SlideShare a Scribd company logo
16. DICKY FAJAR PRIMAVERA NUGRAHA
Investigate the occurrence and types of dental injuries in patients who have
sustained fracture of facial bones
Additional Aim
Clarify whether the occurrence of dental injury correlates with gender, age, trauma
mechanism, and type of facial fracture.
Type of Studies
Retrospective Studies
 Patients who had been diagnosed with maxillofacial injuries
 1 January 2003 – 31 December 2004
 OMFS Departement, Helsinki University Central Hospital, Finland
Predictor as follow:
Type of Dental Injuries (Crown Fracture, Root Fracture, Concussion, Subluxation, Extrusion, Intrusion, Avulsion)
Patient Age (Children, Teenagers, Adults)
Mechanism of Trauma (Fall from ground, height, bicycle accident, motor vehicle accident, assault, sport, and being hit
by an object)
Type of Fracture (Mandibular, Zygomatico-orbital, Orbital, Midfacial, Upper third, Combined)
Dental Injuries and Predictor Variable were analized using X2 –test, Analisis of variance
P values less than 0.05 were considered significant
 Crown Fracture (48%)
 Multiple Dental Injuries (63%)
 Severely Injured Teeth (48%) Almost Half of Patients
 Most of injured teeth in maxilla (61%)
 Incisor Region was the most prevalent Mandible (45%), Maxilla (56%)
Result
 Significant correlation of Dental Injuries with Trauma Mechanism and Fracture
Type
 Motor vehicles accidents and mandibular fracture were significant predictor of
Dental Trauma
 Emphasize the importance of a careful examination or the oral cavity in every
patient presenting facial injury
 Dental injuries in association with facial fracture is often severe. Oral cavity
cannot be ignored when facial fracture patients are examine.
 The notable rate of dental injury observed in the present study emphasized the
importance of a thorough examination of the oral cavity in all patients who have
sustained facial fractured.
 Referral to a dental practice for further treatment and follow up as soon as
possible after discharge from hospital is fundamental

More Related Content

Similar to OCCURRENCE AND TYPES OF DENTAL INJURIES AMONG PATIENTS WITH MAXILLOFACIAL FRACTURES

Management of impacted teeth /certified fixed orthodontic courses by Indian d...
Management of impacted teeth /certified fixed orthodontic courses by Indian d...Management of impacted teeth /certified fixed orthodontic courses by Indian d...
Management of impacted teeth /certified fixed orthodontic courses by Indian d...
Indian dental academy
 
Epidemiologi # mandib
Epidemiologi # mandibEpidemiologi # mandib
Epidemiologi # mandib
Sankurnia Hariwijayadi
 
Traumatic injuries in pediatric dentistry
Traumatic injuries in pediatric dentistryTraumatic injuries in pediatric dentistry
Traumatic injuries in pediatric dentistry
shilpathaklotra
 
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
Healthcare and Medical Sciences
 
Traumatic dental injuries
Traumatic dental injuriesTraumatic dental injuries
Traumatic dental injuries
ibrahimaziz15
 
Vertical root fracture
Vertical root fractureVertical root fracture
Vertical root fracture
HIMANI THAWALE
 
Surgical-Orthodontic Treatment of Impacted Canines
Surgical-Orthodontic Treatment of Impacted CaninesSurgical-Orthodontic Treatment of Impacted Canines
Surgical-Orthodontic Treatment of Impacted Canines
Abu-Hussein Muhamad
 
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
Abu-Hussein Muhamad
 
Pre prosthetic orthodontic implant for management of congenitally unerupted l...
Pre prosthetic orthodontic implant for management of congenitally unerupted l...Pre prosthetic orthodontic implant for management of congenitally unerupted l...
Pre prosthetic orthodontic implant for management of congenitally unerupted l...
Abu-Hussein Muhamad
 
Delayed multidisciplinary management of an intrusively luxated maxillary late...
Delayed multidisciplinary management of an intrusively luxated maxillary late...Delayed multidisciplinary management of an intrusively luxated maxillary late...
Delayed multidisciplinary management of an intrusively luxated maxillary late...
Parth Thakkar
 
110th publication sjm- 1st name
110th publication  sjm- 1st name110th publication  sjm- 1st name
110th publication sjm- 1st name
CLOVE Dental OMNI Hospitals Andhra Hospital
 
Clinical study of impacted maxillary canine in the Arab population in Israel
Clinical study of impacted maxillary canine in the Arab population in IsraelClinical study of impacted maxillary canine in the Arab population in Israel
Clinical study of impacted maxillary canine in the Arab population in Israel
Abu-Hussein Muhamad
 
Pattern of Pediatric Mandibular Fracture in Central India
Pattern of Pediatric Mandibular Fracture in Central IndiaPattern of Pediatric Mandibular Fracture in Central India
Pattern of Pediatric Mandibular Fracture in Central India
iosrjce
 
Cavo surface margin in various restorations
Cavo surface margin in various restorationsCavo surface margin in various restorations
Cavo surface margin in various restorations
Indian dental academy
 
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdf
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdfUjmm tads orthodonticshjhjmnhjnnjjmm .pdf
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdf
sharkawyorthodontist
 
Traumatic dental injuries.pptx
Traumatic dental injuries.pptxTraumatic dental injuries.pptx
Traumatic dental injuries.pptx
Parikshit Kadam
 
New microsoft office power point presentation
New microsoft office power point presentationNew microsoft office power point presentation
New microsoft office power point presentation
Shilpa Ahuja
 
Combined orthodontic and prosthetic therapy special considerations.(52)
Combined orthodontic and prosthetic therapy special considerations.(52)Combined orthodontic and prosthetic therapy special considerations.(52)
Combined orthodontic and prosthetic therapy special considerations.(52)
Abu-Hussein Muhamad
 
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSIONTHE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
Abu-Hussein Muhamad
 
Incidence Of Canine Impaction In Palestinian
Incidence Of Canine Impaction In PalestinianIncidence Of Canine Impaction In Palestinian
Incidence Of Canine Impaction In Palestinian
Abu-Hussein Muhamad
 

Similar to OCCURRENCE AND TYPES OF DENTAL INJURIES AMONG PATIENTS WITH MAXILLOFACIAL FRACTURES (20)

Management of impacted teeth /certified fixed orthodontic courses by Indian d...
Management of impacted teeth /certified fixed orthodontic courses by Indian d...Management of impacted teeth /certified fixed orthodontic courses by Indian d...
Management of impacted teeth /certified fixed orthodontic courses by Indian d...
 
Epidemiologi # mandib
Epidemiologi # mandibEpidemiologi # mandib
Epidemiologi # mandib
 
Traumatic injuries in pediatric dentistry
Traumatic injuries in pediatric dentistryTraumatic injuries in pediatric dentistry
Traumatic injuries in pediatric dentistry
 
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
Traumatic Dental Injuries among 8-12 Year Old Sudanese Children in Khartoum S...
 
Traumatic dental injuries
Traumatic dental injuriesTraumatic dental injuries
Traumatic dental injuries
 
Vertical root fracture
Vertical root fractureVertical root fracture
Vertical root fracture
 
Surgical-Orthodontic Treatment of Impacted Canines
Surgical-Orthodontic Treatment of Impacted CaninesSurgical-Orthodontic Treatment of Impacted Canines
Surgical-Orthodontic Treatment of Impacted Canines
 
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...
 
Pre prosthetic orthodontic implant for management of congenitally unerupted l...
Pre prosthetic orthodontic implant for management of congenitally unerupted l...Pre prosthetic orthodontic implant for management of congenitally unerupted l...
Pre prosthetic orthodontic implant for management of congenitally unerupted l...
 
Delayed multidisciplinary management of an intrusively luxated maxillary late...
Delayed multidisciplinary management of an intrusively luxated maxillary late...Delayed multidisciplinary management of an intrusively luxated maxillary late...
Delayed multidisciplinary management of an intrusively luxated maxillary late...
 
110th publication sjm- 1st name
110th publication  sjm- 1st name110th publication  sjm- 1st name
110th publication sjm- 1st name
 
Clinical study of impacted maxillary canine in the Arab population in Israel
Clinical study of impacted maxillary canine in the Arab population in IsraelClinical study of impacted maxillary canine in the Arab population in Israel
Clinical study of impacted maxillary canine in the Arab population in Israel
 
Pattern of Pediatric Mandibular Fracture in Central India
Pattern of Pediatric Mandibular Fracture in Central IndiaPattern of Pediatric Mandibular Fracture in Central India
Pattern of Pediatric Mandibular Fracture in Central India
 
Cavo surface margin in various restorations
Cavo surface margin in various restorationsCavo surface margin in various restorations
Cavo surface margin in various restorations
 
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdf
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdfUjmm tads orthodonticshjhjmnhjnnjjmm .pdf
Ujmm tads orthodonticshjhjmnhjnnjjmm .pdf
 
Traumatic dental injuries.pptx
Traumatic dental injuries.pptxTraumatic dental injuries.pptx
Traumatic dental injuries.pptx
 
New microsoft office power point presentation
New microsoft office power point presentationNew microsoft office power point presentation
New microsoft office power point presentation
 
Combined orthodontic and prosthetic therapy special considerations.(52)
Combined orthodontic and prosthetic therapy special considerations.(52)Combined orthodontic and prosthetic therapy special considerations.(52)
Combined orthodontic and prosthetic therapy special considerations.(52)
 
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSIONTHE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSION
 
Incidence Of Canine Impaction In Palestinian
Incidence Of Canine Impaction In PalestinianIncidence Of Canine Impaction In Palestinian
Incidence Of Canine Impaction In Palestinian
 

Recently uploaded

Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
rishi2789
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
bkling
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
debosmitaasanyal1
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
Gokuldas Hospital
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
Josep Vidal-Alaball
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Jim Jacob Roy
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
Dr.pavithra Anandan
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
chiranthgowda16
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
SwisschemDerma
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 

Recently uploaded (20)

Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
 
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 4_ANTI VIRAL DRUGS.pdf
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
All info about Diabetes and how to control it.
 All info about Diabetes and how to control it. All info about Diabetes and how to control it.
All info about Diabetes and how to control it.
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
 
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS)
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 

OCCURRENCE AND TYPES OF DENTAL INJURIES AMONG PATIENTS WITH MAXILLOFACIAL FRACTURES

  • 1. 16. DICKY FAJAR PRIMAVERA NUGRAHA
  • 2. Investigate the occurrence and types of dental injuries in patients who have sustained fracture of facial bones Additional Aim Clarify whether the occurrence of dental injury correlates with gender, age, trauma mechanism, and type of facial fracture. Type of Studies Retrospective Studies
  • 3.  Patients who had been diagnosed with maxillofacial injuries  1 January 2003 – 31 December 2004  OMFS Departement, Helsinki University Central Hospital, Finland Predictor as follow: Type of Dental Injuries (Crown Fracture, Root Fracture, Concussion, Subluxation, Extrusion, Intrusion, Avulsion) Patient Age (Children, Teenagers, Adults) Mechanism of Trauma (Fall from ground, height, bicycle accident, motor vehicle accident, assault, sport, and being hit by an object) Type of Fracture (Mandibular, Zygomatico-orbital, Orbital, Midfacial, Upper third, Combined) Dental Injuries and Predictor Variable were analized using X2 –test, Analisis of variance P values less than 0.05 were considered significant
  • 4.  Crown Fracture (48%)  Multiple Dental Injuries (63%)  Severely Injured Teeth (48%) Almost Half of Patients  Most of injured teeth in maxilla (61%)  Incisor Region was the most prevalent Mandible (45%), Maxilla (56%) Result
  • 5.  Significant correlation of Dental Injuries with Trauma Mechanism and Fracture Type  Motor vehicles accidents and mandibular fracture were significant predictor of Dental Trauma
  • 6.  Emphasize the importance of a careful examination or the oral cavity in every patient presenting facial injury  Dental injuries in association with facial fracture is often severe. Oral cavity cannot be ignored when facial fracture patients are examine.
  • 7.  The notable rate of dental injury observed in the present study emphasized the importance of a thorough examination of the oral cavity in all patients who have sustained facial fractured.  Referral to a dental practice for further treatment and follow up as soon as possible after discharge from hospital is fundamental