Thursday, May 11, 2017

Medical and orofacial considerations in traumatic dental injuries

Department of Pediatric Dentistry
Lutheran Medical Center
Resident: Albert Yamoah, DDS                                    Mentor: Dr. Sapir                                                      Date: 05/11/2017
Article Title: Medical and orofacial considerations in traumatic dental injuries
Author(s): Subramanian K. and Chogle S. M. A.
Journal: Dent Clin N Amer
Date: 2009
Major Topic: medical and dental evaluation following traumatic dental injuries
Type of Article: Background information/Expert opinion
Main Purpose: To discuss the importance of a complete medical and dental evaluation following traumatic dental injuries.
Key Points: This was an informative instructional guide on how to perform a comprehensive medical and dental evaluation of dental trauma
Medical Considerations
- A comprehensive medical evaluation is required before any dental treatment is rendered.
- All systemic diseases, medications taken, allergies, hospitalizations, and other relevant points should be taken.
- Vital signs should be recorded.
- A quick evaluation of the respiratory and circulatory system should be done.
- Any suspicion of aspiration or airway obstruction should be evaluated with radiograph of the chest.
- The clinical status at time of presentation should be assessed using the Glasgow Coma Scale (includes exam of eyes, verbal sounds, and motor movement).
- A thorough evaluation of all the cranial nerves should be done.

Soft Tissue Examination
- Presence and location of lacerations, contusions, or tissue abrasions should be noted.
- Any asymmetry or distinct change in facial appearance should be noted.

Intraoral Examination
- Done in orderly manner to avoid missing any details.
- Excessive bleeding should be stopped by applying firm pressure with sterile gauze.

Radiographic Examination
- Presence of hematomas, facial asymmetry, deviation of the mandible, or swelling or crepitus on palpation is suggestive of fracture and necessitates radiographic exam.
- The presence of embedded tooth fragments or debris in the soft tissue should also be evaluated with radiographs.

Teeth
- Pulp exposure should be noted and size and location documented.
- The mobility should be documented
- The presence of moderate-to-severe mobility necessitates splinting of the affected teeth for stabilization.
- Percussion should be done in a vertical and lateral direction to diagnose damage to PDL.
- The pulpal response to vitality tests may be widely variable immediately following a traumatic incident.
- Testing should be done in all situations to have a baseline for future comparison.

Assessment:
This was an informative instructional guide on how to perform a comprehensive medical and dental evaluation of dental trauma.
Remarks:
1.  
Assessment of Article: 
·   Level of Evidence/Comments: Expert opinion.


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