Trauma and nerve damage to teeth (Part II)

Jul 24, 2018
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Trauma and nerve damage to teeth (part 2)Trauma and nerve damage to teeth (part 2)

TRAUMATIC INJURIES OF TEETH

CONCUSSION

  • Concussion refers to vascular structures at the tooth apex and periodontal ligament resulting in inflammatory edema
  • No displacement, only minimal loosening of tooth occurs
  • May result in mild avulsion of the tooth from its socket causing occlusal surface to make premature contact with an opposing tooth

Clinical features

  • Tenderness on gentle horizontal or vertical percussion
  • Tooth sensitive to biting forces
  • Patients usually try to modify occlusion to avoid traumatized tooth

Management

  • Soft diet
  • Relief of occlusal interferences
  • Flexible splinting
  • Periodic monitoring with repeated vitality testing and radiographs

Prognosis

  • Pulp necrosis
  • Root resorption is very rare

LUXATION

  • Dislocation of the tooth from its socket after severing of the periodontal attachment
  • Usually two or more teeth involved
  • Teeth mostly affected: deciduous and permanent maxillary incisors
  • Mandibular teeth seldom affected
  • Vitality testing: temporarily decreased or undetectable
  • Vitality may return after weeks or several months
  • Depending on magnitude and direction of traumatic force
  • Subluxation
  • Extrusive luxation
  • Lateral luxation
  • Intrusive luxation

SUBLUXATION

Subluxation denotes an injury to supporting structures of the tooth that results in abnormal loosening of the tooth without frank dislocation.

Clinical features

  • Teeth are in normal location or limited elevation of tooth from its socket
  • Abnormally mobile
  • Extravasated blood emanating from gingival crevice depicts PDL damage
  • Tenderness to percussion and masticatory forces

EXTRUSION

  • Partial displacement of a tooth out of its socket
  • Often found in deciduous teeth

Clinical features:

  • Tooth appears elongated
  • Usually displaced palatally
  • Bleeding from gingival sulcus
  • Mobile

LATERAL LUXATION

Movement of tooth in a direction other than intrusive or extrusive displacement

Clinical features

  • Comminution or crushing of alveolar process accompany tooth dislocation
  • Movement direction depends on:
  • Orientation and magnitude of the force
  • Root shape
  • Tooth may be pushed through buccal or less commonly lingual cortical plate
  • Root apex palpable insulcus area

Management (Subluxation, Extrusion, Lateral luxation)

  • Restoring teeth to normal position by digital pressure under LA
  • Comminuted pieces of alveolar bone to be repositioned by digital pressure
  • Removal of occlusal interferences if necessary
  • Immobilization for 2-3 weeks using flexible splints
  • Root canal therapy prior to splint removal
  • Extraction of the traumatized teeth should be the last resort
  • Periodic follow up clinically and radiographically

Prognosis

  • Pulp necrosis: Open apex -9%, Closed apex -55%
  • Chances of surface resorption
  • Inflammatory resorption can be seen in association with pulp necrosis
  • Due to compression to the PDL, both inflammatory and replacement resorption may occur

INTRUSION

  • Displacement of tooth into alveolar process
  • Comminution or crushing of alveolar process accompany tooth dislocation
  • Often seen with deciduous dentition, less in permanent dentition

Clinical features

  • Reduced height of clinical crown
  • Gingival bleeding evident
  • High metallic sound on percussion
  • Maxillary incisors may be intruded into the alveolar process
  • Damage to adjacent teeth especially underlying permanent teeth

Management for intrusion:

Depends entirely upon the stage of root development

Immature root formation

  • Spontaneous eruption can be anticipated
  • Luxation of tooth slightly with the forceps done if no signs of re-eruption after 10 days
  • Pulpal healing is monitored during the period of re-eruption at 3, 4, 6 weeks after injury
  • In case of negative response of the pulp or periapical radiolucency
  • Endodontic therapy with calcium hydroxide dressing is done

Completed root development

  • Spontaneous re-eruption is unpredictable
  • Orthodontic extrusion is indicated over a period of 2-3 weeks
  • Prophylactic endodontic therapy is indicated as frequency of pulp necrosis

Prognosis

  • Pulpal necrosis-Open apex-63%, Closed apex –100%
  • External surface, inflammatory and replacement resorption are very frequent findings, especially in teeth with complete root development
  • Severe complication can be seen as late as 5-10 years after trauma

AVULSION

  • Complete displacement of a tooth from the alveolar process
  • Can occur due to direct or indirect trauma 

Clinical features

  • Seen in relatively younger age group
  • Maxillary central incisors-most commonly avulsed teeth in both dentitions
  • Affects single tooth mostly
  • Socket is found empty or filled with coagulum
  • Lip laceration
  • Fracture of alveolar process may occur 

Management

  • If avulsed tooth is not found clinically or radiologically, chest or abdominal radiograph to locate it
  • Reimplantation of permanent teeth. The prognosis depends on:
  • Condition of tooth
  • Time out of socket
  • Viability of residual PDL fibres
  • Splinting
  • Endodontic therapy after reimplantation
  • Follow up

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DISCLAIMER : “Views expressed above are the author’s own.”



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