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PubMed2000

[Tooth and jaw injuries following violence--diagnosis and treatment in emergency department].

Research over the last decade has confirmed that facial injuries caused by violence occur most frequently among young males, often under the influence of alcohol, and less frequently in women and children following domestic violence. Evidence of injuries may be used in court or in claims for compensation, and must be carefully documented. Facial asymmetry, deviation of the mandible in opening, altered occlusion and/or abrasions under the chin may be indications of jaw fractures; such patients are referred to oral surgery units for further treatment. Lacerations and ulceration in the oral mucous membrane should be treated as skin wounds. A fractured tooth should be referred to a general dental practitioner. Luxated teeth should be carefully replaced and immediately referred to a dentist for fixation. Completely avulsed teeth should immediately be replaced, preferably at the site of the accident, or immediately upon arrival at the clinic. Prompt referral to a dental practitioner for follow-up treatment is essential for the success of replantations. Additional documentation of the injury may be provided by photographs, radiographs and drawings. The letter of referral to the dentist should contain the following information: data on the patient, the circumstances, clinical findings, treatment performed and prescriptions given, together with advice given to the patient.

Adult↗
PubMed1984

The effect of citric acid on repair after delayed tooth replantation in dogs.

An experimental study of maxillary incisors in dogs was carried out to test the hypothesis that demineralization of denuded root surfaces by citric acid to expose collagen matrix fibrils might improve the rate of periodontal regeneration after replantation of traumatically avulsed and dried teeth, provided that the root surface is not traumatized during replantation or postoperatively. Experimental teeth (group 4) were allowed to dry in air for 45 min. A mid-portion of the root was then root-planed extensively, treated with citric acid for 3 min, rinsed with saline, and replanted. The apical region and a cervical collar were not instrumented, ensuring precise reseating and stability of the tooth during the postoperative period. Control teeth were either replanted immediately (group 1), bench-dried for 45 min and replanted (group 2), or bench-dried and the entire root surface root-planed and acid-treated before replantation (group 3). Histological examination of block specimens after 21 days of healing showed complete periodontal regeneration in group 1 and, by contrast, a high rate of ankylosis, inflammatory resorption, and surface resorption in group 2. Root planing and acid treatment of bench-dried teeth (group 3) did not improve the healing response, whereas the mid-root region of teeth in group 4 showed an absence of inflammatory resorption and less ankylosis than groups 2 and 3. These preliminary observations indicate that the frequency of adverse healing results after delayed replantation can be reduced by removing nonvital soft tissue remnants, demineralizing the root surface, and preventing mechanical trauma to the root surface in the postoperative period.

Animals↗
PubMed1980

The effect of removal of the coagulum in the alveolus before replantation upon periodontal and pulpal healing of mature permanent incisors in monkeys.

The effect of removal of the coagulum in the alveolus before replantation upon periodontal and pulpal healing was studied in green Vervet monkeys (Cercopithecus aethiops). Mandibular lateral incisors were extracted. The extra-alveolar period before replantation was 60 min. The storage medium for the extracted teeth was physiologic saline. On the right side of the mandible, the coagulum was removed before replantation, using syringe with saline assisted by a spoon-shaped excavator. On the left side, the tooth was replanted with the coagulum in situ. The replanted teeth were examined histologically after 8 weeks. The histometric analysis showed no significant difference in periodontal or pulpal healing between the two groups. Based on this finding, it is suggested that replantation of avulsed mature teeth be carried out immediately, without any attempt to remove the coagulum.

Animals↗
PubMed1998

Unusual dental injuries following facial fractures: report of three cases.

We report 3 cases of unusual dental injuries following facial fractures. The first patient sustained intrusion of a maxillary incisor into the nasal cavity following a mandibular fracture. The tooth dislocated into the pharynx and was found lodged in the piriform fossa during surgery. The second patient sustained intrusion of molars into the maxillary sinus following maxillary and mandibular fractures. His treatment was delayed due to life-threatening hemorrhage. The third case involved ingestion of multiple avulsed teeth into the alimentary tract following severe maxillofacial fractures. Although the diagnosis was made more than a week after the injury, the patient did not suffer any complications as a result of the dental avulsion. The aim of this report is to emphasize the possibility of associated dental injuries in patients with facial fractures. The trauma surgeon should be cognizant of the importance of carrying out a thorough intraoral examination during the initial evaluation. Any missing tooth should be considered as possibly displaced into other tissue compartments, and must be routinely searched for with x-rays of the skull, cervical spine, chest, and abdomen. If full intrusion injury is suspected, further diagnostic investigation with facial computed tomography scanning may be worth while.

Adolescent↗
PubMed2005

Medicolegal aspects of replanting permanent teeth.

Replantation of a permanent tooth is an intervention that carries the same responsibilities in terms of informed consent as a surgical procedure. Unlike many procedures that can be planned in advance, an avulsion requires decision-making shortly after the injury, often by a distraught patient or parent. Under these circumstances, patients or parents prefer, or may even pressure, clinicians to make the replantation decision for them.Later, the parents may seek advice of other professionals or be confronted by lay opinions or Internet information that may lead them to doubt the decision or even feel betrayed by the dentist who provided the acute care. This article uses an actual parent complaint to illustrate the medicolegal aspects of the replantation decision and describe measures to be taken by the clinician faced with this situation.

Child↗
PubMed1975

[Study of an anatomical approach to the lower wisdom teeth and their roots: the lingual route].

The authors describe the theoretical arguments which incited them to practise a lingual approach for avulsion of the lower wisdom teeth and their roots. In their account and the photos which illustrate it, they show the advantages which the use of this route provides: -simplicity, -surgical comfort for the patient, -rapidity, -and quality of surgical after-effects. The latter are analyzed from statistical tables collected on 308 cases corresponding to the avulsion of 364 wisdom teeth or roots.

Humans↗
PubMed1995

[Tooth mobility disclosing an osteolytic process].

Excepting cases of trauma, dental mobility is often mistakenly neglected as a clinical sign. Dental mobility can in fact be the first sign of osteolytic processes or tumour development. A retrospective study noted that dental mobility may be the inaugural sign of osteolytic processes in the maxillary bone in up to as many as 40% of the cases. Pyorrhea+ is often misdiagnosed leading to unnecessary avulsion and delaying diagnosis of the osteolytic disease.

Adolescent↗
PubMed1995

Medical care of the dental patient.

The family physician frequently makes decisions relating to patients' dental health. The physician can address patients' concerns about tooth eruption or the adverse effects of mercury amalgam. Predisposing factors for dental disease, such as use of certain medications, existing medical conditions (e.g., xerostomia) and traumatic injury, often are first noted by the family physician. Dental emergencies, including abscess and avulsion, can be initially managed by the physician and then referred to the dentist. The physician can coordinate care with a dentist when a patient has dental trauma, requires medical management for a dental procedure or has a medical condition that increases the likelihood of dental disease.

Emergencies↗
PubMed1997

[Unilateral nasal obstruction,. An unusual complication of nasotracheal intubation].

Partial avulsion of the middle turbinate is an unusual complication of nasotracheal intubation, while minor nasal mucosal trauma is common. We report a case in a 25 year-old healthy-woman, diagnosed four years after nasotracheal intubation for removal of wisdom teeth under general anaesthesia, consisting in a unilateral nasal obstruction related to partial avulsion of the middle turbinate.

Adult↗
PubMed1979

Evaluation of antihemorrhagic activity of V. F.

In the prophylaxis of surgical interventions performed in the Dental Clinic for dental avulsions under general anesthesia, the V. F. (peptides deriving from the enzymatic degradation of bovine Factor VIII) has been shown to be particularly active in the reduction of the quantity of blood lost per tooth, corresponding to a reduction in blood loss of an average of 40% to 45%. The "double blind" experiment confirmed a significant hemostatic capacity of the preparation. V. F. in extremely small doses (1 mg/day) divided into two daily, oral administrations, isn't toxic, isn't habit forming and doesn't provoke immunological reactions. On the basis of its positive characteristics (diminution of blood lost without alteration of the parameters of coagulation or platelet aggregation), V. F. seems to be the preparation of choice for the treatment of hemorrhagic diathesis not accompanied by coagulation defect, and also as a preventive measure in minor surgical interventions where small vessels are involved and hemostasis cannot be achieved surgically.

Clinical Trials as Topic↗
PubMed1997

An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: Dentists' knowledge of management methods and their perceptions of barriers to providing care.

AIM: To assess dentists' knowledge of and perceived barriers to treatment of dental injuries. DESIGN: Cross-sectional postal questionnaire and personal interview. SUBJECTS AND METHODS: Questionnaires from 153 GDPs and 53 CDOs were received giving details of emergency options on 17 imaginary dental injuries and perceived barriers to treatment of trauma. Structured interviews with 21 of the GDPs and 19 CDOs seeking knowledge on diagnosis and long-term follow-up and treatment took place. Age and gender of dentist, type of practice and postgraduate courses attended were noted. MAIN OUTCOME MEASURES: Mean knowledge scores. RESULTS: Of a maximum of 14 correct responses on emergency treatment of injured teeth the mean was 7.5. Only 19% knew for how long avulsed teeth should be splinted. Of a maximum of 37 correct responses on long-term follow-up of treatment the mean was 15.4. Only 10% would correctly treat acute abscess on a traumatised tooth. 82% of dentists thought dental trauma should be treated in the primary care service, but 86% of GDPs thought fees for this type of treatment were too low. 72% of CDOs thought the treatment occupied too much clinic time and was not the responsibility of the CDS. CONCLUSIONS: Dentists in the primary care sector have insufficient knowledge to treat dental trauma.

Adolescent↗
PubMed1991

Oral prosthodontic rehabilitation for traumatic sports injuries.

Sports injuries to the mouth and oral cavity may be treated with a variety of prosthetic treatment methods. These may include a temporary removable appliance, especially when adjacent teeth are unrestored and free of caries. Other traditional forms of prosthetic rehabilitation can range from conventional clasped removable partial dentures to traditional fixed prosthesis. The use of clip bar overdentures has demonstrated their clinical acceptability, especially for athletes involved in contact sports. The optimal treatment for patients suffering tooth loss, however, is the use of the osseointegrated implant. This concept, developed and refined by P.I. Branemark, permits successful replacement of single as well as multiple lost teeth. Criteria for patient selection must be evaluated carefully, especially for immediate fixture placement in sockets of avulsed teeth. Professional athletes in high-impact contact sports should receive a resilient prosthesis and protective appliance to use during the sport season, followed by a screw-retained nonremovable prosthesis to be used in the off season. Considering all forms of prosthodontic treatment available to patients with missing teeth, the use of osseointegrated implants currently appears to be the most biologically conservative approach. Retrospective studies document the effectiveness of the treatment of partially edentulous jaws, results similar or better than those reported for fully edentulous patients indicate the effectiveness of the Branemark method of osseointegration.

Athletic Injuries↗
PubMed2000

A retrospective classification of tooth injuries using a new scoring system.

The WHO classification presently in use categories dental trauma only according to the main injury. A new scoring system will now enable more precise and complete diagnosis of tooth injuries. In an initial retrospective investigation, 100 traumatised teeth were classified according to the WHO and the new scoring systems. Clinical and radiological examinations and another evaluations using the new scoring system were made at the time of follow-up examination. Avulsion, intrusion, and root fractures (score < 30) showed the most unfavourable findings at the time of the accident. In comparison, the most favourable findings were shown by concussion and first degree crown fracture (score > 70). A comparison to the WHO classification occasionally revealed noticeable score variations within a single WHO type of injury. Generally, a strong interdependence was observed between the evaluations at the time of the accident and at the time of the follow-up examination (P < 0.001). If the score at the time of the accident was equal to or larger than 57, a successful therapy was usually ensured (P < 0.001). The new scoring system enables more complete diagnosis as well as permitting statements to be made concerning prognosis.

Chi-Square Distribution↗