A Clinical Guide to Dental Traumatology

by Berman, Louis H.; Blanco, Lucia; Cohen, Stephen

• ISBN13: 9780323040396
• ISBN10: 032304039X
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-09-25
• Publisher: Elsevier Science Health Science div

Summary

This practical, highly illustrated book describes the treatment and management of commonly encountered traumatic injuries to the teeth. It relates these types of trauma to crown fractures, root fractures, luxation injuries, and exarticulations. A step-by-step reference, this book also discusses complications that may involve surrounding soft and hard tissues, plus those that may arise in managing medically compromised patients. Hundreds of full-color photographs and illustrations show concepts and depict case studies and treatment outcomes. Step-by-step descriptions of treatment plans offer recipes for treating patients according to type of injury. For each type of traumatic injury, youll learn these key steps: How to perform a correct initial assessment of the problem. How to determine whether the patient suffers any related problems. How to record the injury and its subsequent treatment in the patient record. How to avoid future problems by ensuring that the entire tooth is treated including any hidden injury to the pulp or dentin. Information on etiology and epidemiology of problems promotes more effective treatment of specific injuries and conditions. The Law and Dental Trauma chapter explains legal issues unique to treating dental injuries under emergency conditions. Psychological Impact of Injuries chapter describes the reactions that trauma patients may have, and how dentists can improve treatment by providing the patient with emotional support and holistic management. Chapters on hard tissue injuries focus on injuries to tooth/hard tissue anatomy and one chapter examines soft tissue management discussing types of trauma and their effects on surrounding oral tissues. Introductory chapter provides an overview of topics discussed in the book. Hundreds of references are listed alphabetically at the end of each chapter with research studies and current articles for further research. An interdisciplinary approach includes periodontal, endodontic, and pediatric considerations for specific types of injuries.

Table of Contents

Introduction	p. 1
Definition and Classification of Injuries	p. 4
Hard Tissue Injuries	p. 4
Soft Tissue Injuries	p. 5
Etiology and Epidemiology	p. 5
Trends	p. 7
Predetermining Factors	p. 9
Prevention	p. 10
Conclusion	p. 10
Patient Assessment	p. 12
Medical Emergency Considerations	p. 12
Oral Emergency Considerations	p. 14
Patient History	p. 14
Soft Tissue Clinical Examination	p. 15
Soft Tissue Radiographic Examination	p. 16
Hard Tissue Clinical Examination	p. 16
Hard Tissue Radiographic Examination	p. 21
Pediatric Considerations	p. 22
Geriatric Considerations	p. 23
Conclusion	p. 24
Crown Fractures: A Practical Approach for the Clinician	p. 27
Classification	p. 28
Etiological Factors	p. 28
Diagnosis and Clinical Findings	p. 28
Radiographic Findings	p. 28
Biological Considerations and Treatment Principles	p. 28
Enamel Infractions and Enamel Fractures	p. 29
Diagnosis	p. 29
Histopathology	p. 29
Treatment	p. 29
Prognosis	p. 29
Enamel-Dentin Fracture Without Pulp Involvement (Uncomplicated Crown Fractures)	p. 29
Diagnosis	p. 29
Histopathology	p. 30
Treatment	p. 30
Prognosis	p. 31
Enamel-Dentin Fracture with Pulp Involvement (Complicated Crown Fractures)	p. 31
Diagnosis	p. 31
Histopathology	p. 34
Factors Influencing Choice of Treatment	p. 34
Treatment: Mature and Immature Teeth	p. 35
Pulp-Capping Agents	p. 37
Prognosis	p. 39
Treatment Techniques for Nonvital Teeth	p. 39
Mature Teeth	p. 39
Immature Teeth	p. 39
Restoration of Immature Roots	p. 43
Crown Fractures in Primary Teeth	p. 43
Clinical Appearance	p. 43
Radiographic Appearance	p. 43
Biological Considerations	p. 43
Uncomplicated Crown Fractures (No Pulp Exposure)	p. 43
Complicated Crown Fractures (Pulp Exposure)	p. 43
Intraalveolar Root Fractures	p. 51
Terminology and Epidemiology	p. 51
Clinical Presentation	p. 52
Radiographic Presentation	p. 52
Healing Classifications	p. 53
Sequelae	p. 54
Pulp Survival With Canal Obliteration	p. 54
Internal Resorption	p. 54
External Resorption	p. 54
Loss of Crestal Bone	p. 58
Healing Parameters	p. 58
Fracture Location	p. 58
Diastasis	p. 58
Tooth Maturity	p. 59
Gender	p. 59
Management	p. 59
Splinting	p. 60
Endodontic Treatment	p. 60
Treating the Coronal Fragment	p. 61
Treating the Coronal Fragment and Removing the Apical Fragment	p. 61
Treating the Coronal and Apical Fragments at the Same Time	p. 62
Removing the Coronal Fragment and Treating the Apical Fragment	p. 65
Pediatric Considerations	p. 67
Conclusion	p. 69
Luxation Injuries	p. 72
Classification	p. 73
Etiology and Epidemiology	p. 73
Diagnosis of Luxation Injuries: Radiographic and Clinical Aspects	p. 73
Concussion	p. 74
Subluxation	p. 74
Lateral Luxation	p. 74
Extrusive Luxation	p. 75
Intrusive Luxation	p. 76
Treatment of Luxation Injuries	p. 79
Emergency Treatment	p. 79
Posttrauma Follow-up Evaluations and Treatment	p. 91
Sequelae of Luxation Injuries	p. 92
Types	p. 92
Diagnostic Means to Detect Sequelae on Follow-up	p. 95
Expected Healing Outcome of Luxation Injuries	p. 95
Conclusion	p. 96
Avulsions	p. 99
Etiology and Epidemiology	p. 100
Key Issues Associated with Prognosis and Management of Avulsed Teeth	p. 100
Pulpal Damage: Comparing Mature and Immature Teeth	p. 100
Periodontal Damage	p. 100
Emergency Management of Avulsion Injuries	p. 100
At the Site of the Injury (Outside the Dental Office)	p. 100
Emergency Management at the Dental Office	p. 101
Sequelae of Avulsion Injuries	p. 110
Consequences of Pulpal Necrosis	p. 110
Consequences of Periodontal Damage: External Root Resorption	p. 111
Posttraumatic Follow-up and Management	p. 114
Need for Endodontic Treatment	p. 114
Recall Frequency	p. 116
Treatment Options for Open Apex Teeth That Failed to Revascularize	p. 119
Expected Healing Outcome of Avulsions	p. 121
Epidemiological Data	p. 121
Signs of Nonhealing	p. 122
Treatment Options	p. 122
Avulsed Primary Teeth	p. 123
Conclusion	p. 123
Alveolar Fractures	p. 127
Epidemiology and Etiology	p. 127
Terminology and Classification	p. 128
Clinical and Radiographic Findings	p. 129
Treatment	p. 130
Antibiotic Treatment and Tetanus Prophylaxis	p. 130
Reduction	p. 132
Fixation and Immobilization	p. 132
Rehabilitation	p. 136
Healing	p. 137
Sequence of Fracture Healing	p. 137
Complications	p. 142
Malocclusion	p. 142
Loss of Alveolar Bone	p. 142
Loss of Teeth	p. 142
Endodontic Implications	p. 142
Prognosis and Outcome Assessment	p. 143
Pediatric Considerations	p. 143
Conclusion	p. 146
Soft Tissue Injuries and Management	p. 149
Epidemiology of Soft Tissue Injuries	p. 149
Etiology of Soft Tissue Injuries	p. 150
Management of Soft Tissue Injuries	p. 152
The Face	p. 152
Immediate Treatment of Facial Trauma	p. 156
Complementary Treatment for Facial Trauma	p. 158
The Lips	p. 159
Cyanoacrylates and their Dental Applications	p. 159
Clinical Examination of the Lips	p. 159
Radiographic Examination of the Lips	p. 163
Technique for Closing Lip Wounds with Cyanoacrylates	p. 164
Advantages of Cyanoacrylates	p. 165
Disadvantages of Cyanoacrylates	p. 169
The Mucosa	p. 169
The Labial Frenum	p. 170
The Tongue	p. 174
Healing Mechanism of Oral Soft Tissue Wounds	p. 174
Preventive Measures to Avoid Soft Tissue Injuries	p. 176
Conclusion	p. 176
The Law and Dental Trauma	p. 181
Dental Laws and Licensing Regulations	p. 181
Legal Issues	p. 182
Standards of Care	p. 182
Unprofessional Conduct	p. 182
Violations of Statutes	p. 182
Consent Issues	p. 182
Informed Consent/Refusal	p. 183
Burden of Proof	p. 184
Causation	p. 184
Conduct of Others	p. 184
Good Faith Settlement	p. 185
Nature of Injury	p. 185
Nature of the Trauma	p. 185
Standards for Trauma Cases	p. 186
Good Samaritan Defenses	p. 186
Nonintentional Injury/Accident/Sporting Cases	p. 186
Abuse and Battery Cases	p. 187
Confidentiality and Privileges	p. 187
Immunity	p. 187
Failure to Report	p. 187
Recognition of Abuse	p. 187
Iatrogenic Trauma Cases	p. 188
Conclusion	p. 189
The Psychological Impact of Dental Injuries	p. 190
The Literature on Psychological Reactions to Physical Injuries	p. 190
Reviewing Emotional and Behavioral Symptoms that may Accompany Dental Injuries	p. 192
Acute Stress Disorder	p. 192
Posttraumatic Stress Disorder	p. 192
Other Signs of Distress	p. 192
Implications for the Dentist in Providing Support to a Psychologically Affected Patient	p. 192
Conclusion	p. 193
Orofacial Trauma Prevention	p. 195
Athletic Mouthguards	p. 196
History of Mouthguards	p. 196
Types of Athletic Mouthguards	p. 197
Orthodontic and Mixed Dentition Considerations	p. 202
Compliance and Acceptance of Mouthguards	p. 202
Role of the Dentist in Orofacial Trauma Prevention	p. 203
Mouthguard Fabrication	p. 203
Athletic Team Dentists	p. 214
Field Treatment Bag	p. 217
Smokeless Tobacco	p. 218
Blood Pressure	p. 219
Heart Rate	p. 219
Eating Disorders	p. 219
Conclusion	p. 219
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