A review on the various types of physical injuries of teeth. Bibliography - Shafers 8th Ed

1. Made by – Ishaan Adhaulia (Intern 2020-2021)

2. Injury
• An injury can be any harm to the body
• Physical injuries can be categorized mainly
into three categories
1) Physical injuries to the Bone
2) Physical injuries to the Teeth
3) Physical injuries to the Soft tissues

3. Physical injuries to Teeth :
- Bruxism
- Fractures of teeth
- Cracked Tooth Syndrome
- Abrasion

4. Bruxism
Night Grinding
Bruxomania

5. Bruxism is the habitual grinding or clenching of the teeth, either during
sleep or as an unconscious habit during waking hours
Aetiology
Local factors – unconscious attempts made by the child as a counter
mechanism to :
a) Place maximum number of teeth in contact
b) During transition from deciduous to permanent dentition
c) During placement of the individual tooth planes so that the musculature
will be at rest.

6. Bruxism
Systemic Factors
• Gastrointestinal disturbances
• Subclinical nutritional deficiencies
• Allergy
• Endocrine disturbances
These all have been reported as causative factors

7. Bruxism
Psychological Factors
• Anxiety / Fear / Stress / Rage / Rejection
• Emotional Tension
- Bruxism is a manifestation of nervous tension in children
- Common in patients admitted in mental institutions
- Polysomnographic studies suggested that sleep bruxism
episodes are part of sleep arousal response (change in depth
of sleep)

8. Bruxism
Occupational Factors
• Seen in watchmakers
• Voluntary bruxism is also recognized in
habituated chewers of tobacco, chewing gum,
tooth-picks or pencil

9. Bruxism
Clinical Features :-
• The patient makes a grating or grinding noise.
• The effects are divided into :-
Effects on dentition – occlusal facets
Effects on periodontium – loss of integrity results in
drifting of teeth and gingival recession

10. Bruxism
• Effects on the Masticatory Muscles – hypertrophy
and trismus.
• Effects on the Temporomandibular joint – alter
opening and closing movements.
• Head pain
• Psychological and Behaviour effects.

11. Bruxism
Treatment
• Treatment of psychological cause
• Removable splints to be worn at night may be constructed to
immobilize the jaws or to guide the movement so that periodontal
damage is minimal
• Botulinum toxin (Botox) has been very successful in treating the
grinding and clenching of bruxism.
Botox when injected into the masseter muscle, weakens the
muscle enough to stop the grinding and clenching, but not so much
as to interfere with chewing or facial expressions.

12. Fractures of Teeth

13. Fractures of teeth
• Tooth fracture is a common injury which may arise in a variety of
situations, the most frequent of which is sudden trauma
Aetiology
- Most common in children as they get hurt often while playing sports.
- Some cases of fracture occur when a tooth is weakened by a large
restoration, leaving thin walls or unsupported cusps which give way under
the stress of mastication
- Internal resorption
- Teeth which have had root canal therapy

14. How do we classify tooth fractures?
• Classification given by Ellis & Davey in 1960
being the most detailed one is discussed in
the next few slides.
• They classified tooth fractures into 9 different
classes.

15. Class 1 : Simple fracture of the
crown, involving little or no dentin
Class 2 : Extensive fracture of the crown,
involving considerable dentin but not the
dental pulp
Class 3 : Extensive fracture of the crown,
involving considerable dentin and exposing
the dental pulp

16. Class 4 : The traumatized tooth becomes
non-vital, with or without loss of crown
structure
Class 5 : Teeth lost as a result of trauma
Class 6 : Fracture of the root, with or
without loss of crown structure

17. Class 7 : Displacement of a tooth,
without fracture of crown or root
Class 8 : Fracture of the crown en
masse and its replacement
Class 9 : Traumatic injuries to
deciduous teeth

18. Cracked Tooth
Syndrome

19. CTS
• Cracked tooth syndrome (CTS) is characterized
by sharp pain on chewing without any obvious
reason, which is actually caused by a 'hidden'
crack of the tooth.
• The typical symptom is sharp fleeting pain
when releasing biting pressure on an object

20. CTS
• While biting down, the segments are usually moving
apart and thereby reduce the pressure in the nerves of
the pulp.
• When the bite is released, the 'segments' snap back
together sharply increasing the pressure causing pain.
• Diagnosis is made by a device called ‘Tooth Slooth’

21. CTS
Aetiology
• Attrition
• Bruxism
• Trauma
• Accidental biting on a hard object
• Presence of large restoration
• Improper endodontic treatment

22. CTS
Treatment
• The site, direction, and size of the crack or fracture
dictate the choice of the treatment.
• It ranges from stabilization with a stainless steel band
or crown to endodontic treatment and restoration.
• If untreated, CTS can lead to severe pain, possible
pulpal necrosis, and peri-apical abscess.

23. Abrasion
• Wearing away of tooth substance
due to mechanical means is known
as abrasion
• The most common cause is the
faulty brushing techniques.
• Habits such as opening the hairpin
constantly using anterior teeth,
holding bobby pins, and holding
pipe also produce a characteristic
form of abrasion.