Time and again, teeth are injured as a result of falls, accidents or external violence. Children in particular often fall, whether during their first attempts at walking, romping or cycling. In dental trauma – colloquially known as dental injury – (synonym: ICD-10-GM S09.-: Other and unspecified injuries to the head), a distinction is made between pure injury to the hard tooth substance and injury that also involves the periodontium. Furthermore, soft tissue injuries may occur, which are accompanied by bleeding from the mouth. In the deciduous dentition, the central upper incisors are usually affected. Only rarely are the lower incisors, canines and molars (grinders, which are large, multi-cusped molars in the posterior region) damaged. In the permanent dentition, crown fractures are the most common. The prevalence (disease frequency) of dental trauma is up to 30% in almost all age groups (in Germany).
Symptoms – Complaints
When the tooth hard tissue (generic term for enamel, dentin (tooth bone) and root cementum) is injured, the tooth remains in its bone compartment, called the alveolus.Fractures of the tooth hard tissue are divided into three areas: Crown, crown root and root fractures. In most cases, the affected tooth is still in its bone compartment. However, there are also numerous injuries in which the tooth is pushed out of or into its alveolus, causing the tooth to be displaced or lost entirely. Subluxation is when the affected tooth is loosened. If the tooth is displaced by an injury, it no longer lies correctly in its alveolus. A distinction is made between lateral luxation (lateral displacement) and intrusion (displacement of the tooth inward) and extrusion (displacement of the tooth outward). If a tooth falls out as part of an injury, this is referred to as total luxation. Possible symptoms after tooth injuries:
- Pain
- Bite sensitivity
- Temperature sensitivity
- Percussion sensitivity (knock sensitivity).
- Increased tooth mobility
- Bleeding
- Tooth is intruded (shorter)
- Tooth is extruded (longer)
Pathogenesis (disease development) – etiology (causes)
Dental injuries are the result of traumatic events. These include falls, exposure to violence, and accidents (e.g., traumatic brain injury, TBI).
Follow-up
Teeth may be so severely damaged after trauma that pulp (tooth nerve) death occurs, resulting in endodontic therapy (healing of root canals). Likewise, root canal obliteration (root canal occlusion) and internal or external resorptions may occur in the affected teeth. In the case of fractures in the middle third of the root, the affected tooth must usually be extracted, leaving a gap in the tooth row that requires restoration. If a tooth is reinserted after total dislocation, ankylosis (the tooth fuses with the bone and loses its inherent mobility) may develop.
Diagnostics
The first look is for soft tissue injuries. In this regard, penetrating injuries should be given priority for subsequent treatment. Possible tooth loosening is checked palpatorily (palpation). If a fracture of one or more teeth is suspected, X-ray diagnosis is essential. A dental film provides information about the location and extent of fractures of individual teeth. However, after falls, accidents or violence, a panoramic radiograph should sometimes also be taken to rule out any fractures in the mandible or the temporomandibular joint. A negative vitality test after trauma is not necessarily an indication for root canal treatment, since sensitivity can return even weeks to months after trauma. If this is not the case or if symptoms occur that necessitate root canal treatment, it should be performed.
Therapy
If a tooth falls out, there are some rules to follow to enable the tooth to be reinserted or to significantly increase the chances of success. The following should be done: Tooth fragments or completely knocked out permanent teeth must be stored in isotonic saline solution immediately after the trauma until therapy.The best place to transport a knocked-out tooth is in the oral cavity. However, this is not feasible with small children due to the risk of swallowing or even aspiration of the tooth.In these cases, the tooth should be kept moist; transport in a little milk is recommended. If you want to be sure to store the tooth properly, you can use the tooth rescue box, as mentioned above.Likewise, it is important not to clean the tooth yourself under any circumstances, no matter how dirty it may sometimes appear. Cleaning destroys the delicate root membrane, which is absolutely necessary for the tooth to heal again. Therefore, keep the tooth moist and visit an oral surgery practice or clinic as soon as possible. There, the tooth will be professionally cleaned and, if possible, reinserted. During the subsequent therapy, care must be taken to ensure effective analgesia. If penetrating injuries are present, these must be treated as a priority. Care must be taken to ensure that no tooth fragments or foreign bodies remain in the wound. The treatment of injured deciduous teeth should be carried out with due consideration of the costs and benefits. The therapy of a tooth enamel fracture always depends on the exact localization of the injury. If only some enamel is broken off, the tooth can be rebuilt using acrylic.If the dentin (tooth bone) is also affected by the fracture, the dentin wound must be treated with a calcium hydroxide preparation.If the pulp (tooth nerve) is opened, an attempt can be made to preserve the vitality of the tooth, depending on the size of the wound. However, if this is not possible, the tooth must be root canal treated. If the root of a tooth breaks, an attempt can be made to preserve the tooth if the fracture is in the upper or lower third of the root. If the root of the tooth is fractured in the middle, the tooth must usually be extracted. If a subluxation is present, it is recommended to immobilize the tooth for one to two weeks and initially to pay attention to a particularly soft diet in order to avoid unnecessary stress on the loosened tooth and to allow it to heal again. A displaced tooth is first repositioned, which means that it is brought back into its correct position. This is followed by splinting the tooth to allow it to heal. Soft food and non-loading of the tooth also contribute to the success of the therapy.Teeth that are intruded, i.e. displaced inwards, can spontaneously re-position themselves, provided that root growth has not yet been completed. However, teeth with completed root growth must undergo orthodontic extrusion – shifting the tooth outward.
