Traumatic Injuries and Their Management

Traumatic injuries to tooth may involve one or the other part of tooth or adjoining periradicular structures. Let us go through them one by one, but before that let us look at the general principles of treating traumatic injuries.

General Principles for Treating Trauma

The general principles for treating trauma that must be kept in mind are:

1) History, examination and assessment

Establish priorities based on the nature and severity of injuries. Potentially life threatening complications need to be handled on priority basis.

2) Protection of

 a) Pulp (if exposed)

 b) Root surface (e.g., during repositioning)

The pulp and root surfaces should be carefully handled to prevent iatrogenic complications and promote healing.

3) Reposition – Immediately of Teeth, bone, soft tissues

All soft and hard tissues should be repositioned and stabilised at the earliest.

4) Stabilisation of

 a) Bone and Teeth: splint (rigid or flexible) .Stabilisation of hard tissues may involve intraoral or extra oral devices .

 b) Soft Tissues: Sutures should be placed as required especially in esthetically critical areas e.g. in cases of split lip. All efforts should be made to promote healing by primary intention.

5) Temporary restorations.

Restorations should be placed at the earliest to protect the pulp and for esthetic rehabilitation.

6) Medications

a) Systemic: tetanus, antibiotics, analgesics, anti-inflammatory agents should be prescribed as necessary.

b) Local: Intra-canal dressings like chlorhexidine gel or Calcium hydroxide paste may be required to promote healing and or prevent resorption.

7) Follow-up- a systematic regime of follow up should be instituted to monitor healing.