Oral Trauma: From Suturing to Plating

INTRODUCTION

Prior to surgical repair of any damaged hard and soft tissues, the aim of treatment for head trauma should focus on (1) stabilizing the cardiovascular and respiratory systems to obtain optimal blood pressure and oxygenation, and (2) preventing or limiting secondary brain injury such as cerebral edema or ischemia. 1

TOOTH WEAR

Abrasion is tooth wear caused by contact of a tooth with a non-dental material (such as a tennis ball or cage bars). Attrition is tooth wear caused by tooth-to-tooth contact (such as when a maloccluding tooth contacts another tooth). If tooth wear removes enamel and dentin faster than odontoblasts can form dentin, the pulp may either succumb to prolonged chronic inflammation or become exposed, inflamed and necrotic. 1

TOOTH FRACTURE

If the fracture involves enamel only, the consequences are minimal. If dentin is exposed, bacteria could pass through dentinal tubules to the pulp. A tooth fracture is called complicated when it exposes the pulp. Crown-root fractures are fractures that involve the crown and root(s) of the tooth. It can be uncomplicated or complicated. A root fracture is a fracture involving the root (far more common with than without pulp exposure). If uncomplicated fractures with near pulp 1 exposure and complicated fractures are left untreated, pulp necrosis ultimately results. Fractures of canine teeth are usually due to hit-by-car trauma, falls from heights, kicks and hits. Certain working dogs are more prone to fracture of canine teeth if their distal tooth surfaces are weakened by wear from chewing on cage bars. Carnassial tooth fractures in dogs are often caused by chewing on very hard objects. Tooth resorption is typically the cause of crown fracture in cats, with root fragments remaining in the alveoli. Complicated tooth fractures require extraction or endodontic therapy to avoid complications from periapical disease. […]