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Patient Story

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A 9-year-old boy presents to his pediatrician after suffering trauma to his face 45 minutes ago while jumping on a trampoline (Figure 37-1). The mother presents with a tooth folded in a wet napkin. There are no signs or symptoms of trauma to other craniofacial structures nor signs of neurological trauma. Upon examination, a fully rooted permanent tooth is noted to have been lost from its socket and the adjacent tooth is fractured. He is diagnosed with avulsion of the maxillary right central incisor. After a call to the child’s dentist, the pediatrician reimplanted the tooth as directed (Figure 37-2). The boy was then sent directly to the dentist for evaluation and stabilization.

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FIGURE 37-1

Maxillary right central incisor is completely avulsed out of its socket and maxillary left central incisor is fractured involving enamel and dentin. (Used with permission from the Division of Pediatric Dentistry and Community Oral Health, The Ohio State University.)

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FIGURE 37-2

Avulsed permanent teeth should be reimplanted as soon as possible. Handle the tooth by the crown and avoid touching the root. (Used with permission from the Division of Pediatric Dentistry and Community Oral Health, The Ohio State University.)

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Introduction

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Dental trauma may involve a tooth fracture or the traumatic displacement of a whole tooth. Intraoral and extraoral soft tissue (involving the gingiva, oral mucosa, and the tongue) may be injured as well.

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Epidemiology

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  • Dental trauma is most common among children with a slight male predilection; the most commonly traumatized teeth are the maxillary central incisors.1

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Etiology and Pathophysiology

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  • Most incidents of trauma are caused by accidents in or around the home or at school.

  • The impact of the injury may cause damage to the hard tissue of the tooth, the pulpal tissue within the tooth, the periodontal ligament which holds the tooth in the arch, the alveolar bone, intraoral soft tissue, the maxilla/mandible, or other craniofacial structures.

  • Dental trauma, or delayed treatment of a traumatized tooth, may cause necrosis of the pulp tissue within the tooth necessitating root canal therapy or inflammation of the periodontal ligament, which can result in resorption of the root.

  • After ruling out neurological and damage to other craniofacial structures, referral to a dentist is necessary for a thorough clinical and radiographic intraoral examination.

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Risk Factors

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  • Malocclusion of maxillary/mandibular teeth.

  • Lower socioeconomic status.

  • Risk-taking children.

  • Children being bullied or under emotionally stressful conditions.

  • Children with obesity or ADHD.2

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Diagnosis

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Clinical Features
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  • Tooth fractures:

    • Enamel fracture—Fracture confined to the outer enamel surface without ...

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