Dental trauma

Dental trauma is also a public dental health problem that typically occurs at a young age [44]. There is some evidence that its incidence is increasing, as young people take part in more dangerous sports and other pass-times, and so are more prone to inflict injuries on their teeth [45]. Treatment to repair the damage caused by trauma is expensive, and some sort of maintenance and possibly upgrade of the treatment may be necessary for the rest of the patient s life [44]. 

Determining the number of patients who experience the effects of dental trauma is complicated, and two statistics are used, namely prevalence and incidence. Prevalence is the measure of the total number of experiences of dental trauma within a given population and once such an event has occurred, it remains within the population as long as the individual in question remains within that population. By contrast, the incidence refers to the number of new patients experiencing dental trauma within a given period of time, typically 1 year [44]. 

Age is another important risk factor in traumatic dental injury [44], School children and teenagers are at greatest risk and studies have shown that over 70% of all reported dental injuries occur before that age of 19 years [56-59], There is now also evidence of growing numbers of dental injuries in older patients [44], This arises because such patients are increasingly likely to retain their teeth into old age, and these teeth can be damaged, for example in falls. In a study in New Zealand, it was shown that dental trauma in the elderly had the highest rate in males aged 65-74 [60], and that this was part of a pattern of increased numbers of injuries in the elderly as a result of falls. 

H.D. Sgan-Cohen, G. Megnagi, Y. Jacobi, Dental trauma and its association with anatomic, behavioral and associated variables among fifth and sixth grade schoolchildren in Jerusalem, Community Dent. Oral Epidemiol. 33 (2005) 174-180. 

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

Mouth bleeding with dental extractions or trauma... 

Herpes labialis or cold sores can be precipitated by trauma to the lips and sunlight. In patients whose immune system is compromised, such as in immunosuppression or in cases of viral infections, herpes labialis may be precipitated. Dental caries do not precipitate cold sores. 

Therapy is determined by the level of factor VIII deficiency. Severely affected patients have concentrations less than 1 %, in moderate disease this is present between 1 and 5 % whereas plasma levels between 5 and 30 % may be associated with bleeding only after trauma such as dental extraction. Additionally, the choice of replacement is modified by the site of bleeding and the presence or absence of inhibitors that interfere with the function of the factor. Cryoprecipitate or lyophilised concentrate is becom-... 

The effect of fluoridation on adult dental health is harder to quantify. There are several reasons for this. Adults vary in the extent to which they may have been exposed to fluoride while growing up, and they may experience tooth loss for reasons other than dental caries, for example, trauma or periodontal disease. However, despite these difficulties, what evidence there is points to fluoride being beneficial for adult healthcare [136,137], and for older adults in particular, conditions such as root caries has been demonstrated quite clearly to be less prevalent in regions where the drinking water is fluoridated [138,139], The overall conclusion from all of these studies is that the whole population benefits from fluoridation in terms of improvements to their overall dental health. 

It is indicated in the treatment of a variety of painful inflammatory conditions, including osteoarthritis, oncology, postopera-tively, trauma, sports injuries, ear, nose and throat disorders, dental surgery, bursitis/ tendinitis, thrombophlebitis, upper airways inflammation and gynaecological disorders. Nimesulide has shown to be well tolerated even by aspirin sensitive asthmatic patients. 

For trauma of head, neck and spine - neurosurgical, ophthalmological, ENT (ear, nose and throat), and dental... 

If a major salivary gland is lost from trauma or disease, or if nasal allergies or sinus infections cause persistent mouth-breathing, or if tobacco smoking persists, the oral cavity becomes dry (xerostomia). The oral mucosa and teeth become covered with bacteria and dental caries and periodontal disease become difficult to control. The functions of whole... 

Marketsandmarkets (2012) Bio-Implants Cardiovascular, Spine, Orthopedics, Trauma, Dental Ceramics, Biomaterial, Alloys, Polymers, Allo/Auto/Xenografts, Synthetic. Report code MD-1190, Press release, September 2012. 

The pulp contains sensitive cells which can be damaged by extensive mechanical trauma to the tooth, or by chemical assault from substances released from materials used to repair the tooth. The pulp can also become infected and transmit that infection to the rest of the body through the circulatory system. For this reason, the bacterially mediated disease of dental caries is potentially serious and should not be left untreated [5],... 

Dental traumatic injury often results in fracture of the affected tooth, an injury that necessitates substantial repair. This fracture can vary in severity, from involving the enamel only, through involving both enamel and dentine, to involving both tissues and also exposure of the pulp. Trauma can also affect the root of the tooth, which can themselves be fractured as a result of the incident [44], Comphcations involving the root can often follow traumatic events, and may require endodontic treatment prior to repair of the fractured tooth crown. Certain patients may damage an already traumatized tooth, and this can inhibit the healing process in the tooth and lead to a variety of complications [61],... 

As well as lesions caused by the effects of dental caries and mechanical damage caused by trauma, teeth can suffer damage due to non-carious lesions. These typically occur in the cervical region of the tooth and for many years were attributed to the effects of abrasion from toothbrushing [67], However, the current view is that these lesions are caused by biomechanical effects, and they are now generally known as ( fraction lesions [67,68],... 

This chapter has outhned the conditions that lead to damage to the teeth, and shows that the effects of dental caries, trauma and periodontal disease can be profound in terms of loss of tooth structure and indeed of the teeth themselves. In the clinic, dentists carry out repairs on these conditions routinely using a variety of artificial materials. These materials have emerged as a result of many years of extensive research carried out internationally by the research community that includes basic scientists with interests in chemistry, materials science and bioengineering, as well as clinicians. 

The tooth pulp can become exposed by a variety of processes, including deep caries, trauma or accidentally during cavity preparation in the dental chair [60]. The consequences can be severe, and include pain, infection and necrosis. When the pulp is exposed, steps need to be taken to manage the situation, and these involve either pulp capping with an appropriate material [60,61] or removal of the pulp followed by sealing of the tooth roots. In the present section of the chapter, we consider briefly materials for the first of these options, pulp capping. 

The pulp of the tooth is a delicate specific tissue and there are severe consequences for its health if it becomes exposed [ 1 ]. Several things can lead to its exposure, specifically trauma of the tooth, dental caries and accidents in tooth preparation. Exposure can be followed by infection and inflammation, resulting in considerable pain to the patient and potential morbidity of the pulp itself. When exposure occurs, therefore, the tooth requires treatment. One approach involves complete removal (extirpation) of the pulp and root canal therapy. 

Furthermore, PMMA-Ca0-Si02 nanohybrid materials were shown to be suitable for bone cement and dental composite resin applications, due to their good bioactivity and improved mechanical properties [363]. PDMS-zirconia nanohybrids were proposed as suitable materials for tissue-implant integration purposes because they have beneficial effects on the proliferation and viability of human primary osteoblast and fibroblast cells and thus can be used as promising coatings for orthopedic trauma implants [364]. 

Poly(ether ether ketone) (PEEK), in various formulations, is found in a wide variety of applications as an alternative biomaterial to ceramic, metal and other polymer implants (such as UHMWPE). These applications include trauma fixation, as well as dental, orthopaedic and spinal implants and, as a result of ongoing research, the uses of PERK as a biomaterial continue to grow (Toth et al. 2006). Research conducted by Morrison et al. (1995) emphasised the biocompatibility of PEEK and its composites. This may mean that the probability of adverse tissue reactions induced by wear debris may be minimised through the use of PEEK as an implant material. 

The recent introduction of cone-beam CT for facial and dental applications is an interesting development in this field. The technology is at an early stage of assessment but preliminary studies indicate that within this area of application its performance, both generally and in facial trauma, may be comparable to conventional MSCT in use (Heiland et al. 2004 SCARFE et al. 2006 Shi et al. 2006), with the attraction of dose efficiency (Tsiklakis et al. 2005 Ludlow et al. 2006). 

Many of the examples demonstrate the relationship of dental problems to the maxillary sinuses (Figs. 13.4-13.6, 13.12, 13.17). CT of the maxilla and teeth can deliver important information for our ENT colleagues about sinus disease, root disease, displaced root remnants, antrostomy, and fistulas. HR CT is also unrivaled after trauma with midface and jaw fractures and developmental anomalies, such as cleft palate. 

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