A tooth can be injured under various circumstances. Quite often, when receiving various kinds of injuries, patients turn to specialized institutions to provide the necessary assistance only some time after the incident. The consequence of this is that it is much more difficult for specialists in this situation to diagnose the injuries and prescribe the necessary treatment.
Types of dental injuries depend on various factors. During the receipt of this or that damage, the age of the victim and the condition of his teeth play an important role. So, for example, with an acute injury of the front teeth in children, either the loss of the tooth or its destruction occurs.
Depending on whether temporary teeth are damaged or permanent, various kinds of injuries predominate. So, for example, when temporary teeth are damaged, one of the most common injuries is dislocation. In second place is a fracture, least often a crown fracture. If a permanent tooth is injured, then the picture of the popularity of injuries is completely different. In the first place among the possible injuries is a partial fracture of the crown. On the second - a dislocation, and on the third - a bruised tooth and a fracture of the crown. As you know, a tooth can be damaged at any age. In children, this usually happens between 1 and 3 years of age and also between 8 and 9 years of age.
Types of injuries and their treatment
Among the various acute injuries, the most common are:
- bruised tooth;
- dislocation of the tooth;
- tooth fracture;
- fracture of the root of the tooth.
bruised tooth
In the first few hours after the victim received this type of injury, he may experience severe pain. The pain tends to increase at a time when the victim makes attempts to bite off something. In some cases, during a bruised tooth, the victim may burst a bundle of blood vessels. This will most likely lead to hemorrhage into the pulp area. Its condition can be determined by odontometry. This procedure should be carried out a couple of days after the injury.
The basis of treatment is to ensure the rest of the oral cavity. To achieve this, it is necessary to exclude solid foods from the daily diet. Small patients often do additional grinding of the cutting edge of the antagonist tooth. If the tooth is already permanent, then this procedure is highly undesirable. If irreparable damage has occurred in the pulp, it is recommended to perform surgery - as a rule, this is cutting the crown. Next, the damaged pulp is removed, and the canals are sealed. Sometimes a crown whitening procedure may be necessary.
dislocation of the tooth
A dislocation is considered to be a shift of the teeth. It can occur due to the influence of various kinds of forces on the tooth that can cause injury. If the periodontium is in good condition, it is very difficult to dislocate the tooth. If the bone tissue is exfoliated, then dislocation can happen even from eating hard food.
Dislocation of the tooth is divided into several subspecies:
- isolated;
- with a fracture of the root of the tooth;
- with damage to the alveolar process or the body of the jaw.
There is also another classification of dislocations, according to which these injuries are divided into complete, incomplete and impacted. With a complete dislocation, the victim's tooth falls out completely. With incomplete - the root of the tooth is only partially shifted from the recess (alveoli). With such a dislocation, there is a rupture of the periodontal fibers. If the dislocation is impacted, the tooth is completely or partially displaced from the hole. The shift is directed towards the jaw. Such a dislocation is almost always accompanied by erosion of the connective tissue of the teeth. The victim feels pain in the area of one or more teeth. In addition, tooth mobility may be felt. The patient can accurately report the time of occurrence of the dislocation, as well as what caused the injury. To avoid negative consequences, you need to contact a specialist.
The first thing a dentist should do after a patient contacts him is to determine whether there is a need to save a tooth. In order for the preservation of the tooth to be worthwhile, its bone tissue must be in good condition. At least, it should be at least 50% of the length of the root of the tooth. The treatment consists in the fact that under the influence of anesthesia the tooth is set in place, after which it needs to be provided with rest. The state of rest is achieved by applying a splint, which can be made of wire or special plastic. After that, procedures are carried out to determine the state of the pulp.
Sometimes it happens that during the displacement of the root, a bundle of vessels may break, but in some cases it may remain without damage. If the neurovascular bundle is still ruptured, it must be amputated and the canal sealed. However, when determining the state of the pulp, one should not forget that in the first few days, against the background of the injury, a weakening of the excitability of the pulp is characteristic. If, after treatment, the excitability of the pulp increases, the tooth can be considered fully restored.
Sometimes, when contacting a specialist, the victim may complain not only of severe pain, but also that the tooth has become shorter. This indicates that the root of the tooth is most likely driven into the jaw. In this case, the victim necessarily has a rupture of the vascular bundle. Treatment consists in fixing the tooth motionless in the correct position, as well as in the implementation of surgery, in which the pulp is removed.
Also, an acute injury can be accompanied by a complete dislocation of the tooth. Treatment of such damage is the replantation of the tooth. But such actions will be successful only if the periodontal tissues have not undergone changes.
The tooth replantation operation consists of the following steps:
- trepanation of the tooth;
- pulp amputation;
- canal filling;
- treatment of the root part and the hole with an antiseptic;
- setting the tooth in place;
- fixation.
If the appeal to a specialized institution occurred in the first 30 minutes after the injury, the tooth takes root quite quickly and serves for a long period.
Tooth fracture
Diagnosing this type of injury is not difficult. Treatment depends on the degree of tissue damage. If only part of the crown broke off and the pulp chamber was not affected, then the treatment consists in restoring the missing part of the tooth with the help of a composite filling material. In this case, the exposed dentin is isolated with a gasket. Good results are observed if the restoration is carried out using a cap. In some cases, it may be necessary to use parapulpal pins.
If, however, during the injury, the cavity of the tooth nevertheless opened up, then initially it is necessary to anesthetize and remove the pulp. But this is carried out if there is no way to save it. After that, the channel is sealed. Sometimes it may be necessary to improve the conditions for fixing the seal. For this, a pin is used. It is fixed in the canal and closed with a seal. The broken part of the crown is restored using a filling material and a cap.
When deciding on the restoration of a broken part of the tooth, it should be remembered that this procedure must be carried out as soon as possible after the injury. If this is not done in a timely manner, the consequences can be very adverse.
Fracture of the root of the tooth
Depending on the nature of the fracture and its localization, diagnostics will also be carried out. It is on these indicators that the solution to the question of the possibility of preserving and using the root of the tooth depends. At the stage of diagnosis of such damage, the main role is given to fluoroscopy.
If during the diagnosis it turns out that the fracture is longitudinal, comminuted or diagonally oblique, then the root of the damaged tooth cannot be used as a support at subsequent stages.
If the diagnosis shows that the fracture is transverse, then much will depend on the level at which it is. In the event that a fracture of the tooth root occurred in its upper or middle part, treatment begins, which consists in trepanning the tooth. After that, a procedure is carried out associated with the removal of the pulp and subsequent filling of the canals. Fragments are connected using special pins.
After all the channels are sealed, actions are taken to restore the position of the tooth.
Most often, children accompanied by their parents turn to specialized institutions with complaints of dental damage. Childhood injuries have their own specifics of diagnosis and treatment.
Recently, acute injuries are common. This is due to the fact that sports such as hockey, football and many other sports games that use power struggle techniques are becoming more and more popular. It is noticed that acute damage to the teeth is more common in males than in females.
It is also worth considering the fact that dental injuries can be accompanied by various complications, among which it is worth highlighting the odontogenic cyst of the frontal section. This indicates that not all specialists are sufficiently familiar with how exactly it is necessary to treat traumatic injuries in young patients.
Treatment of injuries in children
The duration of treatment for dental injuries in children differs significantly from the duration of treatment for similar injuries in adults. The duration of treatment procedures can vary from a few days to several years. It all depends on how severe the injury is, whether the root system of the damaged tooth is sufficiently formed. And, of course, from the chosen method of treatment. The optimal solution during the treatment of a dental injury in a child and during the subsequent rehabilitation period would be to divide the process into several stages.
Stage #1
It starts from the moment the injured child seeks help from a specialist, and continues until the time when he receives qualified help from medical workers.
At this stage, the patient should be provided with emergency care in any specialized institution. If the patient who applied for emergency medical care, except for a tooth injury, does not have any other damage, he must be referred to a dentist. A dentist-therapist deals with a similar type of damage in children. For this reason, it would be better if the child is immediately referred to him, bypassing dentists with a different specialization, so that the patient receives the necessary assistance as soon as possible. Timely provision of the necessary actions will positively affect further treatment.
First aid in this case consists of the following:
- assessment of the patient's condition;
- establishing a diagnosis;
- anesthesia if necessary.
Also, when contacting a medical institution, it should be remembered that in some cases it is better to get qualified help from specialists a couple of days later than to rush and fall into the hands of unqualified doctors. This will help reduce the number of possible complications up to tooth loss.
Stage #2
This stage should begin with an anamnesis, finding out the reasons that led to the tooth injury, and continue with the provision of qualified treatment until complete clinical recovery.
Stage 3
At this stage, the patient recovers and restores the function of damaged teeth. After that, it is necessary to continue monitoring with the dentist.
Such an approach to the treatment and rehabilitation of young patients who applied to medical institutions allows the patient to receive more qualified assistance, which he certainly needs.
During the preparation of an anamnesis, some nuances must be observed. In the medical history it is mandatory to enter answers to the following questions:
- when exactly the injury occurred;
- whether there was a sharp pain;
- whether there were appeals to other specialists and to whom exactly;
- whether the necessary assistance was provided, and if so, what kind.
There are also questions that will not affect the outcome of treatment, but the answers to which may be needed while filling out other important papers. Among them are the following:
- does the patient know who exactly hit him;
- what object was struck or the injury was received without outside help;
- at which time the injury occurred.
There are a number of questions that help the attending physician determine the presence or absence of allergies to different types of drugs. In addition, additional questions will help determine the general condition of the patient. This is due to the fact that during an injury, a tooth fragment can enter the respiratory tract. If it turns out that this did happen, or there is even the slightest suspicion that this could happen, the patient needs to urgently undergo an X-ray examination of the chest.
It should also be borne in mind that the clinical picture of damage is very diverse. This is due to the damage itself and the specific structure of the teeth in children. Regardless of the nature of the dental injury, a number of clinical studies are carried out for the patient, and if necessary, additional examination methods may be prescribed.
