A student’s guide to dental trauma

Umair Afzal shares a guide to understanding tooth wear, including the different types, preventative measures and what causes it.

In an effort to make the crucial topic a little less complex, Umair Afzal shares his guide to understanding dental trauma.

Dental trauma was a topic that I often found challenging as a student. There seemed to be so many factors to consider, and it appeared like a lot to learn amongst the rest of the content that could come up in final exams.  

Traumatic dental injuries often occur most frequently in children and young adults. Older adults can also injure themselves, but this is statistically less frequent. According to the International Association of Dental Traumatology (IADT), luxations are the most common injury in primary teeth, and crown fractures are the most common in permanent dentition (2020).

Below, I have provided a brief overview of dental trauma as a starting point for your revision, which I hope will start you off as you develop your knowledge.  

Important sources of information

The main places I looked to as a student (and reviewed when writing this article) were as follows. Each have been hyperlinked:

  1. International Association for Dental Trauma guidelines
  2. Dental Trauma Guide
  3. Dental Trauma UK website
  4. Faculty of General Dental Practice (FGDP) comments on dental trauma (sections 2.2.5 and 6.6.2)
  5. British Society of Paediatric Dentistry website
  6. Clinical Problem Solving in Orthodontics and Paediatric Dentistry
  7. Relevant scientific literature and textbooks (eg the BDJ).

It is worth noting that these sources will only take you so far when managing cases involving trauma. We can only apply the guidelines after evaluating the clinical circumstances, the patient’s characteristics and, most importantly, once you clearly understand the immediate and long-term outcomes of the various available treatment options.

Because trauma often occurs in young people, losing a tooth can have a lifetime of effects. Where possible, we should always try to preserve the pulp in immature teeth to ensure continued root development. For example, an immature permanent tooth can heal after traumatic pulp exposure, luxation injury or root fracture.

FGDP radiography recommendations for dental trauma

The FGDP radiography guidance (2018) discusses how intraoral radiographs will provide the most significant diagnostic detail for dental trauma. Panoramic radiographs can diagnose mandibular fractures. However, if there is evidence of a bony fracture, referring the patient for a complete radiographic examination in a secondary care setting is probably more appropriate.

Depending on the nature of the injury, taking several intraoral radiographs from different angles may be necessary. Extraoral views, including anterior occlusal, are sometimes helpful for luxation injuries.

Sometimes, a CBCT scan may be desirable to assess the true nature of luxation injuries and/or cortical plate involvement. FGDP (2018) also states that a periodic review of injured teeth, including those with horizontal root fractures, is essential.  

Managing avulsed teeth

IADT describes avulsed teeth as one of the most serious dental injuries. These refer to teeth that have been knocked out, and the long-term effects depend on the actions taken at the place of the accident.

A widely adopted public health campaign has focused on raising awareness, encouraging people who knock out ‘grown-up teeth’ to ‘pick it, lick it, stick it’. It is worth noting that this only applies to adult teeth. Never try to re-insert a baby tooth.

If it’s impossible to put the tooth back in position, we advise patients to put it in milk and go to a dentist. A dentist can sometimes glue fragments back into position if teeth have broken or chipped. We recommend finding the fragment and taking it to a dentist to see if they can re-attach it.

The guidance we recommend to patients is as follows:

  • Step one: pick the tooth up
    • This should be done by the crown only (avoid holding the root)
  • Step two: lick the tooth
    • Ideally, rinse it in water/milk to help clean this
  • Step three: stick the tooth back in the correct position (adult teeth only)
    • If the tooth cannot be re-implanted, place the tooth in a storage liquid.
    • Ideally, we want to place this in milk, saliva, or saline
  • Step four: bite on some tissue paper or soft cloth to hold it in place
  • Step five: contact a dentist and go straight there.

(Mnemonic I used for this: purple lizards see behind cars)

Advice after a traumatic injury

After a traumatic incident, we provide tailored advice to patients appropriate to each situation. Examples of the advice we can give include the following (taken from IADT 2020):

  • Avoid contact sports
  • For up to two weeks, have a soft diet (depends on how well a patient can tolerate this)
  • Brush with a soft toothbrush after each meal
  • Use a chlorhexidine daily mouth rinse twice daily for two weeks.

Final thoughts

Dental trauma is a crucial area to understand and feel confident about once you are a newly graduated safe beginner. I would encourage students wanting to learn more about this area to read through the guidelines linked above, discuss clinical cases with their tutors, and learn about the treatments available to manage these cases.

Read more from The Dental School Handbook:

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