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Trauma Management

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Dental trauma

Dental trauma is unpredictable and most commonly happens in the home, with school being the second most common location. Injuries occur through direct or indirect impact, but the extent of the injury is directly related to the energy of impact, shape of the impacting object, direction of the impact, and the reaction of the tooth and surrounding tissue.

Signs And Symptoms

Dental trauma can manifest with bleeding from the oral soft tissue or the actual tooth socket. Bruising or swelling of the soft tissue at the trauma site  may occur. Dental injuries can involve a single tooth or multiple teeth. For example, the entire tooth or half of the tooth could be avulsed from the socket, or pieces of the tooth could be chipped off. The tooth could be luxated or mobile, and the patient may complain of pain or sensitivity. Luxation injuries are most common in primary teeth, and typically have favorable outcomes. However, avulsions are the most traumatic and severe form of TDIs and have less favorable outcomes.

The goal in managing dental trauma is full recovery of the dental pulp and periradicular tissues. If proper healing does not take place, complications can arise months or years after the injury. Concerns such as pain, tooth discoloration, apical periodontitis, pulp necrosis, fistulas, or external inflammatory root resorption can develop, resulting in the need for more extensive treatment or tooth loss. When the injury occurs, trauma first aid should be provided immediately, coupled with a timely examination by an oral health professional 

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Considering sports are a leading cause of dental trauma, the American Academy of Pediatric Dentistry recommends the use of protective gear, including a custom mouthguard when engaging in high-risk sport activities. Besides protecting the teeth and soft tissues from lacerations, crown and root fractures, luxations and avulsions, mouthguards protect the jaw from fracture and dislocation and provide support for edentulous spaces. When forceful impact to the face or jaw occurs, the mouthguard acts as a cushion to redistribute the shock of impact and stabilize the mandible. A properly fitted mouthguard of 3 mm thickness can absorb enough force from a blow to the jaw to prevent a concussion
Pediatric dental trauma is most common among younger children who are still developing coordination, as well as adolescents involved in sports. The resulting orofacial injuries can result in pain, tooth loss, dysfunction, and diminish the patient’s quality of life. Understanding the risk for TDIs and performing trauma first aid when they occur will help contribute to successful management of these events. In addition, educating parents/caregivers, coaches and athletes about TDI prevention can increase the use of mouthguards in high-risk sports.