous tooth structure and
subsequent infection of the underlying pulp. A resin (plastic) restoration of
the lost tooth portion is placed for esthetics and function. In cases where the
missing tooth fragment can be found, it can be reattached to the remaining tooth
portion with dental adhesives. The treated teeth are then monitored
post-operatively for signs of possible infection over a period of several months
to a year.
Tooth Displacement Injury -- Loosened or Dislodged Teeth
The predominant treatment goal for displaced teeth
focuses on protecting the supporting tissue known as the periodontal ligament
from bacterial invasion and subsequent infection resulting from the injury. This
tissue surrounds the root of the affected tooth and has the primary function of
attaching the tooth to the bone.
Dental treatment includes stabilizing the excessively loosened or
displaced tooth by means of short-term splinting. The splinting device consists
of an orthodontic brace wire attached to the affected tooth and adjacent teeth
with resin adhesive for a one to two-week period. Additional treatment may
include esthetic restoration of tooth portions damaged by the injury as
previously mentioned, and post-treatment monitoring for signs of healing.
Tooth Avulsion -- Teeth That Have Been Knocked Out
Treatment goals for knocked-out teeth are focused on enhancing
periodontal ligament survival. The critical variable is the length of time that
the tooth has been out of the mouth without any means of providing hydration and
nutrition to the periodontal ligament cells attached to the avulsed root
surface. This time length is known as Extra-Oral-Dry-Time (EODT). If the EODT is
less than one hour, the chances for periodontal ligament survival is quite good,
provided the appropriate management is started immediately.
Dental treatment of avulsion involves minimizing the EODT by immediately
replacing the tooth back into the socket or immediately placing it in a
transport/storage solution to hydrate and nourish the periodontal ligament cells
still attached to the root. The most readily available transport media is cool
milk. Special tissue culture fluids are even better, but generally are available
only from a dentist, drug stores, or school health clinics. On-site tooth
avulsion management includes the following. 1) Rinse the knocked-out tooth under
tap water only if there is dirt. 2) Replant the tooth in its socket and keep it
held in position, or place it in milk (or culture fluid, if available). 3)
Immediately take the child to a dentist who will stabilize the tooth with
splinting devices previously mentioned and provide the necessary treatment of
the pulp and the periodontal ligament.
The more we can do to enhance the excellent healing potential of the
traumatized tissues in children, the better the outcome.
