Monday, May 14, 2018

Medical and orofacial considerations in traumatic dental injuries

Resident: Suhyun Rue, DMD                                                                                     Date: 05/16/2018
Article Title: Medical and orofacial considerations in traumatic dental injuries
Author(s): Subramanian K. and Chogle S. M. A.
Journal: Dent Clin N Amer (2009) 53: 617-626
Date: 2009
Major Topicmedical 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.
- 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 of Article
·   Level of Evidence/Comments: Expert opinion.

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