Injuries to the periodontium- luxation in temporary and permanent dentition (intrusion (central

luxation), extrusion (peripheral luxation) ), etiology, clinical picture, treatment.

Dental trauma refers to trauma (injury) to the teeth and/or periodontium (gums, periodontal

ligament, alveolar bone), and nearby soft tissues such as the lips, tongue, etc. The study of dental
trauma is called dental traumatology.

Dental injuries[
Dental injuries include:

 Enamel infraction
 Enamel fracture
 Enamel-dentine fracture
 Enamel-dentine fracture involving pulp exposure
 Root fracture of tooth
Periodontal injuries

 Concussion (bruising)
 Subluxation of the tooth (tooth knocked loose)
 Luxation of the tooth (displaced)
o Extrusive
o Intrusive
o Lateral
 Avulsion of the toot (tooth knocked out)

Risk factors

 Age, especially young children

1. Primary dentition stage (2–3 years old, when children's motor function is
developing and start learning how to walk/ run)
2. Mixed dentition stage (8–10 years old)
3. Permanent dentition stage (13–15 years old)
 Male > Female 
 Season (Many trauma incidents occur more in summer compared to winter)
 Sports, especially contact sports such as football, hockey, rugby, basketball and skating 
 Piercing in tongue and lips
 Military training
 Acute changes in the barometric pressure, i.e. dental barotrauma,  which can
affect scuba diversand aviators
 Class II malocclusion with increased overjet and Class II skeletal relationship and
incompetent lips, are the significant risk factors

Prevention
Prevention in general is relatively difficult as it's nearly impossible to stop accidents from
happening, especially in children who are quite active. Regular use of a gum shield
during sports and other high-risk activities (such as military training) is the most effective
prevention for dental trauma. They are mainly being fitted on the upper teeth as it has higher risk
of dental trauma compared to the lower teeth. Gum shields ideally have to be comfortable for
users, retentive, odourless, tasteless and the materials should not be causing any harm to the
body. However, studies in various high-risk populations for dental injuries have repeatedly
reported low compliance of individuals for the regular using of mouthguard during activities.
Moreover, even with regular use, effectiveness of prevention of dental injuries is not complete,
and injuries can still occur even when mouthguards are used as users are not always aware of the
best makes or size, which inevitably result in a poor fit.
Types of gum shield

 Stock ready-moulded
o Not recommended as it does not conform the teeth at all
o Poor retention
o Poor fit
o Higher risk of dislodging during contact sports and airway occlusion which may
lead to respiratory distress
 Self-moulded/ Boil and bite
o Limited range of sizes, which may result in poor fitting
o Can be easily remoulded if distorted
o Cheap
 Custom-made
o Made with ethylene vinyl acetate
o The most ideal type of gum shield
o Good retention
o Able to build in multiple layers/ laminations
o Expensive
One of the most important measures is to impart knowledge and awareness about dental injury to
those who are involved in sports environments like boxing and in school children in which they
are at high risk of suffering dental trauma through an extensive educational campaign including
lectures, leaflets, posters which should be presented in an easy understandable way.

Management
The management depends on the type of injury involved and whether it is a baby or an adult
tooth. If teeth are completely knocked out baby front teeth should not be replaced. The area
should be cleaned gently and the child brought to see a dentist. Adult front teeth (which usually
erupt at around 6 years of age) can be replaced immediately if clean. See below and the Dental
Trauma Guide website for more details. If a tooth is avulsed, make sure it is a permanent tooth
(primary teeth should not be replanted, and instead the injury site should be cleaned to allow the
adult tooth to begin to erupt).

 Reassure the patient and keep them calm.

 If the tooth can be found, pick it up by the crown (the white part). Avoid touching the
root part.
 If the tooth is dirty, wash it briefly (10 seconds) under cold running water but do not
scrub the tooth.
 Place the tooth back in the socket where it was lost from, taking care to place it the
correct way (matching the other tooth)
 Encourage the patient to bite on a handkerchief to hold the tooth in position.
 If it is not possible to replace the tooth immediately, ideally, the tooth should be placed
in Hank's balanced salt solution, if not available, in a glass of milk or a container with the
patient's saliva or in the patient's cheek (keeping it between the teeth and the inside of the
cheek - note this is not suitable for young children who may swallow the tooth). Transporting
the tooth in water is not recommended, as this will damage the delicate cells that make up the
tooth's interior.