DENTAL TRAUMA-

HISTORY & EXAMINATION

Dr. Maham M. Lone
Assistant Professor
Operative Dentistry
SIOHS, JSMU
 LEARNING OBJECTIVES
• Classify dento-alveolar injuries.
• Discuss importance of medical and dental history of
a patient presenting with history of dental trauma.
• Discuss extraoral & intraoral examination of patient
presenting with history of dental trauma.
• Discuss appropriate radiographs needed for an
accurate diagnosis.
 3

DENTAL TRAUMA

• Most common presentation in pediatric clinic.

• Damage to dental and peri-radicular structures.

• Fear and anxiety of children makes management difficult.

• Improperly managed  affects self-esteem & quality of life.

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 4

ETIOLOGY
Most accident prone times:
2-4 years for primary dentition
7-10 years for permanent dentition

Contact
Falls Collision
sports

Road traffic
Child abuse
accident 12/4/2022
 5

PREDISPOSING FACTORS

• Increased overjet and

protrusion of upper incisors
• 3-6mm  twice the risk
• >6mm  thrice the risk

• Incompetent lip closure

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EPIDEMIOLOGY
• Major threat to anterior teeth.

• Highest incidence for dental injuries  up to 12 years

of age.

• Boys  more often injured than girls (2:1).

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MOST AFFECTED
• Teeth:
• Anterior segment
• Maxillary central incisor

• Primary dentition:
• Concussion, subluxation and luxation

• Permanent dentition:
• Luxation and fracture injuries

• Maxillary central incisor>maxillary lateral incisor> mandibular

incisor 12/4/2022
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CLASSIFICATION

Ellis WHO
classification classification

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 WHO CLASSIFICATION

Dento-
Alveolar
Injuries

Hard dental
Periodontal Supporting Gingiva/ oral
tissues &
tissues bone mucosa
pulp
 DENTO-ALVEOLAR INJURIES
Dental hard Periodontal Supporting Gingiva/ oral
tissues & pulp tissues bone mucosa
Comminution of
Enamel
Concussion alveolar socket Laceration
infraction
wall

Fracture of
Enamel
Subluxation alveolar Contusion
fracture
socket wall

Enamel– Fracture of
Extrusive
dentine alveolar Abrasion
luxation
fracture process

Complicated Lateral Fracture of

crown fracture luxation alveolus

Uncomplicated Intrusive
crown–root fracture luxation

Complicated
crown–root Avulsion
fracture

Root fracture
 DENTO-ALVEOLAR INJURIES
Hard dental tissues & pulp

Enamel infraction Enamel fracture

Enamel–dentine Complicated
fracture crown fracture

Complicated
Uncomplicated crown–
crown–root
root fracture
fracture

Root fracture
 DENTO-ALVEOLAR INJURIES

Periodontal tissues

Concussion Subluxa- Extrusive Lateral Intrusive

Avulsion
tion luxation luxation luxation
 DENTO-ALVEOLAR INJURIES

Supporting
bone

Comminution Fracture of Fracture of

Fracture of
of alveolar alveolar socket alveolar
alveolus
socket wall wall process
 DENTO-ALVEOLAR INJURIES
Gingiva or oral
mucosa

Laceration Contusion Abrasion

 15

ELLIS AND DAVEY

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 HISTORY

What When Where

Other Lost
How
injuries teeth
 17

HISTORY
• Medical history
• Congenital heart diseases
• Epilepsy
• Bleeding disorders
• Allergies
• Past dental history
• Regular attenders  more cooperative
• Immunization status
• Tetanus toxoid injection:
• If trauma on contaminated soil
• If no booster dose for past 5 years. 12/4/2022
 18

GENERAL EXAMINATION

• Head-to-toe examination to rule out other injuries.

• Signs of shock pallor, cold skin, irregular pulse,

hypotension.

• Symptoms of head injury suggesting brain

concussion, or maxillofacial fractures

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 EXTRA-ORAL EXAMINATION

• Observe and palpate:

• Facial swelling, bruises, laceration 
underlying bone and tooth injury
 EXTRA-ORAL EXAMINATION

• Lacerations  careful debridement before

suturing.
 EXTRA-ORAL EXAMINATION

• Limitation of mandibular movement

• Mandibular deviation on opening and closing
• Bony step deformity
• Are wounds clean or contaminated?
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INTRA-ORAL EXAMINATION

• Laceration, hemorrhage and swelling

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 INTRA-ORAL EXAMINATION

• Mobility:
• Mobility in horizontal and vertical direction.

• Several teeth move together en-bloc  fracture

of alveolar process is suspected.

• Excessive mobility  suggest root fracture or

tooth displacement.
 INTRA-ORAL EXAMINATION

• Reaction to percussion

• Assesses PDL inflammation

• Luxated teeth  always tender

• Dull note  indicates root fracture

 INTRA-ORAL EXAMINATION

• Color of tooth 

• Early color change due to pulp breakdown 

visible on palatal surface of gingival third of
crown.
 INTRA-ORAL EXAMINATION

• PULP sensibility tests.

• Thermal tests or electric pulp test.

• Unreliable  co-relate with clinical &

radiographic exam.
 PULP TESTING

NEGATIVE
POSITIVE
Shock-wave’ effect 
damages apical nerve Does not rule out later
supply. pulpal necrosis.
Indicates pulpal damage,
NOT necessarily necrotic
pulp.
 28

SENSIBILITY ASSESSMENT

• Conduction capability is sufficiently deranged to

inhibit nerve impulse from an electric or
thermal stimulus.

• Traumatized tooth  vulnerable to false-

negative readings from such tests

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 29

SENSIBILITY ASSESSMENT
• Initial examination:

• Thermal and electric pulp tests of all anterior

teeth (canine to canine) of maxillary and
mandibular teeth.

• Repeat tests at 3 weeks, 3, 6, 12 months, and

at yearly intervals following trauma.

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 30

SENSIBILITY ASSESSMENT
• Carbon dioxide snow (CO2, −78° C) or
dichlorodifluoromethane (−40° C)
• more accurate responses

• EPT  better response when tubules are closed:

• Limited value in young teeth
• Better in elderly patients or traumatized teeth
undergoing premature sclerosis.
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 PULP VITALITY ASSESSMENT

• Laser Doppler flowmeter 

• Most reliable way
• Most sensitive measure of pulp vitality.
 RADIOGRAPHS 32

Ascertain
Detect root Sub-gingival
extent of root
fracture crown fractures
development

Detect foreign
Determine Detect jaw
body in soft
resorption fracture
tissue

Stage of
Check
permanent Follow-up
periapical
tooth evaluation
radiolucency
development
 33

RADIOGRAPHS
• International Association of Dental Traumatology
(IADT) recommends at least four different
radiographs for almost every injury.
• Periapical x-ray-
• Direct 90-degree on long axis of tooth,
• Two with different vertical angulations,
• One occlusal film.

• Soft-tissue laceration  radiograph injured area at

lower voltage prior to suturing
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 ORTHOPANTOMOGRAM

• Holistic overview

• When underlying bony injury is suspected.

 PERIAPICAL RADIOGRAPHS

• Reproducible ‘long-cone technique’

• Two radiographs at different angles to detect
root fracture
 PERIAPICAL RADIOGRAPHS

• Periapical films positioned behind lips  to

detect foreign bodies.
 OCCLUSAL
• Detection of root fractures when used intra-orally

• Detection of foreign bodies within soft tissues

when held at side of mouth in a lateral view.
 CONE BEAM COMPUTED
TOMOGRAPHY (CBCT)

• Limited field scans to

assess:

• Complex dento-
alveolar trauma,
• Severe luxation
injuries,
• Fracture of overlying
alveolar complex.
 CONE BEAM COMPUTED
TOMOGRAPHY (CBCT)
• horizontal root fractures.
 40

DOCUMENTATION
PHOTOGRAPH

• Pre and post treatment photograph for

documentation

• To assess outcome of treatment

• For medico-legal purpose
• Always obtain written consent

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 CHECKLIST BEFORE TREATMENT

Central nervous
When, where and
Patient’s system Patient’s general
how injury
demographics symptoms after health
occurred
injury

Tooth reactions
Treatment History of
Disturbances in to thermal;
patient received previous dental
bite sensitivity to
elsewhere injuries
sweet/sour

Teeth sore to
Any spontaneous
touch or during
pain in teeth
eating
TRAUMA STAMP
 LEARNING OBJECTIVES
• Classify dento-alveolar injuries.
• Discuss importance of medical and dental history of a
patient presenting with history of dental trauma.
• Discuss the extraoral and intraoral examination of
patient presenting with history of dental trauma.
• Discuss the appropriate radiographs needed for an
accurate diagnosis.