Trauma

| Oral trauma is the second reason for consultation after caries in pediatric dentistry and is one of the few reasons that can constitute a dental emergency

Oral trauma can cause injury to the teeth, supporting tissues or periodontium, lips, oral mucosa, jaw bones, and jaw bones.

The most common causes of oral trauma are falls, work accidents, traffic accidents and injuries that occur during sports. The periods of the year where more dental injuries occur are summer and spring.

The most frequent injuries that usually occur as a consequence of these accidents in primary dentition are dislocations. While in the permanent dentition, dental fractures are more frequent.

The upper central incisors, the upper lateral incisors and the lower incisors are the teeth with the highest prevalence in which these injuries relapse.

There are predisposing factors that can contribute to tooth injury when trauma occurs. These factors are protrusion of the upper incisors, tooth protrusion of upper and lower incisors, overbite (the upper incisors cover the lower incisors) and protrusion of the upper jaw bone.

Depending on the injured structures and the place where the injury lies, we can classify oral traumas into:

Injuries to dentinal tissues

Coronary fractures are the most frequent in the permanent dentition. It is produced by the direct application of force frontally on the crown or visible part of the tooth.

Uncomplicated, that is, in no case does the pulp tissue be affected.

Coronary enamel fractures without dentin involvement, therefore, the most superficial tissue of the tooth is affected. They are minimal thickness fractures and have a very good prognosis.

Coronary enamel and dentin fractures; These fractures are deeper and their treatment will be more complex.

Complicated they affect the pulp tissue of the tooth.

Coronary enamel, dentin and pulp fractures of the tooth. Its treatment will depend on the degree of exposure of the pulp. It will also depend on the type of dentition, temporary or permanent. If it is permanent, the degree of maturation of the tooth root must be taken into account.

Crown-root fractures the affected tissues will be the enamel, dentin, cementum, periodontium and, in most cases, the pulp. pain appears, a characteristic being that pain appears on chewing.

Root fractures affect the periodontium, cementum, dentin, and pulp.

Horizontal root fractures, the most frequent production mechanism is due to the action of horizontal trauma on the crown. Clinically, it produces pressure pain on the dental crown due to inflammation in the supporting tissue or periodontium, around the fractured root.

Vertical root fractures describe the fracture line. The most common causes are chewing of hard food, during root canal treatment or endodontics, and during root canal post placement. They are difficult to diagnose radiologically and their prognosis is very poor.

Supportive tissue injuries

Subluxations produce a minimal injury to the periodontal ligament and the vascular-nervous tissue that nourishes and innervates the tooth due to moderate dental trauma. Clinically, slight tooth movement is observed due to the periodontal ligament injury. They have a good prognosis, in general.

Dislocations there is a displacement of the tooth.

Extrusive luxation produces a displacement of the tooth out of the dental alveolar bed, where the dental root is housed. There is injury to the periodontium and the vascular-nervous tissue.

Lateral dislocation produces a horizontal trauma that displaces the crown towards the interior of the mouth and the tooth root is displaced outwards. In addition to injury to the periodontium, the vascular-nervous tissue, there is frequently injury to the alveolar bone.

Intrusive luxation trauma occurs, which displaces the tooth into the alveolar bone. The force of the trauma is applied in the same direction in the direction of the longitudinal or axial axis of the tooth.

Avulsion is the complete exit of the tooth from its bone bed where it is lodged, traumatic tooth fall by application of a force perpendicular to the longitudinal axis of the tooth. It is more common in teeth that are in the process of maturation or root formation. It constitutes a dental emergency. The injured tissues are the gingival or gingiva insertion, the periodontal ligament, the vascular-nervous tissue and sometimes the alveolar bone.