Clinical
Management of traumatic injuries to
the permanent dentition Dr Robert Philpott argues that a strict adherence to biological principles and a common-sense approach is key when dealing with trauma patients
L
iterature on the management of dental trauma in general practice suggests that difficulties may be encountered due to gaps in knowledge and
a lack of training on the subject. Barriers to providing this care include lack of time, lack of confidence in diagnosis and inadequate remuneration (Hamilton et al ı997, Stewart & Mackie 2004, Jackson et al. 2005, Hu et al. 2006). Coupled with this is the fact that these patients may present relatively rarely in practice, adding to the stresses associated with management. The keys to managing traumatic injuries
involve correct technical management underpinned by a sound knowledge of the biological processes at play. This incorporates detailed history- taking, prompt emergency management and structured long-term follow-up to deal with the delayed complications often encountered.
How, what, when, where? Initial interview of the patient must focus on any potential head injury, with emphasis on whether there has been a loss of consciousness. Often, many patients may have attended a local emergency
“It is important to ask the patient what they feel has happened to their teeth... use their own words to describe the injuries”
24 Ireland’s Dental magazine Fig 1 Multiple concomitant injuries to the dento-alveolar complex following a traumatic injury
department for immediate management prior to presentation at a dental practice. One of the primary goals of immediate
patient management is reassurance. History-taking should begin with questioning of the patient in relation to how the injury occurred. The patient should be allowed to give their version of events with minimal interruption from the clinician. This component of the history may be especially important if there are any criminal or civil proceedings which may follow. Interview in relation to the type of injury
the patient has suffered may begin to shed light on the severity of the injury and the tissues involved. It is important to ask the patient what they feel has happened to their teeth i.e. whether the teeth are broken or not and whether there have been any alterations to the occlusion. History- taking should encourage the patient to use their own words to describe the injuries. Examination of previous photographs may shed light on the pre-operative situation. Interestingly, DentalTraumaUK, a new
charity recently founded in the UK, has recommended that clinicians encourage the general public to join the ‘selfie’ craze, taking a photograph of their smile, thereby providing invaluable information for the clinician managing a dental trauma. The time elapsed since the injury may
have an effect on pulpal and periodontal ligament survival and influence our decision making in relation to the treatment we choose. Re-implantation of an avulsed tooth may not be possible if an extended time has passed since the injury due to clot formation and remodelling of the socket. The site of the injury may influence
our decision on whether the patient will need tetanus prophylaxis although, as aforementioned, this may often have been dealt with in a hospital setting. The site of the injury may also need to be searched for any missing tooth fragments while cleaning of avulsed teeth contaminated with any gross debris will need to be completed before an attempt at re-implantation.
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