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Dental Trauma Rounds 30/3/2015

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by

Trang Nguyen

on 5 September 2016

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Transcript of Dental Trauma Rounds 30/3/2015

A few numbers
Dental Trauma
MCH dental clinic
Fractures
Luxations
Avulsion
I have no conflicts of interest to declare
Objectives:
1) Recognize the most common types of dento-alveolar trauma seen at the MCH
2) Identify priority cases for immediate or early intervention
3) Understand the clinical implications in multidisciplinary care for the management of dento-alveolar traumas
30% of children have or will have one or more permanent teeth damaged before the age of 14.
Falls: 35%
Bicycles or non-motorized vehicles: 29%
Fights and other violent incidents (adolescents): 15%
Sports et unsupervised activities: 11%
Others: 10%
Signs of mandibular fracture
deviation on opening
step defect on palpation
change in occlusion
sublingual hematoma
vertical gum laceration

Chin impact: increased risk of condylar fracture
Loss of the avulsed permanent tooth
Additional costs to patient
orthodontic repositioning of luxated tooth
Replacement of avulsed tooth with prosthesis
Once growth complete : implant and crown
Estimated cost for the patient : > 8000$

Luxation
Avulsion
Concussion
subluxation
Extrusive
or lateral
luxation

Intrusive
luxation
Tooth out of socket

Never reimplant primary teeth
When in doubt call dentistry
If tooth not found- consult dentistry to rule out intrusion


Permanent teeth - Call dentistry
reimplant immediately and have patient bite on gauze
if not possible:
place tooth in cold milk or HBSS
if dry time >60 min prognosis low
>60 min : ankylosis and pulp necrosis
Basma Dabbagh, DMD, MSc, FRCD(c)
Pediatric Dentist
Division of Dentistry, Montreal Children's Hospital
basma.dabbagh@muhc.mcgill.ca

2004-2013 : 3453 traumas
Average 350 dental traumas/year (278-429)
Males > females
Higher risk:
Toddlers learning ambulatory skills
Individuals with special healthcare needs
seizure disorders, developmental disabilities, ADHD,etc.
Patients prone to syncope
Athletes
Triage
Class I
Class II
Rule out neurological injury
Clean mouth and teeth with wet gauze





Determine if primary or permanent teeth




Determine type of trauma
Fracture
Luxation
Avulsion - PERMANENT TOOTH CALL DENTISTRY ASAP
Soft tissue laceration
Alveolar bone and jaw fracture
If a piece of tooth or a whole tooth is missing
Rule out aspiration
Primary teeth - Call dentistry
luxated tooth interferes with occlusion
tooth mobility risk for aspiration
increased mobility >1 mm (within 24 hours)

Permanent teeth (call dentistry)
displaced teeth should be repositioned and splinted ASAP
delay can compromise prognosis


CASE 1
9yo male presents to ER
cc: hit in face with baseball bat
and avulsed tooth
ER physician assessment:
Medically stable
Discharged with recommendation to see dentist the next day (no dental service)

Avulsion 11, luxation 12, fracture 21 and 42
Case 2
4 year old boy
CC: bleeding and pain in mouth after
HPI :fell from bed, missing tooth not found

Case 3
17 year old male
cc: skidoo accident with severe intra-oral injuries
Presents to ER in regional hospital (no dental service)
Multiple referrals with no treatment (dentist, plastic surgeon, other hospitals)
Seen at MCH 5 days after trauma

Case 4

Class II fracture #51
soft tissue radiograph: foreign body in lip

Thank you
"Smart people learn from their mistakes.
But the real sharp ones learn from the mistakes of others."
Fablehaven

Age
Number of dental traumas
Dental traumas at MCH by age
Ellis classification
Primary and permanent teeth:
Class I - II : refer to family dentist / dental clinic




Class III- IV: Call dentistry





Soft tissue laceration (and tooth fragment not located): Call dentistry to rule out foreign body before suturing wound

enamel
enamel
dentin
Alveolar bone and jaw fractures
Take panorex if suspect mandibular fracture
If evident- CTscan
Patient presents to MCH 24 hours later:
Reimplantation of 11 and repositioning of 12 not possible
Avulsed and luxated permanent teeth require immediate intervention

Consequences
2 days later
Intraoral radiograph taken
intruded primary incisor

When tooth cannot be located,
important to rule out intrusion
ER assessment:
A chest radiograph is ordered to exclude aspiration
radiopacity is seen in the lungs
brochoscopy is done under GA
foreign body not found




THM


Avulsion #32, 42, 43
Severe lingual luxation # 31, 41
Severe intrusion and luxation #43
Fracture buccal alveolar segment of anterior mandible
Severe soft tissue laceration
Exposed mandibular bone and necrosis

Consequences of late referral
Poor prognosis of luxated teeth
Need for bone graft in future
Estimated additional cost due to late referral: 3000$
Total cost >8000$
THM

Always rule out foreign body presence before suturing wounds when tooth fragment is missing
7 yo female presents to ER
CC: tooth fracture and lip laceration

Lip laceration is sutured and patient is refered to dentistry
THM
Patient discharged with a dental referral
Dental consult
THM
Permanent teeth trauma require early intervention
Need for increased awareness of our services in regional centers
Treatment:
Teeth repositioned and splinted to maintain alveolar bone
Dental exam
tooth repaired
lip reopend to remove tooth fragment and resutured
Thank you!
Class III
Class IV
enamel
dentin
pulp
enamel
dentin
pulp
tooth
Call dentistry
Avulsion of permanent tooth
Luxation of permanent tooth
Pulp exposure primary or permanent tooth
Patient not able to close mouth properly
To rule out foreign body in soft tissue wound
Concussions and subluxation: refer to family dentist or dental clinic
Full transcript