Classification of Injury
Accidents that produce injuries to the teeth are common in children and adults. After careful examination including X-rays, dentist decides to go for the treatment. It depends whether the tooth apex is fully formed or has immature apex.
The extent of these dental accidents can be evaluated as followed. First, the injury to the tooth should be classified.
Class I fracture : A fracture only of the enamel of crown of the tooth.
Class II fracture : An injury extending into the dentin, but with no exposure of the pulp.
Class III fracture : An extensive injury to the coronal portion of the tooth with pulp exposure.
Class IV fracture : A fracture occurring at or below the cementoenamel junction of the tooth.
Fracture of Jaws
The break in continuity of bone is known as fractures. The jaw bones are two in number. The upper jaw is known as maxilla having 16 teeth in adults. It is intimately connected with other bones of the skull. The upper jaw is fixed. The lower jaw is known as mandible, having 16 teeth in adults. It is intimately connected with the floor of the mouth. This mandible is movable and articulates with upper-jaw through a mandibular joint known as temporo-mandibular-joint.
Causes of fracture
Traumatic
1. Automobile accident
2. Industrial mishap
3. Boxing or fight
4. Fall or gun-shot wound
Non-traumatic
1. Old age
2. Due to disease
Types of fractures
1. Simple
The bone fractures, but the fractured ends are not exposed to air.
2. Compound
The bone is fractured and the fractured bone ends are exposed to air.
3. Multiple
The bone is fractured in several areas. There are three views of X-ray to be taken to diagnose fracture.
1. A dental X-ray film will reveal fracture of teeth and surrounding bones.
2. An extra oral film will reveal one side of fracture of jaws.
3. The maxilla and mandible including mandibu-lar-joint dislocation will reveal only in X-ray. This view is Ortho-Panthomo-Gram (ORG.).
Treatment
1. Maintenance of airway is like first aid. The primary importance is to have a live patient. The immediate measures should be to restore the airway. Then assure and restore his general condition by assisting him in a comfortable position. Try to remove any foreign body from the mouth. As soon as possible visit the dentist and get hospitalized if there is a shock or severe loss of blood.
2. When the patient has recovered the fractured parts are administered under local anaesthesia by a dental surgeon. Then he fixes it with wires so that the fractured part does not move and closes it with wires. After three weeks and carefulexamination and confirmation with X-rays, he removes the wires. The diet recommended is liquid with plenty of nourishment. After wiring the nourishment is sent through saline intravenouslyand through the sulcus area of cheek.
3. If there is bleeding through the ear or the eye neurosurgeon is consulted.
Mandibular Joint
The mandible articulates with the upper jaw through a mandibular joint known as temporo-mandibular-joint. There are two joints: one is on the right and one is on the left. They are just located in front of auricle of the ear.
Disorders of joint
• Pain in the joint-area.
• Difficulty in opening and closing of jaws.
• Snapping and cracking during chewing.
• Dislocation of joint.
• Lock-jaw-restriction of movement due to bony union of jaw joint.
Treatment :
• Analgesics and antibiotics will relieve pain, and infection may be controlled.
• Application of heat at the affected areas.
• Joint area should be at rest, that is voluntary limitation through a dental appliance.
• If the jaw is ankylosed, patient should be referred to orthopaedic surgeon.
Clicking-jaw
Often noise is caused when tired or overworked orthopaedic muscles fail to pull the jaw bone through its motions evenly, which is common. Sometimes, however jaw clicking is caused when muscles and ligaments that support the joint are overly stretched and are chronically out of alignment, making the bones of the jaw grind together all the time. Temporomandibular joint disorder (TMJ) in some cases, can lead to a lock-up of the jaw and headaches, and pain in the jaw and neck.
Systemic Disease’s Effect on Oral Cavity
It is said that the mouth is the mirror of the body The oral cavity is examined and the value of such protocol is based on the fact that many diseases of the body manifest in the mouth and often these manifestations are the earliest recognisable features.
Oral Changes
1. Bleeding and enlarged gum.
2. Dental caries due to neglect.
3. Teeth are loose, ulcerated.
4. Hairy tongue in HIV.
Blood Pressure Heart Disease Diabetes Infectious Diseases HIV
Treatment
1. Help and approval of physician to carry procedures.
2. A very light cleaning of food debris and filling of carieous teeth.
3. In extensive cases hospitalisation is a must.
4. Advise accordingly by looking into personal dental conditions.
Dentist Guidance & Not the Treatment
Your mouth is the mirror of your body. The dentist finds the symptoms in the mouth but the disease is somewhere in the body. The patient is having the disease in the body and its consequences are seen in the mouth. Suppose you spy something strange, say ulcer in the mouth and if it persists for more than 2 weeks, then with the help of a dentist you may get the correct guidance.
Mouth Symptoms Problem
* Upper Toothache. Sinuses pain.
* Gums red, swollen red spots on palate. Infection due to fungus.
* Hairy tongue and ulcer. HIV or thrush.
* Change in colour of tongue. Vitamin deficiency.
* Red swollen gum; foulsmell. Diabetes.
The dentist refers the patient to the physician.