Classification of dental trauma & management of dental avulsions

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Melvyn Kelley
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1 Dr Tony Skapetis The University of Sydney Clinical Director Education WCOH Clinical Senior Lecturer University of Sydney Classification of dental trauma & management of dental avulsions

University of Sydney Tony_Skapetis@wsahs.nsw.gov.

2 Take home messages: You can make a difference when it comes to teeth as well!

3 Dental nomenclature & tooth anatomy. Gabriel snow angel

4 Learning Outcomes Understanding of the main components of tooth anatomy and structure. The ability to describe and record both the primary and secondary dentition using appropriate nomenclature. The ability to classify dental traumatic injuries.

The ability to describe and record both the primary and

5 Basic tooth anatomy

6 Lets talk in tooth No s & make things easy!

7 Deciduous or Primary Teeth

8 What about in the mixed dentition? Gabriel at 7yrs

9 OPG of a 7 year old

10 Assessment & Classification of traumatic dental injuries

11 Things to look for: Soft tissue injuries lacerations, de-gloving. Tooth mobility Occlusal (bite) level of injured teeth Any tooth pieces missing? Where are they? Of 6000 patients presenting with facial injuries to ED, 48% had dental trauma. (Gassner R et al, Oral Surg Oral Med Oral path Oral Rad & Endo Jan 99). Ref: Day P F. and Monty S. Duggal. (2006). "The role for 'reminders' in dental traumatology: 3. The minimum data set that should be recorded for each type of dento-alveolar trauma - a review of existing evidence." Dental Traumatology 22(5):

Of 6000 patients presenting with facial injuries to ED, 48% had dental trauma.

12 Classification of traumatic injuries Ref: WHO publication: Application of the International Classification of Diseases to Dentistry and Stomatology ICD-DA 3rd edition 1994 Two main groups: Injuries to the hard dental tissues of the mouth. Injuries to the periodontal tissues or supporting tissues of the teeth. Bastone et al. Epidemiology of Dental Trauma: A review of the Literature. Aust Dent J, 2000;45:(1):2-9.

13 Injuries to the hard dental tissues of the mouth: Crown infraction an incomplete fracture of the enamel without loss of tooth structure. Uncomplicated crown # Crown # without pulp exposed Complicated crown # Crown # with pulp exposed Uncomplicated crown-root # Crown # extending below the gum line & involving the tooth root but not exposing the pulp. Complicated crown-root # Crown # extending below the gum line & involving the tooth root but also exposing the pulp.

Uncomplicated crown # Crown # without pulp exposed Complicated crown # Crown # with pulp exposed Uncomplicated

14 How would this injury be classified using WHO classification?

15 Injuries to the periodontal tissues or supporting tissues of the teeth: Root fractures where the tooth root only is involved Concussion refers to injury to the tooth supporting structures without abnormal loosening or displacement Subluxation Tooth loosening without displacement Intrusive luxation Tooth is pushed into tooth socket, towards gum Extrusive luxation Tooth is pushed away from tooth socket but not yet avulsed Lateral luxation Tooth is pushed either antero-posteriorly or mesio-distally i.e. sideways of its long axis. Avulsion Tooth has come out of socket completely

luxation Tooth is pushed into tooth socket, towards gum Extrusive luxation Tooth is pushed away from tooth socket but not yet avulsed Lateral

16 Which teeth are involved in this injury (13yr old boy) and how would this be classified?

17 Gabriel Gabriel at at 8yrs.who 8yrs.who needs needs patients patients when when you you have have 4 boys! boys! Classify Classify this this injury. injury.

18 Dental luxations & avulsions Useful link:

19 Learning outcomes : Ability to provide effective emergency treatment for dental avulsion. An understanding of luxation injury management

20 Luxations & avulsions involving deciduous teeth: Key points: Never reimplant a deciduous tooth For near avulsions, if the tooth is interfering with the bite or is at risk of being swallowed or inhaled, extract it. Make sure the tooth has been accounted for Refer to dentist when practical Useful link:

at risk of being swallowed or inhaled, extract it.

21 Luxation (displacement) injuries involving permanent teeth Where possible, if interfering with bite &/or an inhalation risk..try & reposition & splint. Refer to dentist ASAP since these injuries are time critical. Useful link:

22 Avulsions and splinting of permanent teeth Key points: Best if done immediately or within a few hours of injury. Storage medium is most important. Splinting time is days Refer to dentist ASAP or within 2 week if able to splint

23 Avulsions: What is OK to transport an avulsed tooth in? Fresh milk Skim milk Chocolate milk Soy Milk Egg albumin Breast milk Contact lens saline Saliva Yes Yes No No Yes Yes Yes Yes

24 17 yr old playing cricket & caught ball with mouth

26 Avulsed Avulsed tooth tooth showing showing ligament ligament cells cells around around root root portion portion vital vital to to reimplantatioimplantation re- success. success. Paediatric Dentistry, Westmead Hospital

27 Treating an avulsion

28 Splinting avulsed tooth to adjacent teeth with GIC

29 Emergency splints A good temporary splint can be made using Al foil and Blu-Tac (or equivalent). Use the patients mouthguard or orthodontic retainer. Stomahesive wafer cut to size.

30 Post re-implantation instructions: Determine tetanus immunisation status. Give oral Doxycycline (100mg for adults) 2x/day for 7 days if >12yrs. If <12yrs give Penicillin V. Chlorhexidine(0.1%) mouthwash 2x/day for 7 days. Soft diet for 2 weeks. Follow up by dentist as soon as practical.

31 Dental Trauma Kit from RDN contact Rose Ellis:

32 Questions???

Emergency management of dental trauma

Australasian Emergency Nursing Journal (2010) 13, 30 34 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/aenj CLINICAL PRACTICE UPDATE Emergency management of dental trauma