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DENTOALVEOLAR TRAUMA

DENTOALVEOLAR TRAUMA. AO ASIF PRINCIPLES OF OPERATIVE TREATMENT OF CRANIOMAXILLOFACIAL TRAUMA AND RECONSTRUCTION AUGUST 11& 12, 2007. BRETT L. FERGUSON DDS FACD. CHAIRMAN ORAL AND MAXILLOFACIAL SURGERY UNIVERSITY OF MISSOURI-KC SCHOOLS OF MEDICINE AND DENTISTRY. TO BE OR NOT TO BE.

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DENTOALVEOLAR TRAUMA

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  1. DENTOALVEOLAR TRAUMA AO ASIF PRINCIPLES OF OPERATIVE TREATMENT OF CRANIOMAXILLOFACIAL TRAUMA AND RECONSTRUCTION AUGUST 11& 12, 2007

  2. BRETT L. FERGUSON DDS FACD CHAIRMAN ORAL AND MAXILLOFACIAL SURGERY UNIVERSITY OF MISSOURI-KC SCHOOLS OF MEDICINE AND DENTISTRY

  3. TO BE OR NOT TO BE INVOLVED OR FRACTURED IS THE QUESTION

  4. Hard and Soft Tissue Manifestations

  5. CLINICAL EVALUATION • Soft tissues • Nerves • Skeleton • Dentition

  6. DENTOALVEOLAR TRAUMA • Injuries involving the teeth, the alveolar portion of the maxilla/mandible and the adjacent soft tissues

  7. NATIONAL HEALTH AND NUTRITION EXAMINATON SURVEY • Subjects from 6-50 years of age • Enamel fracture identified as most common sequela of trauma- 45.8% • 25% of US pop. with dental trauma • Upper centrals most commonly traumatized tooth • M:F 1.5:1

  8. EPIDEMIOLOGY CON’T • Prevalence in hospital emergency departments: 4.6% to 10.5% of trauma admissions have dental trauma 42% age less than 6 y.o., 21% age 6-10 and 11% age 11-15, however 79% involved permanent teeth. 45% of patients have concomittant soft tissue injuries

  9. ASSOCIATION OF OTHER OROFACIAL INJURIES • 1/3 of all mand. condyle fractures involve injury to 3.7 teeth • If the MOA was a MVA to produce the condyle fx, then related injury to teeth was 47% • Bilateral condyle fx resulted in 64% of pts with dental injury • Unilateral condyles: 25% with dental injury • Endoscopy/intubation= .06% dental injury

  10. HistoryDirection of Force

  11. FACIAL AND MANDIBULAR INJURIES SINGLE MOST COMMON ANTECEDENT OF TMJ INTERNAL DERANGEMENT

  12. EVALUATION OF DENTOALVEOLAR TRAUMA

  13. EXAMINATION • Usually associated with trauma or violence therefore trauma survey mandated for elucidation of other injury patterns

  14. ASSESSMENT • Debridement and removal of intraoral and extraoral blood • Record location and size of all lacerations, abrasions, contusions, hematomas • Radiography to include periapicals, panoramic and if head and neck trauma then a standard radiographic survey • TMJ assessment

  15. Missing Teeth • In the mouth • In the body • In the Street

  16. MECHANISM OF INJURY

  17. WHAT IF NO APPARENT ACCIDENTAL CAUSE HIGH INDEX OF SUSPENSION FOR CHILD AND ELDER ABUSE

  18. 50 % OF DIAGNOSED CHILD ABUSE CASES WITH OROFACIAL TRAUMA

  19. CLASSIFICATION: BASED ON DESCRIPTION OF INJURY

  20. Diagnosis • Crown fracture • Root fracture • Concussion/subluxation • Extrusion/lateral luxation • Intrusion • Avulsion • Alveolar fracture

  21. NONDISPLACEMENT VS DISPLACEMENT INJURIES • Nondisplacement: Concussive i.e. tooth has sustained an injury but not displaced, not mobile but very sensitive to percussion • Displacement: Luxation i.e. displacement or dislocation from socket. Types: 1)Extrusive; 2) Intrusive 3) Lateral luxation 4) Avulsion/Exarticulation

  22. CROWN FRACTURES • Crown fxs comprise 26-76% of injuries to permanent dentition • enamel vs dentin vs pulp vs cementum • ROOT FRACTURES VS CROWN FXS AND NEED TO RESTORE AND/OR EXTIRPATE PULP

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