Dental Trauma!

On average, one-third population is affected by dental trauma before the age of 35. Traumatic dental injuries can affect the oral cavity, face, and sometimes the head and neck. As 85% of all oral injuries are considered traumatic, they tend to occur unexpectedly and are often the result of unavoidable risk factors, such as falls, and sports-real injuries, such as riding a bull, rollerblading, and zip lining. and other accidents. The rates are higher for those younger than 24.

Dental trauma accounts for 5% of bodily injuries among all ages and may represent up to 17% of injuries among children of preschool age.4,15.  The financial burden and indirect costs of trauma are high, considering the expense of treatment and transportation, loss of productivity, and loss of school. These injuries are more common among children aged 0 to 6, and older children aged 10 to 12.1,6,7,12,13,16,17.

PROFESSIONAL ASSESSMENT AND CARE

When a patient presents with dental trauma Using the following approach can help improve overall care and outcomes: It will help with your ability to complete a SOAP Form for both dental and medical billing.

1. As replantation is time sensitive, collect the avulsed tooth from the patient and place it in saline solution or replant, if appropriate.

2. Complete a medical/dental history (inquire about the details of the accident and previous history of other trauma-related injuries.

3. Assess vital signs.

4. If the injury occurred with contact from an object or the ground, inquire about a tetanus booster.

5. Document the timeline and the circumstances surrounding the injury. Make sure you know where the accident occurred, when, and how so the documentation is complete for choosing the diagnostic codes.

6. Complete an extraoral and intraoral evaluation, identify the dental injury site and document abnormal findings, and discuss the findings with the patient and/or parent/caregiver.

7. Palpate and examine the neck, face, and head.

• Palpate and observe the temporomandibular joint and ask the patient to open and close and shift the jaw from right to left
• Gently palpate and examine the intraoral soft and hard tissues

8. Ask the patient to close to a neutral bite and document the occlusion.

9. Use transillumination to evaluate for color changes in the teeth.

10. Inquire about tooth sensitivity and document if any teeth are sensitive to percussion or palpation.

11. Check for mobility of teeth and document the degree of mobility. Document if teeth are displaced.

12. Percussion testing may be performed by gently tapping the involved tooth and surrounding teeth. Test by using a finger before using an instrument.

• Teeth that feel soft may be injured or mobile
• Teeth that have a ring to percussion may be intruded or ankylosed
• Caution should be observed if using pulp sensibility tests, as neural activity in the tooth may be in shock right after an injury and negative results may appear during the first couple weeks following dental trauma
• If the patient has an existing document on record, compare the findings

13. Take radiographs and extraoral and intraoral photographs. Radiographs can be used to document pulpal and necrotic changes, infections, and fractures. They can also aid in determining the developmental stages of children with primary teeth and immature permanent teeth.

14. Consider whether the story matches the injury. If the timeline of events, circumstances surrounding the injury, and the appearance of the injury do not add up, seek more information, as suspicions of abuse should not be ruled out.

15. Once the type of dental injury is determined, an individualized care plan can be recommended.

The International Association of Dental Traumatology guidelines for managing dental injuries (available at at-dentaltrauma.org) provide a detailed reference for treating primary and permanent teeth. Treatment may range from smoothing chipped or rough edges to root canals or replanting an avulsed permanent tooth. Depending on the severity of the injury, all repositioned teeth should be splinted with a flexible splint for at least one to five weeks. A flexible splint can include bonding teeth together, or fabricating an occlusal mouthpiece to hold teeth in place. Prescribing antibiotics or antimicrobial mouth rinses should be considered when evaluating for infection and assessing the circumstances surrounding the injury. Appropriate follow-up should be based on the presentation, and referrals made accordingly. Post-assessment and treatment communications should be provided verbally and in writing to the patient and parent/caregiver. The information should describe the treatment, prognosis, expected complications and need for follow-up. Additionally, all communicated information should be documented in the patient’s clinical notes.