Fractures of the Teeth & Jaws Joseph L. McQuirter , DDS Oral and Maxillofacial Surgery

1. Fractures of the Teeth & JawsJoseph L. McQuirter, DDSOral and Maxillofacial Surgery

2. Fractures of the Teeth & Jaws (Orofacial Fractures) Dentoalveolar(teeth and surrounding bone) Mandibular(lower jaw) Maxillary (upper jaw)

3. List the types of orofacial injuries List anatomic structures commonly affected by orofacial injuries Describe functional impairments resulting from orfacialfractures Explain the mechanism of injury for orofacialfractures Become familiar with the diagnostic work up for patients presenting orofacialinjury List the treatment options and surgical intervention for orofacialfractures Understand the approach to treatment for specific orofacialfractures List common early and late complications of orofacial injuries Learning Objectives

4. Fractures of the Teeth and Jaws Dentoalveolar Mandibular Maxillary

5. When facial bones break How effective are our attempts to repair?

6. Mechanism of Injury Accidental Intentional • Assault • Domestic • Workplace • Associated with Crime • Interpersonal Conflicts • Self Inflicted • Vehicular Injury • Sports • Falls

7. Mechanism of Injury • High Impact • Low Impact • Penetrating

8. High Impact Facial Fractures Vehicular high speed deceleration type-injury

9. Sports Related Injuries(low impact)

10. Fall Injury (unrestrained)

11. Rihanna Lucy Newman • Assault • Domestic • Workplace • Associated with Crime • Interpersonal Conflicts

12. Fist blow to face

13. Sports Safety Equipment

14. In spite of our best efforts and millions being spent to protect and ensure safety there are still unexplained injuries

15. Fractures of the Teeth and Jaws Dentoalveolar Mandibular Maxillary

16. DentoalveolarFractures (Dental / Tooth) (Alveolar Bone) Dental Alveolar Bone

17. Dentoalveolar Fractures Fracture of teeth and adjacent alveolar bone

18. Classification of Tooth Injuries Fracture of tooth crown without pulp involvement Fracture of tooth crown with pulp involvement Crown root fractures Root fractures Concussion injuries Luxation injuries Tooth avulsion (Exarticulation) 4 3 2 1

19. Alveolar Bone Fractures

20. Diagnosis – Dentoalveolar injuries1. Clasic signs of inflammation from injury (Pain, swelling, redness)2. Mobility 3. Malocclusion (malaligned/displaced teeth)

21. Etiology of Dentoalveolar Injuries Altercations Falls Seizure disorders Sporting activity Vehicular injuries Endoscopic procedures (anesthesia intubation) Abusive behavior Mental health disorders

22. Treatment Objective1. RESTORE FORM 2. RESTORE FUNCTION

23. RESTORE FORM~Place displaced teeth of tooth/bone segment back to their natural position~ Stabilize repositioned teeth/bone segment

24. RESTORE FUNCTION~ Normal bite - Non injured teeth should come together without interference from the displaced/fractured segments.~ Preserve vitality of dislodged teeth or dentoalveolar segment

25. Prognosis is Dependent on Viability of Pulp and Periodontal Tissues

26. Injuries to the tooth Fracture of tooth crownwithout pulp involvement Fracture of tooth crown with pulp involvement Crown root fractures Root fractures Concussion injuries Luxation injuries Tooth avulsion (Exarticulation) Root Canal Treatment Likely 4 3 2 1

27. Injuries to the tooth Fracture of tooth crown without pulp involvement Fracture of tooth crown with pulp involvement Crown root fractures Root fractures Concussion injuries Luxation injuries Tooth avulsion (Exarticulation) Requires reduction and stabilization Requires reimplantation and stabilization

28. Intruded Tooth Avulsed Tooth Extruded Tooth

29. Out of mouth for less than 2 hours Reimplant immediately if possible Transport in Hank’s solution, milk, saline or saliva (mouth) Provide local anesthesia Saline irrigation and gentle evacuation of blood from socket Reimplant tooth and stabilize Tooth avulsion

30. Transport media for the avulsed tooth In the tooth socket Saliva (in the mouth) Milk Hank’s balanced salt solution ViaSpan cold storage solution

31. Hank’s balanced salt solution, commercially available as : Save-A-Tooth (Phoenix Lazarus, Inc.) (Save-A-Tooth is a mainstay in many athletic first aid kits) Preserving The avulsed tooth ViaSpan, cold storage solution is currently available as an organ transport solution

32. Reduce Dentoalveolar Fractures

33. Simple, non-traumatic stabilization for mobile teeth and dentoalveolar fractures

34. Missing teeth, tooth fragments, broken fillings, appliances must be accounted for ~ Aspirated ~ Ingested ~ Witnessed expelled tooth at the injury location Traumatic occlusion Infection Loss of Teeth and Bone Associated injuries ~ Blunt head trauma ~ Soft tissue injuries ~ Bleeding ~ Infection risk (Tetanus prophylaxis /risk) Complications of Dental Injuries

35. Tongue Bite - Look for Tooth Fragment Ingested Tooth Tooth Fragment in Lip Aspirated Tooth

36. Lead Poisoning from Retained and Swallowed Shotgun Pellets in Maxillofacial Gunshot Injury • McQuirter JL, et al. Elevated Blood Lead Resulting from Maxillofacial Gunshot Injuries: Three Case Reports of Ingested Lead Particles after Gunshot Injury to the Face. J Oral MaxillofacSurg 61(5):593-603, 2003.

37. Molar tooth dislodged to mid-tongue area from gunshot injury

38. Infection Ankylosis of Teeth Devitalization/Discoloration of Teeth Loss of Teeth/Dentoalveloar Segment Late Complications

39. Dentoalveolar segment loss due to periodontal disease compromising interdental blood supply

40. Fractures of the Teeth and Jaws Dentoalveolar Mandibular Maxillary

41. Mandibular Fractures

42. Diagnosis • Clinical/Physical Findings • Diagnostic Studies

43. Clinical Findings • Altered Form • Altered Function

44. Altered Form • Swelling • Displacement of Anatomical parts • Decreased Muscle Tone

45. Swelling and bleeding

46. Step / Gap defect in dental arch

47. The Opposing Jaw Displaced anatomy in both jaws

48. Superimposition of other anatomical parts sometimes makes radiographic diagnosis difficult

49. Ecchymosis In The Floor of the Mouth Clinical confirmation of suspected fracture

50. Altered Function • Occlusal Abnormalities • Decrease Range of Motion • Deviation of Jaw with Opening • Altered mental nerve function • Structural Integrity of the Bone • Compromised of Host Defense • Soft Tissue Compromise • Speech • Swallowing • Respiration • Bleeding