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Mouth, Teeth, and Oral Cavity

 

Mouth

  • Tongue: Used for tasting, speech, forming food into a bollus and moving it to the back of the mouth to be swallowed. 

  • Soft Palate and Uvula: used to close off the nasopharynx pathway when swallowing

  • Hard Palate: directs food to the back of the throat, assists in speech

  • Palatine Tonsil: lymphatic tissue

  • Lips: food intake, speech articulation, facial expression

 

Teeth

  • Used for chewing and provides point for tongue to push against during speech.

  • 28 teeth total in grown adults

    • Incisors (4 upper, 4 lower): four most anterior teeth, used for cutting food

    • Cuspids (2 upper, 2 lower): tearing food

    • Bicuspids (2 upper, 2 lower): also called premolars, crushing and grinding food

    • Molars (6 upper, 6 lower): crushing and grinding food

  • Three main parts to the tooth: crown, neck, root

 

Assessment

  • Observation

    • Check for bleeding, ecchymosis, discoloration (white, yellow, blue, etc.)

    • Look for obvious deformity, chips, or missing teeth and have patient look in a mirror (they know themselves best!)

    • Check gums for pinkness, discoloration, swelling, or bleeding

    • Tongue Depressor, Pen Lights, and mirrors are useful tools during examinations

  • Annual Dental Examination

    • Patients should have teeth cleaned once a year by a professional

Tooth Extrusion 

  • Partial displacement of a tooth inferiorly (partially pulled out);  caused by direct blow to the mouth.

  • Symptoms - pain, bleeding, temperature sensitivity, elongated appearance of affected tooth

  • Diagnosis - visual observation

  • Treatment - immediate referral to a dentist, who will reposition and splint tooth in place

  • Prevention - mouth guards and facial protection such as masks or cages

  • Athlete should rest a few days prior to return to play, then may participate as tolerated.

Tooth Fracture

  • Fracture of the tooth; caused by direct trauma.

  • Symptoms - pain, missing or displaced tooth, bleeding, swelling.

  • Diagnosis - visual examination, Ellis Classification

  • Treatment - Immediate referral to dentist; take any displaced pieces you can find and put them in a solution of tooth saver or in milk and bring along to the dentist. Artificial teeth may be used to replaced fracture or missing teeth. 

  • Prevention - mouth guards

  • Athlete can participate as tolerated, but should rest after any procedure to replace missing tooth. 

(http://www.pemcincinnati.com/blog/

quick-case-6-problems-teeth/)

Retrieved Nov 13 2014

Ellis Classification

  • Used to describe type of fracture, what tissues are affected, and where the fracture is located on the tooth.

    • Class I: fracture of the crown that only involves the enamel. Damaged teeth are usually nontender, have a rough edge, and don't have a visible color change. 

    • Class II: fracture of the enamel and dentin without pulp exposure; tender to the touch and to air exposure, with the possibility of a yellow layer of detin visible upon examination.

    • Class III: fracture of the crown and dentin with pulp exposure; tender witha visible area of pink, red, or blood at the center of the tooth.

    • Class IV: traumatized tooth with or without loss of tooth structure; non-vital (blood and/or nerve supply has been disrupted)

    • Class V: luxation; tooth dislocates from the alveolus; tooth loss can occur. 

    • Class VI: avulsion; complete separation of a tooth from its alveolus; fracture of the root with or without loss of crown structure. 

    • Class VII: displacement of a tooth without the fracture of crown or root.

    • Class VIII: Fracture of the crown en masse and its replacement.

    • Class IX: fracture of deciduous (baby) teeth

Potential Pathologies

Abscessed Tooth

  • Infection of the tooth; caused by bacteria left behind by poor dental hygiene. 

  • Symptoms - pain, fever, swelling, tooth sensitivity, swollen lymph nodes, bad smell/taste in the mouth.

  • Diagnosis - tapping on the tooth, x-rays performed by a dentist

  • Treatment - referral to a dentist; excision of the tooth, root canal, or antibiotics will be used to treat. 

  • Prevention - good dental hygiene habits

  • Athlete can participate as tolerated. 

("Ellis Classification" 2010)

Tooth Luxation

  • Displacement of the tooth, accompanied by a fracture of the labial bone, the palatial or the linguinal alveolar bones. Caused by direct trauma.

  • Symptoms - pain, bleeding, displacement of tooth, swelling, laxity.

  • Diagnosis - visual observation

  • Treatment - immediate referral to dentist

  • Prevention - mouth guards and facial protection such as masks or cages

  • Athlete should rest a few days prior to return to play, then may participate as tolerated.

Tooth Intrusion

  • Tooth is partially displaced upwards into the gums ("jammed"), caused by direct trauma. 

  • Symptoms - pain, shorter appearance of tooth, swelling of gums, possible bleeding, sensitivity

  • Diagnosis - visual examination

  • Treatment - immediate referral to dentist

  • Prevention - mouth guards and facial protection such as masks or cages

  • Athlete should rest a few days prior to return to play, then may participate as tolerated.

(Starkey 2010)

(Maanika 2013)

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