How to brush your teeth with a broken jaw. Fracture of the lower jaw: causes, symptoms, diagnosis, treatment. Types of splinting for jaw fractures

Splinting of teeth is used in many cases: for jaw fractures; when correcting pathology of the bite or position of the teeth; for periodontal diseases. In this chapter we want to reflect only the option of splinting teeth for periodontal diseases. Splinting of teeth against the background of periodontal pathology is resorted to when significant tooth mobility is observed against the background of pronounced resorption of the alveolar process. They use removable and permanent splints, which are tilted directly to the teeth using various composite materials and reinforcing structures. Removable splints, as a rule, are part of a removable prosthesis and are a complex system of clasps. Such removable splints are the least effective, since they fix the teeth more than they relieve the load, and the fixation is quite conditional and only while wearing the prosthesis.
In some cases, they resort to splinting with various types of half-crowns welded together. In this case, only a small part of the tooth is ground. This type of splinting structures has also become used quite rarely.
The main purpose of splinting teeth together in case of periodontal diseases, more often in chronic generalized periodontitis of moderate and moderate severity, is to: to unload the periodontium and reduce the load on the underlying tissues by redistributing stress from an individual tooth to a group of teeth. If, under normal conditions, a tooth, as part of the periodontal complex, is a perfect engineering structure in which stresses are absorbed, significant ones at that, and differ from each other by orders of magnitude. Thus, with a load on a molar of about 42 kg (average chewing load), at the apex of the tooth root the pressure on the perio
the dontal ligament will be about 800 g; this is not enough; even the course of the trabeculae of the jaw helps to absorb stress, but this is normal. However, if periodontal destruction begins, accompanied by resorption of the alveolar process, destruction of the periodontal grooves and circular ligaments of the teeth, but this is accompanied by the destruction of the periodontium and microbial invasion of the people's tissues and a gradual decrease in the stability of the tooth in the socket and an increase in its mobility. In such conditions, proper treatment cannot be avoided, otherwise it will invariably lead to the loss of the tooth(s). It is in such situations that they resort to splinting a group of teeth. This is most often done in the frontal areas, somewhat less often in the distal areas. The teeth of the lower jaw are more often splinted than the teeth of the upper jaw.
One of the leading reasons is unsatisfactory oral hygiene, which led to the formation of hard dental deposits, which caused the destruction and inflammation of the periodontium. Therefore, before starting to splint teeth, it is always necessary to carry out the most thorough professional oral hygiene with the removal of supra- and subgingival calculus, polishing and grinding of all accessible surfaces of the teeth (crowns and roots). Depending on the periodontal status, splinting of teeth can proceed with preliminary filling of the root canals, with periodontal surgery (gingivectomy or flap, with or without the use of osteosubstitutes and membranes). In all cases, it is necessary to first carry out the most rigorous, full-fledged explanatory and educational work with the patient to explain the causes of the disease and teach the correct methods of individual hygienic measures to care for the oral cavity, teeth and structures, especially since in such a situation it will be even more difficult to do this. And since the patient did not monitor the condition of his teeth and gums earlier, which led to unsatisfactory hygienic and dental status, then a lot of effort must be made to change the patient’s mental and practical approaches to oral hygiene. If there are removable splinting structures, they are cared for in the same way as for conventional removable dentures. The situation is much more complicated in the presence of fixed permanent splints, and the doctor must remember that when creating a splinting non-removable structure directly in the mouth on the teeth, it is necessary to create flow systems in each

Basic and auxiliary oral hygiene products used when splinting teeth for periodontal diseases (S.B. Lithuanian© 1999)

interdental space, and the splints themselves should be as smooth and polished as possible in order to reduce the risk and possibility of plaque accumulation and formation both on the teeth themselves and on the splinting structure. The patient must understand that in such a situation, oral hygiene will be much more labor-intensive and time-consuming, requiring more perseverance on his part. In addition to all this, such a patient will need significantly more oral hygiene products, and they will be used up and become unusable much faster than under normal conditions. A patient with teeth splinted due to periodontitis or periodontal disease must understand that he should carry out hygienic measures in the oral cavity after each meal, and not twice a day. In the same way, he should appear for control visits to the dentist not once every six months, but at least every three months, and in some cases more often. The frequency of visits is determined by the doctor depending on the dental and hygienic status of such a patient.
The list of these hygiene products confirms our words about the laboriousness of the hygienic procedure in the oral cavity with a similar condition of the teeth.
As we can see, the minimum arsenal of oral hygiene products that must be used constantly in the presence of a splinting structure on the teeth, placed to fix mobile teeth against the background of periodontal diseases, consists of six items (Table 6.1.2). Give up some

Table 6.1.2 Optimal set of oral hygiene products used in the presence of fixed teeth splinting structures in the oral cavity for periodontal diseases (S.B. Ulitovsky©1999)

any means from those indicated in the table. 6.1.2, in such a situation it is impossible, since this will immediately affect the hygienic condition of the oral cavity and will inevitably lead to its deterioration due to the avalanche formation of dental plaque -

A mandibular fracture is a serious injury that most often affects men aged 20–40 years. As a result of such injury, partial or complete destruction of the integrity of the bone occurs. Fractures of the lower jaw are diagnosed much more often than injuries of the upper jaw.

This phenomenon is dangerous to human health, as it can cause severe complications, including death. To prevent undesirable consequences, if signs of a fracture of this only movable bone of the skull are detected, you should immediately consult a doctor. In most cases, the patient’s life depends on the timely provision of assistance.

Features of the structure of the lower jaw

The lower jaw is a horseshoe-shaped unpaired skull bone designed for chewing food. The upper parts of its middle and two upward branches end in two processes: anterior (coronal) and posterior (condylar, or articular). The lower jaw has the following anatomical features:

1. The articular process, the middle part of its body and the angle area are typical places that are most often injured.
2. In the area of ​​the angle of the mandible there is the facial artery. It has microscopic parameters, but if it is damaged, heavy bleeding can begin and a hematoma can form.
3. Along the mandibular bone there are branches of the trigeminal nerve, which is responsible for the sensitivity of the mucous membranes of the cheeks and tongue. Its injury causes partial or complete loss of susceptibility of these organs to external factors.
4. The lower jaw and the bones of the facial skeleton are connected through the temporomandibular joint, which makes it possible to chew food. Despite its apparent strength, this connection is quite easy to break.

How are fractures classified?

A jaw fracture is classified according to many criteria. According to the severity of violations of the integrity of the mandibular bone, they are divided into open and closed. In relation to the area of ​​injury, they can be direct or indirect. Based on the line of the crack, this type of fracture is divided into single, double and multiple. The classification of mandibular injuries includes bilateral and unilateral varieties.

In addition, there are fractures of the lower jaw with and without displacement of bone fragments. The described type of injury is also classified into fractures of the canines, incisors, coronoid processes, as well as damage in the area of ​​the angle, which is also called an angular fracture of the mandible.

Open and closed

An open fracture is characterized by displacement and protrusion of parts of the bone, as well as a violation of the integrity of the mucous membranes, muscles and skin. In this situation, there is a high probability of infection of the affected tissues. Often, in addition to the maxillofacial surgeon, a cosmetologist is involved in the treatment. The lower jaw is subject to this type of injury much more often than the upper jaw. With a closed type of fracture, only the bone is damaged, the integrity of the soft tissue is not compromised.

Direct and indirect

Fractures, depending on the location of the damage in relation to the point of application of the traumatic force, are classified into direct and indirect. In the first case, bone injury occurs directly at the specified point. Indirect damage occurs at some distance from it, in a more fragile area. Along with this, there is also a mixed type fracture, the formation of which involves a combination of the first two types.

Single, double and multiple

With a single fracture of the articular process of the lower jaw, 2 fragments of different sizes are formed, the smaller of which moves upward until it comes into contact with the units of the upper dentition and slightly inward under the influence of the lateral pterygoid muscle. In this case, the dental arch narrows, and the midline shifts towards the fracture. The teeth of this fragment, located next to the crack, do not contact the upper units. The closing of the jaws occurs only in the area of ​​large and sometimes small molars.

If a double fracture occurs, the middle of the fragments is displaced downward and inward by the mylohyoid muscle attached to it, the smaller one is shifted upward and slightly inward, the larger one is shifted downward and toward the middle fragment. If a multiple fracture occurs, the bone fragments move in different directions under the influence of the bundles attached to them. In this case, their ends often overlap each other, shifting in the direction of the contracting muscles.

Double-sided and single-sided

With a unilateral fracture, the midline moves towards the crack. In the area of ​​damage, the teeth close tightly together, but in the healthy area they do not touch. For a bilateral fracture, a characteristic feature is upward displacement of both branches of the mandibular bone. In this case, only the large molars close together, in other words, an open bite develops.

With and without displacement of fragments

Displacement injuries are quite dangerous and occur as a result of strong physical impact. Bone fragments move in relation not only to each other, but also to other bones.

There are 3 types of such displacement: sagittal, vegetal and transversal. During a fracture without displacement, the anatomical location of the bones is not disturbed. Often the damage indicated is incomplete.

Traumatic and pathological

Traumatic fractures occur as a result of strong external influence. This can occur during traffic accidents, active and traumatic sports, and fights.

Pathological fractures are a consequence of various severe processes occurring in the body, such as osteoporosis, osteomyelitis, osteochondrosis, tuberculosis, and the development of malignant and benign formations.

About first aid and further therapy - in the video:

Symptoms of a jaw fracture

It is quite simple to understand that the mandibular bone is broken. Symptoms of a fracture:

• the shape of the face changes;
• pain develops, intensifying with any attempt to open the mouth;
• Excessive bleeding occurs with an open type of fracture - in the oral cavity, from the ears and nose;
• swelling and damage to soft tissues is observed;
• hematomas appear;
• The friction of the fragments against each other is accompanied by a crunching sound.

First aid for injury

The likelihood of complications and how long treatment and recovery will take depends on how timely and correctly the first aid is provided to the victim. Emergency assistance consists of:

1. Disinfecting the wound and applying a bandage to it to prevent infection.
2. Pain relief. To relieve pain, you can use non-steroidal anti-inflammatory drugs such as Ketorolac, Diclofenac. To enhance the analgesic effect, injections are recommended. In cases where a fracture is associated with serious complications, it is necessary to use potent drugs, for example Promedol.
3. Stop bleeding. In order to stop the bleeding, you should press the bleeding vessels with your finger and apply a pressure bandage. If the bleeding is not strong, you can limit yourself to a piece of sterile cotton wool soaked in hydrogen peroxide.
4. After the bleeding stops, the broken jaw must be fixed. For this purpose, it is better to use a sling-shaped bandage.

After immobilization of the lower jaw, the patient is urgently taken to a medical facility (we recommend reading: how to straighten a jaw when it is dislocated?).

Treatment of jaw fractures

Injuries to the jaw bones are treated in the Department of Oral and Maxillofacial Surgery. Treatment methods are classified into conservative (orthopedic) and surgical (osteosynthesis). If it is possible to do without surgery, reposition is performed. During this procedure, the bone is given an anatomical position, as a result of which the jaw grows together correctly. If it is not possible to use this method, use an elastic traction device.

• antibiotic therapy;
• taking vitamin D to speed up tissue repair;
• use of anti-inflammatory drugs (Ibuprofen, Ketanov, Movalis);
• agents that restore phosphorus-calcium metabolism (Kalcemin, Calcium D3 Nycomed).

Indications for osteosynthesis are multi-fragmented injuries, reconstructive surgery, neoplastic process in the area of ​​injury, as well as injury to the condylar process, complicated by displacement of the articular head. During the procedure, damaged soft tissues are exposed, bones are repositioned and immobilized using metal structures.

Diet

The diet during the recovery stage has characteristic features. Over a period of time, chewing function is impaired to varying degrees, so you should eat only liquid food. If it is impossible to chew and swallow food, the patient is prescribed food with a daily calorie content of 3000 to 4000 calories. In this case, food with the consistency of liquid cream enters the body through a tube.

In cases where the patient can chew and swallow food, he is shown a diet with the same nutritional value, but the food has the consistency of thick sour cream. After discharge from the hospital, you need to eat fermented milk products, meat broths, drink strained juices and compotes from fresh fruits, berries and vegetables. Food should be varied.

Restoration activities

Rehabilitation is a mandatory stage of treatment. Thanks to calcium electrophoresis, magnetic therapy and infrared irradiation, the injured jaw heals much faster. These methods are especially effective for angular fractures. Therapeutic gymnastics helps develop the joint. It includes regular facial exercises and self-massage of the facial muscles. On average, the duration of the recovery period is 1.5–2 months.

At the same time, to avoid infection of damaged tissues, you should especially carefully monitor oral hygiene. After each meal, it is necessary to rinse the mouth with antiseptic agents. If you cannot open your mouth completely, you can rinse it with a straw.

As soon as possible, you need to brush your teeth twice a day, not forgetting to remove food debris from the interdental spaces.

Possible complications

As a result of violation of the integrity of the mandibular bone, in most cases various complications arise. The most common consequences include:

• heavy bleeding;
• hematomas;
• dislocation of the temporomandibular joint;
• osteomyelitis;
• violation of jaw closure (we recommend reading: why can your jaw click when you open your mouth?);
• false arthrosis;
• dental defects;
• improper fusion of bones;
• neuritis of the facial nerve;
• complete or partial loss of the ability to chew food.

To avoid these consequences, if you notice symptoms of a fracture, you should immediately consult a doctor. Self-medication is strictly not recommended.

General care. In case of injuries to the maxillofacial area, not only timely medical manipulations are of great importance, but also general care for the victim.

In case of non-gunshot and especially gunshot fractures of the upper jaw, it is necessary to monitor the state of nasal breathing, the nature of discharge from the nasal passages, and free the nasal cavity from blood clots and crusts. A 3-5% solution of protargol, an emulsion of streptocide (in petroleum jelly or vegetable oil) should be injected into the nasal passages.

In the first days, the victim should be in bed in a semi-sitting position; this eliminates congestion in the lungs and, in addition, reduces the risk of oral contents (saliva, mucus, food debris, purulent and putrefactive discharge from wounds) entering the respiratory tract (aspiration) and the occurrence of inflammatory pulmonary complications. A victim with more severe injuries, if his condition allows, should be periodically turned from side to side, which also reduces congestion in the lungs.

If the integrity of the walls of the oral cavity is damaged, which is accompanied by constant leakage of saliva and food from the mouth, the victim’s chest must be covered with an oilcloth bib or an oilcloth or rubber saliva bag should be tied under the chin. To reduce salivation, such patients are prescribed 5-8 drops of belladonna tincture (T-rae Belladon-pae) three times a day. Some authors (D. A. Entin) recommended using aeron to reduce salivation. Aeron is given twice a day, one tablet (each Aeron tablet contains 0.0004 g of hyosdiamine camphorate and 0.0001 g of scopolamine), first dissolving them in water.

Oral care. With a number of injuries to the jaws and soft tissues of the maxillofacial area, the chewing function, and often the mobility of the tongue, is significantly affected, as a result of which the self-cleaning of the oral cavity is impaired. As a result, purulent discharge from wounds accumulates in certain areas of the mouth, and food remains are retained. All this leads to severe contamination of the oral cavity and is one of the causes of inflammatory complications.

Prescribing mouth rinses in such cases is not advisable, since the vigorous movements of the soft tissues of the lips and cheeks necessary to clean the mouth are impossible. Therefore, in case of damage to the jaws and adjacent soft tissues, you should regularly rinse your mouth with an Esmarch mug. You can also use a large syringe or rubber balloon for this purpose, but such washing has less effect. Usually, a weak warm solution of potassium permanganate 1: 1000-1: 2000 (one crystal per glass of water) is used for washing. This solution has a known deodorizing effect and eliminates bad breath for some time.

Sometimes, to more vigorously wash away mucus from the oral mucosa, they resort to warm alkaline rinses (1-2% solution of bicarbonate of soda or a solution of ammonia 1:400-1:600). Before washing the mouth, remove the bandage covering the wound and tie a large oilcloth apron around the patient’s neck. If the patient can sit, he tilts his head forward and rinsing is done over a large basin or bucket. The head of a bedridden patient is turned to one side, placing a tray under the lower corner of the mouth. Esmarch's mug is raised above the patient's head to a height of approximately 1 m. The lips and cheeks are pushed back with a spatula, a tip (sterilized) attached to the end of a rubber tube is inserted into the mouth and the vestibule and then the oral cavity are washed with a stream of liquid (Fig. 319).

To prevent the patient from choking, rinsing must be done intermittently. For the same purpose, the patient should be advised to exhale while rinsing the mouth. At the end of exhalation, the rinsing is interrupted.

In the presence of intermaxillary fastening and, therefore, immobility of the lower jaw, the oral cavity is washed through the defects of the dentition or a stream of liquid is directed into the oral cavity through the gap behind the last large molars, inserting the tip deep into the vestibule of the oral cavity alternately on the right and left. At the same time, soft tissue wounds communicating with the oral cavity are washed with a stream of liquid.

For patients with penetrating wounds, mouth rinsing and dressings are changed 2-3 times a day as directed by the doctor. More frequent washing and the necessary dressing changes tire the patient too much. With penetrating wounds, the contents of the mouth constantly flow out of the wound, so it is necessary to monitor the condition of the skin around the wound. If skin irritation occurs under the influence of constant wetting, the wound circumference should be lubricated with zinc ointment ( Ung. Zinci oxydati) or 10% solution of copper sulfate ( Sol. Cupri sulfurici 10%), and then cover with a layer of Vaseline.

After rinsing the mouth, remove remaining pieces of food, rejected tissue and bone fragments with tweezers. If there are splints, check the condition of the ligatures attaching the splint to the teeth, the correctness of its position (does it fit well to the teeth, has it moved onto the mucous membrane of the gums). If there is an intermaxillary bond, the condition of the rubber rings is monitored. If necessary, tighten or replace broken ligatures and replace rubber rings.

Nutrition. The nutrition of patients with damage to the maxillofacial area has its own characteristics. Due to the dysfunction of chewing and sometimes swallowing in such patients, they must receive food in crushed, mushy, and sometimes semi-liquid form.

To introduce semi-liquid food, use a sippy cup, on the spout of which a drainage tube 20-25 cm long is put on. The end of the rubber tube is inserted into the oral cavity. With intermaxillary fastening, the tube is passed through the defect in the dentition, and if all teeth are present, it is advanced into the vestibule of the oral cavity behind the last large molar. Raising the sippy cup and tilting it slightly, pour semi-liquid food into the oral cavity in small portions (Fig. 320).

In the first days, so that a patient who is not accustomed to using a sippy cup does not choke, you should periodically squeeze the rubber tube placed on the spout of the sippy cup with your fingers. In this way, it is possible to ensure that the amount of food required for a swallow enters the mouth. In the future, patients themselves squeeze the tube with their fingers, regulating the flow of food.

Some patients introduce crushed or mushy food into the mouth using a teaspoon and suck it through the gaps in the dentition.

In case of extensive damage to the maxillofacial area or associated inflammatory processes that make it impossible to swallow food, it is necessary to introduce food for some time using a probe through the mouth, and sometimes through the nasal passages or through the rectum. It should, however, emphasize the need for a quick transition to feeding with the help of a sippy cup, which significantly improves the condition of the victim, depressed by the inability to eat food in the usual way. In addition, it makes caring for patients easier.

In cases where the patient cannot swallow, food is administered using a thin gastric tube or a rubber catheter with sufficient clearance placed on a funnel. The probe is inserted into the upper third of the esophagus to a depth of about 25 cm from the level of the front teeth or the nasal opening. It is necessary to check whether the end of the probe has entered the larynx and trachea. For this purpose, pour a small amount of liquid through a funnel (no more than 2-3 tablespoons); if the fluid passes freely and there is no cough, then the probe is inserted correctly. Then liquid food is gradually poured into the funnel, which is received by patients who are fed with the help of a sippy cup.

Tube feeding is carried out 3-4 times a day.

Water and some substances are well absorbed through the rectum - a number of salts (sodium chloride, calcium chloride), carbohydrates (sugar, glucose), alcohol. Fats and proteins, even those contained in milk and eggs, are poorly absorbed and in small quantities. Consequently, nutrition through the rectum cannot be complete. Therefore, the introduction of fluids and nutrients in this way should be considered only as an auxiliary and temporary way of feeding the patient.

Salts and carbohydrates should be administered in an isotonic solution (sodium chloride - in the form of a 0.85-0.9% solution, glucose - in a 5.4% solution, cane sugar - in an 8.5% solution).

The intestines must be cleansed before administering a nutrient or drip enema. Therefore, an hour before the nutrient enema, a cleansing enema is done. A nutritional enema is administered warmed up to body temperature; the amount of fluid administered ranges from 300 to 400 ml. When using a drip enema (60-90 drops per minute), the amount of liquid administered at one time can be increased to 1-1.5 liters.

Fighting oral contamination (oral care)

Oral care for soft tissue injuries and bone fractures should continue throughout the entire period of treatment of jaw wounds, starting from the moment of first emergency care, and during all subsequent periods of observation of the wounded person during transport and inpatient treatment. This is the most time-consuming part of caring for a jaw wound. In case of a fracture of the upper or lower jaw, as well as damage to the soft tissues of the face, an important function of the masticatory apparatus is disrupted - physiological cleaning of the oral cavity. Even in an intact oral cavity, microbial flora constantly exists, which nests in carious teeth, in the interdental spaces, on the surface of the tongue, and penetrates here from the tonsils, from the nasopharynx, and when coughing up from the respiratory tract. However, when chewing, drinking, rinsing the mouth, brushing teeth, the microbial flora in the oral cavity is constantly changing and does not linger unless there are carious teeth, fistulas and other pathological phenomena.

The cessation of chewing function in case of fractures and damage to the soft tissues of the oral cavity, as well as a decrease in this function at high temperatures, in infectious diseases and phlegmon of the tonsils and submandibular region, etc., is affected by the rapid increase in the microbial flora of the oral cavity, increasing its virulence and pathogenicity depending on from the predominance of one or another type of infection.

The best method of combating oral contamination and oral infection is systematically rinsing the mouth with weak solutions of disinfectants.

Oral care at the first examination begins with mechanical cleaning. The edges of the wound and cheek pockets are pulled apart with blunt hooks and all the bays and folds of the oral mucosa are examined; Remnants of food, blood clots, particles of dead tissue, completely free bone fragments, fragments of teeth and foreign bodies lingering here are carefully removed with tweezers, damp soft cotton wool swabs wrapped on a strong wooden stick. Wipe your gums and teeth thoroughly. The oral cavity is well cleaned with a strong stream of a weak disinfectant solution from a rubber balloon or an irrigator with a straight glass tip, which washes all the coves, folds and crevices between fragments and surfaces covered with plaque and cellular decay. Washing here plays the role of mechanical, most gentle cleaning. For washing, it is best to use a copious amount of potassium permanganate solution (1:1,000 - 1:2,000), a solution of hydrogen peroxide with boric acid, etc.

The first rinsing, along with examining the wound, should be done by a doctor, and then it can be entrusted to the nursing staff. In the future, rinsing should be done at least 3-4 times a day, after each meal and at night, to avoid the absorption of infected saliva and pus into the respiratory tract.

Rinsing is done with a glass tip (not thin), holding the patient's head over a wide tray or basin; the walking wounded subsequently rinse their mouths themselves by sitting in front of a stand on which is mounted a bottle or large Esmarch mug, equipped with several rubber tubes to serve several wounded at the same time. The tips are boiling.

With good care, bad breath soon disappears, dirty deposits are cleared; the secretion of pus and saliva decreases; the wounded feel significant relief; their general condition improves.

Already during rinsing of the oral cavity, the whole picture of the damage becomes clear - deep tears and pockets of the oral mucosa; thrombosed or bleeding vessels, areas of bone devoid of periosteum, the number of remaining teeth on the fragments; broken teeth and completely toothless fragments. Deep bleeding pockets are tamponed, bleeding vessels are ligated; exposed bones are covered with folded and sutured periosteum; Completely loose bone fragments and knocked out teeth are also removed. To avoid fusion, the cheek pockets or folds under the tongue, exposed from the mucosa, are lined with strips of iodoform gauze; free bone defects between the fragments are tamponed with iodoform gauze. The open edges of the wound help to thoroughly prepare the teeth for the application of fixing splints; it consists of removing completely loose teeth and tartar with tweezers with an experienced hand and appropriate instruments, especially near the necks of the teeth, where tartar interferes with the advancement of wire ligatures between the dental spaces and the application of splints.

Stone removal is contraindicated if it is impossible to fix the fragments with your hands so that you can apply quite a significant force required when removing the stone, and if this is associated with pain and irritation of inflammatory tissues.

We must not forget about the danger of stone particles being sucked into the respiratory tract in seriously ill patients, which can cause pneumonia from the infection. In such cases, it is better to refrain from this operation until the patient recovers his strength.

Removal of teeth and roots that cannot serve as a support for fixing splints is carried out only in cases where the general condition of the wounded allows it. Then conservative dental treatment is carried out.

In the future, oral care will consist of constant irrigation several times a day, monitoring splints, changing tampons and external dressings.

With open wounds connected to the oral cavity, in addition to pus, a lot of saliva is released. To facilitate the care of such wounded people, it is recommended to hang a special rubber bag under the chin to collect saliva and pus. Rana

can be covered or covered with a light bandage. The skin around the wound is lubricated with Vaseline or zinc paste.

In the absence of a special rubber bag, it can be replaced with an unusable ice pack or a heating pad according to the diagram attached here; to prevent the walls of the bubble from collapsing, a wire frame is inserted on top (Fig. 21).

Sometimes, on the contrary, with a healing wound with a large defect in the soft tissues and bones of the face, patients suffer from drying out of the mucous membrane of the mouth and tongue. To eliminate this painful phenomenon, lubricate the mucous membrane with boro-glycerin or other mixtures (for example, glycerin 400.0, wine alcohol 50.0, essential anise oil 0.2, peppermint oil 0.2).

A good effect is rinsing with a solution of citric acid with half a teaspoon of glycerin per glass and a few drops of a solution of menthol in alcohol.

When a chin is torn off, a protective plate made of celluloid or rubber, made to the shape of the chin and tightly fitted to the edges of the defect, is very useful; it is attached to the headband. The plate prevents saliva from flowing out and the tongue from drying out (Fig. 22).

When the surface of the damaged walls of the oral cavity is cleared of dirty plaque and begins to become covered with granulations, the surgeon’s task is to properly heal the soft tissues in the oral cavity, i.e., eliminate unwanted adhesions and correct epithelization of defects in the mucous membrane, preventing possible wrinkling and narrowing of the openings of the walls of the oral cavity. For this purpose, a number of devices are used that are mounted on oral splints: supporting plates, immediate prostheses, layers of soft gut-percha, etc., a description of which will be given below.

Jaw fracture is a severe pathological situation in which the linear integrity of the bones that form the lower jaw is disrupted. This occurs under the influence of some traumatic factor, the intensity of which exceeds the strength of the bone. A fracture of the lower jaw is a fairly common pathology that occurs among all age categories, but most often it affects young men aged 21 to 40 years. This is due to several factors, which are determined by both socio-economic status and lifestyle, as well as anatomical and physiological characteristics. Tooth fracture is a tooth injury caused by mechanical force. When a fracture occurs, the anatomical integrity of the tooth root or its crown is disrupted. The causes of tooth fracture are mechanical injuries resulting from an impact, a fall, or during chewing when there are solid foreign bodies in food. The frontal teeth of the upper jaw are more susceptible to fractures than the teeth of the lower jaw; often tooth fractures are combined with their incomplete dislocations.

Causes

• Displaced fracture. A fracture with displacement of fragments occurs when bone fragments lose their normal relationship and are displaced under the influence of some internal ( bone heaviness, muscle pull) or external ( direction and force of impact, displacement during movement) factors.
• Fracture without displacement of fragments. In a fracture without displacement, there is a pathological defect between the bone fragments ( fissure or fracture line), however the fragments are correlated correctly. A similar situation is typical for incomplete fractures, in which part of the bone tissue retains its integrity, as well as for fractures that developed under the influence of a low-intensity traumatic factor.
• Comminuted fracture. A comminuted fracture of the lower jaw is quite rare, but it is characterized by the presence of many bone fragments that are displaced to one degree or another. The peculiarity of this fracture is that, firstly, for its occurrence it is necessary to apply a large force to a small area of ​​​​the bone ( for example, when hit with a hammer), and secondly, comminuted fractures require surgical treatment, as they significantly destabilize the bone.

Symptoms

Tooth fracture

Tooth fracture

Clinical manifestations of tooth fracture

Diagnostics

• unilateral displacement of the jaw due to shortening of the body on one side;
• pathological jaw mobility;
• visualization of bone fragments deep in the wound;
• violation of the bone relief;
• asymmetry when opening the mouth;
• spasm of the masticatory muscles;
• crepitus ( crunch) bone fragments during movement.

• in the presence of two or more fractures determined by x-ray;
• jaw fractures involving the dentition;
• suspicion of fractures of adjacent bone formations;
• before surgical treatment of jaw fractures.

Treatment

Surgical treatment of jaw fractures

• the presence of large and small bone fragments;
• strong displacement of fragments and, as a consequence, the impossibility of comparing them without surgical intervention;
• fractures behind the dentition;
• pathological inflammatory or neoplastic process in the fracture area;
• reconstructive operations;
• a small number of healthy, stable teeth on bone fragments.

Bone suture

• inflammatory process in the fracture zone;
• the presence of many small bone fragments;
• osteomyelitis;
• gunshot wounds in the area;
• presence of bone defects.

Bony metal plates

Closed comparison of fragments

Rehabilitation period