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I. Etiology (Causes of Injury)
I. Etiology (Causes of Injury)
• A. Traumatic Incidents
• A. Traumatic Incidents
◦ Fights with other animals.
◦ Fights with other animals.
◦ Automobile impacts.
◦ Automobile impacts.
◦ Getting caught on fences.
◦ Getting caught on fences.
◦ Falling onto hard surfaces.
◦ Falling onto hard surfaces.
• B. Spontaneous/Pathological Fractures
• B. Spontaneous/Pathological Fractures
◦ Due to severe periodontitis around teeth (e.g., mandibular first molars).
◦ Due to severe periodontitis around teeth (e.g., mandibular first molars).
◦ Due to neoplasia.
◦ Due to neoplasia.
II. Diagnosis and Imaging
II. Diagnosis and Imaging
• A. Primary Diagnostic Tools
• A. Primary Diagnostic Tools
◦ CT (Computed Tomography): Assists in assessing the extent of injuries.
◦ CT (Computed Tomography): Assists in assessing the extent of injuries.
▪ Used regardless of whether injuries are caused by fracture or dislocation.
▪ Used regardless of whether injuries are caused by fracture or dislocation.
▪ Determines if the maxilla, mandible, or both are involved.
▪ Determines if the maxilla, mandible, or both are involved.
◦ Dental Radiography/Other Imaging: Can diagnose retained tooth root fragments beneath the gingiva.
◦ Dental Radiography/Other Imaging: Can diagnose retained tooth root fragments beneath the gingiva.
III. Fractured and Avulsed Teeth Management
III. Fractured and Avulsed Teeth Management
• A. Fractured Teeth
• A. Fractured Teeth
◦ Pulp Exposure: Indicated by a red or black spot in the center of an irregular crown surface.
◦ Pulp Exposure: Indicated by a red or black spot in the center of an irregular crown surface.
◦ Treatment Options: Treated as described under endodontic disease.
◦ Treatment Options: Treated as described under endodontic disease.
▪ Options dictated by: extent of the fracture, age of the patient, and duration of time since the traumatic incident.
▪ Options dictated by: extent of the fracture, age of the patient, and duration of time since the traumatic incident.
◦ Potential Treatments: Dental extraction, vital pulp therapy, root canal therapy, and dentinal sealant.
◦ Potential Treatments: Dental extraction, vital pulp therapy, root canal therapy, and dentinal sealant.
◦ Missing Tooth: May be avulsed or fractured with retained tooth root fragments.
◦ Missing Tooth: May be avulsed or fractured with retained tooth root fragments.
• B. Avulsed (Knocked Out) Teeth
• B. Avulsed (Knocked Out) Teeth
◦ Reimplantation Timing: Can be replaced if treated promptly, ideally within 1 hour of trauma.
◦ Reimplantation Timing: Can be replaced if treated promptly, ideally within 1 hour of trauma.
◦ Immediate Transport: Place immediately in saliva, milk, or a transport medium (e.g., Hank's balanced salt solution).
◦ Immediate Transport: Place immediately in saliva, milk, or a transport medium (e.g., Hank's balanced salt solution).
◦ Root Handling: Limit contact with the root surface and keep the surface hydrated to protect periodontal ligament cells and encourage reimplantation.
◦ Root Handling: Limit contact with the root surface and keep the surface hydrated to protect periodontal ligament cells and encourage reimplantation.
◦ Procedure: Gently flush the alveolus and root surface with lactated Ringer's solution.
◦ Procedure: Gently flush the alveolus and root surface with lactated Ringer's solution.
◦ Stabilization: Replace the tooth into the alveolus and stabilize for 2–4 weeks.
◦ Stabilization: Replace the tooth into the alveolus and stabilize for 2–4 weeks.
▪ Stabilization Methods: Interdental wiring or a semirigid splint.
▪ Stabilization Methods: Interdental wiring or a semirigid splint.
▪ Avoid: Rigid stabilization (acrylic or composite) is less ideal because it encourages ankylosis.
▪ Avoid: Rigid stabilization (acrylic or composite) is less ideal because it encourages ankylosis.
◦ Post-Reimplantation Treatment: Root canal therapy is recommended within 1–3 weeks of the reimplantation.
◦ Post-Reimplantation Treatment: Root canal therapy is recommended within 1–3 weeks of the reimplantation.
IV. Jaw and Joint Injuries (Clinical Signs and Complexity)
IV. Jaw and Joint Injuries (Clinical Signs and Complexity)
• A. Mandibular Fractures
• A. Mandibular Fractures
◦ Signs: Acute malocclusion, pain, and inability to eat.
◦ Signs: Acute malocclusion, pain, and inability to eat.
◦ Displacement: Midline of the mandible is usually displaced toward the side of the fracture.
◦ Displacement: Midline of the mandible is usually displaced toward the side of the fracture.
◦ Severe Cases: The mouth may droop open, particularly in bilateral fractures.
◦ Severe Cases: The mouth may droop open, particularly in bilateral fractures.
• B. Temporomandibular Joint (TMJ) Dislocation
• B. Temporomandibular Joint (TMJ) Dislocation
◦ Signs: Clinical signs similar to acute malocclusion, difficulty eating, and discomfort.
◦ Signs: Clinical signs similar to acute malocclusion, difficulty eating, and discomfort.
◦ Displacement: Midline of the mandible is displaced toward the opposite side of the injury.
◦ Displacement: Midline of the mandible is displaced toward the opposite side of the injury.
• C. Challenging Fractures
• C. Challenging Fractures
◦ Location: Caudal mandibular body fractures, especially in the area of, or caudal to, diseased molars requiring dental extraction.
◦ Location: Caudal mandibular body fractures, especially in the area of, or caudal to, diseased molars requiring dental extraction.
◦ Issues: Lack of teeth on both sides of the fracture and thinner bone caudal to the body of the mandible.
◦ Issues: Lack of teeth on both sides of the fracture and thinner bone caudal to the body of the mandible.
◦ Prognosis: Guarded, even with the use of bone plates or miniplates.
◦ Prognosis: Guarded, even with the use of bone plates or miniplates.
V. Fracture Stabilization and Fixation
V. Fracture Stabilization and Fixation
• A. General Principle
• A. General Principle
◦ Preservation of the normal occlusion is imperative.
◦ Preservation of the normal occlusion is imperative.
• B. Maxillary Stabilization
• B. Maxillary Stabilization
◦ Stabilized with: Wire, sutures, or an acrylic splint.
◦ Stabilized with: Wire, sutures, or an acrylic splint.
• C. Mandibular Stabilization
• C. Mandibular Stabilization
◦ Common Repair: Interdental wiring and an intraoral splint made of bis-acryl composite resin.
◦ Common Repair: Interdental wiring and an intraoral splint made of bis-acryl composite resin.
◦ Other Options: Tape muzzling, cerclage wiring, interarch splinting, intraosseus wiring, external skeletal fixation, interfragmentary wiring, bone plates, labial buttons, and miniplates.
◦ Other Options: Tape muzzling, cerclage wiring, interarch splinting, intraosseus wiring, external skeletal fixation, interfragmentary wiring, bone plates, labial buttons, and miniplates.
• D. Interarch Splinting
• D. Interarch Splinting
◦ Definition: Fixation between the upper dental arch and the lower dental arch, predominantly using canine teeth.
◦ Definition: Fixation between the upper dental arch and the lower dental arch, predominantly using canine teeth.
◦ Risk: Successful, but carries a risk of aspiration if the patient vomits while the splint is in place.
◦ Risk: Successful, but carries a risk of aspiration if the patient vomits while the splint is in place.
◦ Alternative: A labial button technique has also been suggested in place of interarch splinting.
◦ Alternative: A labial button technique has also been suggested in place of interarch splinting.
• E. Healing and Support
• E. Healing and Support
◦ Appliance Removal: Typically removed in 6–8 weeks.
◦ Appliance Removal: Typically removed in 6–8 weeks.
◦ Diet during Healing: The pet can usually eat soft food readily.
◦ Diet during Healing: The pet can usually eat soft food readily.
◦ Supplemental Care: A feeding tube is frequently placed until the splint is removed to help supplement nutrition and administer pain medication and antimicrobials.
◦ Supplemental Care: A feeding tube is frequently placed until the splint is removed to help supplement nutrition and administer pain medication and antimicrobials.
VI. Soft Tissue Trauma Management
VI. Soft Tissue Trauma Management
• A. Tissues Involved: Tongue, lip, buccal mucosa, and other soft tissues.
• A. Tissues Involved: Tongue, lip, buccal mucosa, and other soft tissues.
• B. Repair: Primary closure with absorbable sutures.
• B. Repair: Primary closure with absorbable sutures.
• C. Healing Rate: Oral soft tissues are vascular and heal quickly.
• C. Healing Rate: Oral soft tissues are vascular and heal quickly.
• D. Post-Repair Care
• D. Post-Repair Care
◦ Antimicrobial: Oral flushes with dilute chlorhexidine solution every 2 days may help decrease oral bacteria.
◦ Antimicrobial: Oral flushes with dilute chlorhexidine solution every 2 days may help decrease oral bacteria.
◦ Pain Management: Pain medication should be prescribed.
◦ Pain Management: Pain medication should be prescribed.
◦ Protection: An Elizabethan collar may assist in healing by protecting the lesion from the pet's self-traumatizing the area.
◦ Protection: An Elizabethan collar may assist in healing by protecting the lesion from the pet's self-traumatizing the area.
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