DENTOALVEOLAR INJURIES

Welcome to the Kasper, Heaton, Wright, Pagni and Associates web site. This Current Article section is new and will feature surgical updates for your information and review. The articles will change quarterly and will address different aspects of oral and maxillofacial surgery. If you have a topic that would be of interest to you and your colleagues, please send us an e-mail. All articles will be archived for later reference.

The initial article will be on Dentoalverolar Injuries. With the cold weather soon to disappear and Spring around the corner with outdoor activities like Little League baseball, we will start to see more dentoalveolar injuries. This will be an over-view of trauma to the teeth and associated tissues.

Trauma to dentoalveolar structures in adults can occur from auto accidents, sports, falls or work injuries. In children and teenagers, the injuries are most often from falls and sports, respectively. Mouth guards can significantly reduce injuries to teeth when worn by our children during contact sports.

The maxillary anterior teeth are most likely to be injured from direct trauma. Depending upon the nature and severity of the trauma, the injury may involve just the teeth in varying degrees or the alveolar bone and soft tissue with fracture and lacerations. In any event, a thorough history and physical examination is a must to establish a working diagnosis. Appropriate radiographs can then be ordered to confirm the diagnosis and develop a treatment plan. It is important when doing the history and physical to avoid tunnel vision and focus only on the dentoalveolar structures because any trauma can cause other occult injuries which can vary in severity and even be life threatening.

The examination should include intraoral as well as extraoral soft tissues for lacerations and debris. The alveolar bone and jaws should be examined for fractures, which will alter be confirmed by x-rays. The teeth should be evaluated for fracture, displacement and mobility. Periapical x-rays are taken of the traumatized teeth along with a panoramic radiograph to rule out jaw fractures.

Dentoalveolar injuries have been classified so that our description and diagnosis of an injury will be understandable to any consulting colleague. Fractures of the teeth are divided into four categories. Class I fractures involve the enamel only. Class II fractures involve enamel and dentin. Class III fractures involve the pulp. Class IV fractures involve the root.

Injuries are classified with descriptive terms. A concussion injury occurs to a tooth without loosening but with altered sensation to percussion. Subluxation is loosening of the tooth without displacement. Luxation of a tooth occurs with displacement from injury to the alveolar bone and may be intrusive (into the alveolus), extrusive (partially avulsed from the socket), or lateral (with fracture of the alveolar socket). A tooth may also be totally avulsed from the socket.

The goal in treatment should be to preserve function. However, sometimes the treatment plan may dictate removal of teeth if the over-all success will be compromised, as may be the case with periodontically involved teeth. In the long run, the maintenance of good alveolar bone may allow for the best restoration of function. The sequence in treating dentoalveolar fractures is bone, teeth, and then soft tissue. Treatment is usually done from inside (bone) to outside (skin).

This article was meant to be an overview of dentofacial trauma, and future articles will deal with specific treatment of these injuries. I hope that you have found this informative. Please forward your comments to www.khworalsurgery.com.

February 2001