Chapter 53 Dental Injuries
1 How frequently do health care practitioners encounter pediatric dental injuries?
Dale RA: Dentoalveolar trauma. Emerg Med Clin North Am 18:521–538, 2000.
3 What are the other components of the tooth?
Other components of the crown of the tooth include dentin, a softer, microtubular structure, and pulp, which provides the tooth’s neurovascular supply (Fig. 53-1). The root of the tooth, which anchors it to the alveolar bone, consists of cementum, the periodontal ligament, and the alveolar bone.
4 Why is it important to distinguish primary from permanent teeth?
Management strategies for most dental injuries differ according to the type of tooth.
5 How do I make the distinction?
Primary (deciduous) teeth begin to erupt at about 6 months of age and are complete by 3 years. A full complement of primary teeth consists of 10 mandibular and 10 maxillary teeth, including four central incisors, four lateral incisors, four canines, and eight molars. Usually, mandibular teeth erupt before their maxillary counterparts (Fig. 53-2).
Permanent teeth typically begin to erupt at 5 years of age and are complete by 16 years of age. A full complement of permanent teeth consists of 16 mandibular teeth and 16 maxillary teeth, including four central incisors, four lateral incisors, four canines, eight bicuspids (premolars), and 12 molars (seeFig. 53-2).
6 How do I accurately describe which tooth is injured?
The best and easiest way to describe an injured tooth is to divide the mouth into quadrants: right maxillary, right mandibular, left maxillary, and left mandibular. Then describe the type of tooth and the quadrant in which it is located. For example, the terms right maxillary central incisor and left mandibular canine denote both the type of tooth and the quadrant of the mouth in which it is found (seeFig. 53–2). Thus, you need not memorize the complex numbering or lettering systems.
7 How are broken or fractured anterior teeth classified?
In the Ellis classification system, class I fractures involve only the enamel and result in jagged tooth edges but no other sequelae. Class II fractures break through both the enamel and dentin of the crown. The yellowish dentin is visible within the pearly white enamel. Class II fractures are often sensitive to heat, cold, and air. Class III fractures involve the pulp of the tooth. The pink and bleeding neurovascular bundle of the tooth is exposed, along with the dentin. Pain is often severe. Class IV fractures involve the root. The diagnosis must be confirmed by a dental radiograph or panoramic radiograph (Fig. 53-3).
American Academy of Pediatric Dentistry. Clinical guideline on management of acute dental trauma. Chicago, American Academy of Pediatric Dentistry, 2004, p 8. Available at www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=6278
8 How are fractured teeth treated? How soon does a dentist need to be consulted?
Treatment depends on the classification of the tooth fracture:
Class I fractures require filing of sharp tooth edges to prevent oral soft tissue injury. Patients can see a dentist for tooth bonding if cosmetic issues arise.
Flores MT: Traumatic injuries in the primary dentition. Dent Traumatol 18:287–298, 2002.
10 When should I suspect an alveolar ridge fracture?
1 Tooth fractures most commonly occur in the anterior dentition and have 3 classes: Class I involves enamel only; class II involves enamel and dentin; and class III involves enamel, dentin, and pulp.
2 Class II and III fractures receiving proper treatment within 48 hours will have excellent outcomes.
3 Alveolar ridge fractures should be suspected when palpation of the gingiva reveals crepitus or step-offs, there are large gingival lacerations, or several teeth are luxated en bloc.
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