Responsability in management of the early stages in clinical evaluation of oral-facial traumatic events

OBJECTIVES The aim of this work is to examine orofacial traumatic events and their effects and to identify guidelines and behavioral patterns and an appropriate clinical and medico-legal language, that help to identify immediately the traumatic event and its effects and proper management of the same, accordingly with insurance and/or judicial requirements, as well as strictly clinical. We also want to underline the clinical and medico-legal relevance of the first visit. MATERIALS AND METHODS The different aspects of the topic are examined from both a clinical and a medico-legal point of view. Through the analysis of the different types of trauma and procedural schemes this work try to identify a universally recognized terminology, that allows to identify situations, clinical interventions, documentation and trauma assessments. The damaging mechanisms are distinguished in direct traumas (vestibulo-oral, apico-coronal, corono-apical) and indirect (oro-vestibular, corono-apical). In the first case, the harmful outcome occurs directly at the site of traumatism. In the second hypothesis the trauma determines negative outcomes at a distance from the point of impact both at the dental level and sometimes at the bone level. The need to have universal parameters of reference has led to the common use of Andreasen’s 2011 dental trauma classification frequently. This is based on the one from the WHO and applies the principles of the International Classification of Diseases to Dentistry and Stomatology. RESULTS AND CONCLUSIONS The correct diagnosis and early treatment of dental trauma represent an emergency in order to relieve pain, facilitate the reduction of fractures or dislocations or limit the effects, improving the prognosis. The prognosis of dental injuries often depends on the precocity and adequacy of emergency surgery. Unfortunately, the first to intervene are often emergency doctors or pediatricians, who are not always prepared to manage such events or are involved in resolving more serious problems. Oral traumatology, therefore, is not always managed immediately and appropriately. During the first visit it is necessary to crystallize the event and its immediate effects, also through images. It is raccomandable to take photographs of the subject and the damaged tissues. It is also necessary to record, in addition to the personal data of the subject, the modalities with which the trauma occurred, in addition to any interventions already practiced for previous traumatic events and the general state of the subject, including his vaccination status. It is also necessary to examine any skin or soft tissue injuries or lesions of molars or premolars that could induce further investigations and clinical evaluations to rule out pathogenesis suggestive of abuse or mistreatment, while subcutaneous hematomas could indicate fractures of the jaws, as well as abnormalities’ occlusions. The knowledge of the procedures of intervention and clinical evaluation and a suitable documentary collection, helps the clinician to correctly and comprehensively manage the clinical and certification data to protect the injured person. Inadequate management of this approach could lead to errors in clinical and medico-legal evaluation and could exclude compensation, without excluding that the non-identification of illecit conduct could favor the perpetration of violence against weak subjects. The documentary data therefore assumes importance as well as the conduct of the professional involved. The indemnity or protection of insurance policies are based on such adequat