Reason of trauma to tooth
- Grossly carious / Decayed tooth
- Accidents
- Chewing hard food
- Opening bottles, walnut
- Assault
- Excessive grinding of teeth
- Teeth that have undergone root canal therapy and have not received a crown
Primary Tooth Permanent Tooth
TYPES OF TOOTH TRAUMA
Crown Fractures
- Enamel
- Enamel and Dentin
- Enamel, Dentin and Pulp
Root Fractures
- Horizontal – A horizontal crack in the tooth
root - Vertical – a vertical crack in the tooth root
Displaced or loosened teeth within the socket
- Concussion – The tooth has absorbed the force of the injury
- Displacement – The tooth has become dislocated inside the socket
- Avulsion – The tooth is out of the socket
ENAMEL FRACTURE
SIGN AND SYMPTOMS –
- No tenderness / pain
- No mobility
- Tooth seems to be chipped minimally
TREATMENT –
- Bonding, if the broken tooth fragment is available
- Restoration with composite resin
ENAMEL AND DENTIN FRACTURE
SIGN AND SYMPTOMS –
- No pain
- No mobility
- Sensitivity to hot or cold
TREATMENT –
- Bonding, if the broken tooth fragment is available
- GIC or bonding agent and composite resin can be used
- If the exposed dentin is within 0.5mm of the pulp, place calcium hydroxide base and cover with a restorative material
ENAMEL, DENTIN AND PULP
SIGN AND SYMPTOMS
- Pain / tenderness present
- Sensitivity would be there
- No mobility
TREATMENT
- Pulp capping or Partial pulpotomy – to
maintain pulp vitality. - RCT – In patients with mature apical development
- Bonding if the broken tooth fragment is available
- Restoration after pulp treatment with dental restorative materials.
ROOT FRACTURE
Fracture of pulp, dentin and cementum.
VERTICAL ROOT FRACTURE
SIGNS AND SYMPTOMS
- Pain on biting
- Pain may be mild to moderate
- Infection may take place
TREATMENT
- In single rooted teeth – extraction is only treatment
- In multi rooted teeth – fractured root can be removed by hemisection
HORIZONTAL ROOT FRACTURE
When fracture line is perpendicular to the long axis of the tooth.
SIGNS AND SYMPTOMS
- In apical third – mild or no pain, only
detected radiographically - In middle third – pain and tender on percussion infection or swelling
- In coronal – severe pain and tender on percussion, infection or swelling
TREATMENT
- Re-positioning, stabilization and occlusion adjustment
- In case of pulpal damage, root canal treatment.
CONCUSSION
SIGNS AND SYMPTOMS
- Bleeding may be present.
- Tender on percussion positive.
- Non displaced tooth
TREATMENT
- No treatment is needed.
- Monitor pulpal condition for at least one year.
SUBLUXATION
injury to periodontal tissue.
SIGNS AND SYMPTOMS
- Mobility of tooth.
- Undisplaced tooth.
- Pulpal damage can occur.
- Tender on percussion
TREATMENT
- Splinting and root canal treatment.
AVULSION
Tooth is completely out of the socket.
SIGNS AND SYMPTOMS
- Tooth is knocked out completely from socket.
- Bleeding tends to occur.
- Surrounding area is inflamed and lacerated.
TREATMENT
- Early management within 20–40 minutes of injury needs to be done.
- Deciduous teeth should not be replanted due to the risk of damaging the permanent tooth germ.
- After rising the tooth gently, store in saliva, milk or saline.
- RCT one month after re-implantation.
