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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 105-107

Tooth fragment embedded in lower lip following trauma


Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India

Date of Web Publication8-Jan-2018

Correspondence Address:
Dr. Rajeev Pandey
Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_31_17

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  Abstract 


Trauma to maxillofacial region usually leads to damage to teeth and supporting structures. Damage to teeth can occur in isolation or with soft tissue and sometimes may even involve bone. Facial trauma may cause dental fragment embedded in surrounding tissue and that may go unnoticed if not properly examined. Here, we report a case of lip swelling and tenderness caused due to an embedded tooth fragment. The tooth fragment got impacted in the lower lip due to facial trauma 5 months back. Diagnosis was based on clinical history and conventional radiograph. The tooth fragment was successfully removed without any complication.

Keywords: Lip, tooth fracture, trauma


How to cite this article:
Pandey R, Gupta R, Bhagat N. Tooth fragment embedded in lower lip following trauma. Int J Oral Health Sci 2017;7:105-7

How to cite this URL:
Pandey R, Gupta R, Bhagat N. Tooth fragment embedded in lower lip following trauma. Int J Oral Health Sci [serial online] 2017 [cited 2019 Dec 14];7:105-7. Available from: http://www.ijohsjournal.org/text.asp?2017/7/2/105/222397




  Introduction Top


Trauma to facial region can occur due to road traffic accident, falls, assault, and sport-related injury.[1] This may lead to soft tissue injury: abrasion or laceration of facial tissues, dentoalveolar fracture, fracture of teeth, and fracture of facial bones. In dental trauma, crown fracture is most common.[2] The fractured teeth especially the incisors may cause laceration and subsequent bleeding of the surrounding soft tissue. A careful examination of soft tissue is important in such cases as fractured tooth fragments may get embedded in the soft tissues.[3] Tooth fragments are reported to be found in the lower lip, the buccal mucosa, the tongue, and other intraoral sites. Most of the times, the impacted tooth/teeth are deep inside the oral mucosa and require surgical exposure to remove.[2],[4] In most cases, clinical history and conventional radiography leads to the diagnosis. The present article report a case of swelling of lower lip caused due an embedded tooth fragment which was fractured due to trauma to facial region due to road traffic accident 5 months back.


  Case Report Top


A 25-year-old male patient reported to us with pain and swelling in the lower lip for the past 10 days. The patient medical history revealed that patient had a traumatic injury to the lower anterior teeth due to road traffic accident 5 months back. The traumatic injury had caused fracture of the lower anterior tooth. The patient was aware of the tooth fracture but no attempt was made to locate the fractured tooth fragment at the site of accident. The patient had consulted a nearby local medical practitioner for pain and mild swelling caused due to facial trauma just after the accident and was advised analgesics and antibiotics. Subsequently, the patient did not receive any treatment for the fractured tooth. For 4 months, the patient did not feel any discomfort in the lip. Fifteen days before presenting at the clinic, the patient began to have swelling and pain in the lower lip. On clinical examination, a single firm swelling measuring 1 cm × 1 cm was present on left side of the mid line of lower lip. There was no laceration or ulceration present. The swelling was firm in consistency with tenderness. Tooth 32 revealed Ellis Class III fracture with tenderness [Figure 1]. Suspecting a foreign body in the lip (fragment of fractured tooth), a radiograph intraoral periapical was advised. The radiograph revealed a single radiopaque mass similar to that of the fractured tooth fragment [Figure 2]. Based on clinical and radiographic findings a diagnosis of embedded fractured tooth fragment in the lip following trauma was made. The problem was explained to the patient and its removal under local anesthesia was planned. After aseptic draping and painting with 2% Povidone-iodine left mental nerve block was given. A small vertical incision was placed in the proximity of the hard mass and blunt dissection was done using mosquito forcep to expose the embedded tooth fragment. The exposed fragment was grasped with mosquito forcep and removed [Figure 3] and closure of incision was done with 4-0 Vicryl suture. During 1-week follow-up, wound healing was satisfactory [Figure 4]. Extraction of 32 was done as patient refused for any conservative or endodontic treatment.
Figure 1: Image showing swelling over the lower lip (marked with arrow) and fractured tooth 32

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Figure 2: Image showing intraoral periapical radiograph of the lower lip. A radiopaque tooth fragment like foreign body can be appreciated

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Figure 3: Image showing surgically removed tooth fragment embedded in the lower lip

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Figure 4: Image showing 1-week postoperative healing of lower lip along with extracted socket of tooth 32

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  Discussion Top


Traumatic dental injuries have become more common in recent times, comprising 5.12% of all injuries.[5] The majority of people before the age of 19 years experience dental trauma (25% of all school children and 33% of adults).[6] Fracture of teeth and soft tissue injury is the most common and mildest form of trauma that can occur in facial region. Most of the times no or minimal surgical intervention is required for these cases. Sometimes, these cases may get complicated if they are associated with fractured tooth and soft tissue lacerations as tooth fragments may get embedded in soft tissue without the knowledge of the patient and can be easily overlooked during a clinical examination. These types of injuries are most common in pediatric population and early teens.[7] Most commonly the upper anterior teeth are involved mainly incisors.[2] Incidence is more common in boys.[2] Risk factors include increased over jet and incompetent lips. Various classifications have been given for tooth fracture and injury to its supporting tissues.[8] The most commonly used classification was given by Ellis and Davey in 1970. The most accepted and elaborate classification is the WHO (World Health Organization) classification given in 1994. The level of tooth facture is variable and most common type of injury is Class I (Ellis and Davey), i.e., fracture involving enamel. Studies have shown that the pattern of dental injuries are different in deciduous and permanent dentition.[9] Exarticulation and luxations are more common in deciduous dentition and crown-root fractures are more common in permanent dentition. Tooth fragments may get embedded in any part of the oral cavity. Most common site is lower lip. The mechanism of occurrence in this case may be because of an impact force toward the incisors lead to facture of the tooth and it was pushed into the lip. Tooth fragment embedded in the soft tissue may not be easily detected if the injury is of puncture type. In puncture type of injury, there is no soft tissue laceration and only a small wound is present which may be easily missed. Long-term sequel of embedded tooth fragment includes: infection, pain, swelling, fibrosis, scaring, and spontaneous eruption of the fragment and migration of the fragment.[3],[10] Therefore, early diagnosis is essential and treatment is surgical removal. Therefore, it is recommended that all fracture segments should be accounted for and associated soft tissue wound should be thoroughly debrided before closure. Our case was unique in the sense that an adult who was aware of a missing tooth crown delayed the treatment for almost for 5 months. The time from injury to surgical removal of the embedded teeth may delay from days to months and sometimes even to few years. Diagnosis is mainly dependent on the past history including trauma, laceration at the site, and chronic infection. A radiograph is of diagnostic significance if the foreign material is radiopaque as in our case. Differential diagnosis of embedded tooth fragment include: foreign body, sialolith, soft tissue calcification, and subcutaneous lesions. Treatment of the tooth fracture is variable and depends upon the level of the fracture. Most cases require mere esthetic restoration; few of them may require endodontic intervention. With recent developments and availability of better bonding agents and composite material, nowadays reattachment of the fractured segment is possible. Various studies have shown successful reattachment with long-term success.[11] The use of fractured segment is preferred because it eliminates problems of unmatched shade and wear associated with tooth-colored restorative materials.[12]

It is essential to store the fractured or retrieved tooth fragment in aqueous medium such as 0.5% normal saline till reattachment procedure is completed. In the present case, it was noted that neither the patient nor the primary general practitioner attempted to locate the tooth fragment. Ideal treatment in the above case would have been endodontic treatment of the tooth followed by reattachment of the embedded tooth fragment. However, unfortunately the tooth fragment was discarded because the patient did not agree to the reattachment procedure and underwent extraction of the fractured tooth.


  Conclusion Top


This study emphasizes the importance of a detained physical and radiographic evaluation of patient following orofacial trauma and the importance of creating awareness of the emergency room and medical staff in regard to orofacial dental trauma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflflicts of interest.



 
  References Top

1.
Agarwal A, Rehani U, Rana V, Gambhir N. Tooth fragment embedded in the upper lip after dental trauma: A case report presenting an immediate diagnostic approach and complete rehabilitation. J Indian Soc Pedod Prev Dent 2013;31:52-5.  Back to cited text no. 1
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2.
da Silva AC, de Moraes M, Bastos EG, Moreira RW, Passeri LA. Tooth fragment embedded in the lower lip after dental trauma: Case reports. Dent Traumatol 2005;21:115-20.  Back to cited text no. 2
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3.
Lips A, da Silva LP, Tannure PN, Farinhas JA, Primo LG, de Araújo Castro GF. Autogenous bonding of tooth fragment retained in lower lip after trauma. Contemp Clin Dent 2012;3:481-3.  Back to cited text no. 3
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4.
Hara A, Kusakari J, Shinohara A, Yamada Y, Sato N. Intrusion of an incisor tooth into the contralateral frontal sinus following trauma. J Laryngol Otol 1993;107:240-1.  Back to cited text no. 4
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David J, Astrøm AN, Wang NJ. Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India. Dent Traumatol 2009;25:500-5.  Back to cited text no. 5
    
6.
Glendor U. Epidemiology of traumatic dental injuries – A 12 year review of the literature. Dent Traumatol 2008;24:603-11.  Back to cited text no. 6
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7.
Das UM, Viswanath D, Subramanian V, Agarwal M. Management of dentoalveolar injuries in children: A case report. J Indian Soc Pedod Prev Dent 2007;25:183-6.  Back to cited text no. 7
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8.
Bastone EB, Freer TJ, McNamara JR. Epidemiology of dental trauma: A review of the literature. Aust Dent J 2000;45:2-9.  Back to cited text no. 8
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9.
Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.  Back to cited text no. 9
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10.
Agrafioti A, Tsatsoulis IN, Papanakou-Tzanetaki SI, Kontakiotis EG. Primary inadequate management of dental trauma. J Clin Diagn Res 2016;10:ZD12-3.  Back to cited text no. 10
    
11.
Maia EA, Baratieri LN, de Andrada MA, Monteiro S Jr., de Araújo EM Jr. Tooth fragment reattachment: Fundamentals of the technique and two case reports. Quintessence Int 2003;34:99-107.  Back to cited text no. 11
    
12.
Marwaha M, Bansal K, Srivastava A, Maheshwari N. Surgical retrieval of tooth fragment from lower lip and reattachment after 6 months of trauma. Int J Clin Pediatr Dent 2015;8:145-8.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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