Traumatic dental injuries (TDIs) affect children and young adults teeth often, accounting for 5% of all injuries.
Dental trauma affects 25% of all schoolchildren and 33% of adults, with the majority of the injuries happening before they reach the age of 19.
In primary dentition, luxation injuries most common TDIs, whereas crown fractures more typically recorded in the permanent dentition.
To ensure a positive outcome, proper diagnosis, treatment planning, and follow-up are essential.
This update includes a search of EMBASE, MEDLINE, PUBMED, and Scopes for current dental literature from 1996 to 2011,
as well as a search of Dental Traumatology from 2000 to 2011.
The purpose of these guidelines is to provide information on how to treat TDIs quickly and effectively.
It expected that some of the future therapy will necessitate further and tertiary procedures requiring oral trauma specialists. In 2001, the IADT released its initial set of guidelines, which modified in 2007.
The working committee included experienced investigators and clinicians from diverse dental specialities and general practice, as with prior guidelines.
Based on the available literature and expert professional judgment, the latest revision provides the best evidence.
In circumstances when the evidence is inconclusive, the working group’s consensus opinion use to make recommendations,
which then reviewed by members of the IADT Board of Directors.
It accepted that guidelines should use after considering the individual clinical conditions, physicians’ judgment, and patient characteristics,
such as compliance, finances, and comprehension of the immediate and long-term results of treatment alternatives against nontreatment.
The IADT cannot and does not guarantee that following the Guidelines will result in a positive outcome, but believes that doing so will increase the possibilities of a positive outcome.
RECOMMENDATIONS IN GENERAL
Trauma to primary teeth requires special attention
Because of their lack of cooperation and fear, young children are often difficult to examine and treat.
Both the youngster and the parents distressed by the circumstance.
It’s vital to remember that the tip of the wounded primary tooth’s root and the underlying permanent tooth germ has a close association.
Some of the effects of severe trauma to primary teeth and/or alveolar bone include tooth deformity, impacted teeth,
and eruption problems in the developing permanent dentition.
Treatment influenced by a child’s development and capacity to cope with an emergency circumstance,
as well as the time it takes for the wounded tooth to shed and the occlusion. In children, repeated trauma events are common.
Permanent Teeth: Immature vs. Mature
To support ongoing root development, every effort should take to retain pulpal vitality in the juvenile permanent tooth.
The majority of TDIs happen in children and teenagers, and tooth loss has long-term implications.
After traumatic pulp exposure, luxation injury, and root fractures, the immature permanent tooth has a high ability for healing.
Permanent Teeth Avulsion
The prognosis for avulsed permanent teeth largely determined by what happened at the time of the trauma.
The promotion of public awareness of avulsed tooth first-aid treatment active advocated.
The vitality of the periodontal ligament (PDL) and the development of the root determine the treatment options and prognosis for the avulsed tooth.
Instructions for Patients and Parents
Following a TDI, patient compliance with follow-up appointments and home care correlates to better healing.
Patients and parents of young patients should inform about how to care for the injured tooth/teeth for optimal healing,
how to avoid further injury by avoiding contact sports, how to maintain meticulous oral hygiene,
and how to rinse with an antibacterial such as Chlorhexidine Gluconate 0.1 percent alcohol-free for 12 weeks.
If you have a small child, you can use a cotton swab to apply Chlorhexidine Gluconate to the afflicted area. Pacifiers should avoid at all costs.
Permanent tooth avulsion occurs in 0.53 percent of all dental traumas.
Numerous studies reveal that this is one of the most serious dental injuries, and the prognosis highly reliant on the actions done immediately after the avulsion and at the scene of the event.
Replantation is the treatment of choice in most cases, however, it cannot always be done right away.
A good prognosis necessitates proper emergency management and treatment plans.
Individual cases in which replantation is not advised (e.g., severe caries or periodontal disease, non-cooperative patient, severe medical disorders (e.g., immunosuppression and severe cardiac conditions) must handle separately.
Although replantation can save a tooth, it’s crucial to keep in mind that certain replanted teeth have a decreased probability of long-term survival and may even be lost or pulled at a later time.
Emergency management guidelines help provide the best care possible on time.
Following an assessment of the dental literature and discussions in expert groups, the International Association of Dental Traumatology (IADT) has issued a consensus statement.
The groups featured experienced worldwide researchers and clinicians from several disciplines including general dentistry.
In cases where the evidence inconclusive, recommendations made based on consensus and, in rare cases, a majority decision by the IADT board members.
All of the suggestions are based on a low degree of evidence.
As a result, the guidelines should regard as the most up-to-date best evidence and practice, based on a literature study and the opinions of experts.
Dentists, other healthcare professionals, and patients should use guidelines to help them make decisions.
They should also be trustworthy, intelligible, and practical to provide proper care as effectively and efficiently as feasible.
It is accepted that guidelines should use based on the unique clinical conditions, physicians’ judgments,
and patient characteristics, such as compliance, finances, and comprehension of the immediate and long-term results of treatment options versus nontreatment.
The IADT cannot and does not guarantee that strict adherence to the Guidelines will result in beneficial outcomes,
but believes that their use will increase the likelihood of a successful outcome.
AT THE SCENE OF THE ACCIDENT, FIRST AID FOR AVULSED TEETH
Dentists should always prepare to provide appropriate first aid for avulsed teeth to the general public.
Healthcare professionals, in addition to boosting public awareness through, for example, mass media initiatives.
Following these serious and unexpected injuries, guardians and teachers should give instructions on how to proceed.
The optimum therapy at the injury site is immediate replantation.
If this is not possible for some reason, there are other options, such as employing multiple storage media.
Make that the avulsed tooth is permanent (primary teeth should replant):
- Maintain a tranquil environment for the patient.
- Locate the tooth and grasp it by the crown (the white part). Keep your hands away from the root.
- If the tooth is unclean, rinse it under cold running water for 10 seconds and reposition it. Encourage the patient or guardian to have the tooth replanted. When it replaced Bite on a handkerchief to keep the tooth in place.
- If this is not possible, or if replanting the avulsed tooth is not possible for other reasons (e.g., an unconscious patient), store the tooth in a glass of milk or another suitable storage medium and bring it to the emergency clinic with the patient. The tooth can transported to the mouth and retained inside the lip or cheek if the patient is awake. Because the patient may swallow the tooth if he or she is extremely young, it is best to have the patient spit into a container and place the tooth in it. Avoid storing your items in the water!
- If special storage or transport media (e.g. tissue culture/transport medium, Hanks balanced storage medium (HBSS or saline) available at the scene of the accident, such media should be employed.
- Seek emergency dental care right away.
Avulsed permanent teeth treatment guidelines
The maturity of the root (open or closed apex) and the condition of the periodontal ligament cells influence the treatment option.
The state of the cells is determined by the storage media and the amount of time spent out of the mouth, with the dry time being particularly important for cell survival.
All PDL cells become nonviable after a dry duration of 60 minutes or more.
As a result, determining the tooth’s dry period before it replanted or placed in a storage media is critical based on the patient’s history.
Before beginning therapy, the doctor must make a general assessment of the state of the cells by classifying the avulsed tooth into one of three groups:
- The PDL cells almost certainly alive (i.e. the tooth has been replanted immediately or after a very short time at the place of the accident)
- The PDL cells may be viable, but their viability is jeopardized. The tooth has been stored in a medium (e.g. tissue culture medium, HBSS, saline, milk, or saliva, and the total dry time has been less than 60 min).
- The PDL cells aren’t alive. When the trauma history indicates that the total extraoral dry time more than 60 minutes, regardless of whether the tooth stored in an additional medium or not, or if the storage medium was non-physiologic, this is an example of this.