Shotgun fracture

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Molars of the maxilla and mandible in a clench: Schematic representation of the cause of a shotgun fracture
Shotgun fracture: longitudinal fracture of a premolar

A shotgun fracture (also shotgun fracture , rabbit meal fracture ) is understood in dentistry to mean a longitudinal fracture of a tooth due to unintentional biting into a small, rigid body, thus by an unnatural force. The biting force , which is normally a maximum of 0.8 kN / cm² in humans  , can be increased by a factor of 100 because it hits the tooth at certain points.

Due to their small size, the small solids are caught between the cusps of the crown, so that lateral expansion or sideways evasion is not possible. In addition to the shotgun fracture , a tooth fracture can also result from other traumatic effects, such as accidents or bruxism ( grinding of teeth).

designation

The descriptive name comes from the tooth fracture (breakage) caused almost exclusively by biting a shotgun when eating game (hare, rabbit, game ) that was shot with shotgun.

causes

In addition to biting into a shotgun, such a longitudinal fracture of a tooth can be caused by biting into an unground grain in whole grain products , a cherry stone in jam or fruit cake, an unpopped corn in popcorn , a component ("king") of a three kings cake , a stone in a salad or Bread or nutshell residues in the food. Premolars and molars (small and large molars) that have deeply cutting fillings on both approximal sides are particularly at risk . This was confirmed among others by R. Trushkowsky, ST Talim and KS Gohil, who found that the most common cause of a Cracked Tooth Syndrome ( english tooth fracture disease ) as they called it, such a "Kauunfall" is.

Symptoms and Diagnosis

Initially, you feel a sharp stabbing pain. A broken fragment of the tooth can be easily movable in a lateral direction. As a result, the tooth hurts when chewing or reacts to heat, cold or sweets. If only a tiny fracture gap has arisen, whereby a fracture fragment does not have to be mobile, bacteria invade the fracture gap over time and delay painful pulpitis (tooth nerve inflammation).

The initially felt stabbing pain can also only be caused by a compression ( contusion ) of the tooth in the alveolus (tooth socket), which does not necessarily cause a tooth fracture. The tooth in question can react negatively to vitality tests (cold test) for a long time (up to several weeks) . In order to ensure that no further damage has occurred and that the tooth is permanently devitalized (dead), vitality tests must be carried out at regular intervals.

therapy

Depending on the type of tooth fracture, the tooth can be saved with a tooth crown , possibly including endodontic treatment ( root canal treatment ). However, in most cases it will need to be extracted (removed).

Liability issues

According to § 823 BGB in connection with § 1 and § 4 of the Product Liability Act , an innkeeper is liable for the damage caused by such a tooth injury. Basically, it is the responsibility of the innkeeper to serve guests food that is safe to eat and free of defects. The host or his cook has a special duty of care when preparing wild animals, since experience has shown that the animals were shot with shot. However, the guest is partly to blame. The Swiss Federal Supreme Court also ruled on such a fracture when consuming a cherry jam. The Munich District Court denied liability in a decision (judgment of February 12, 2015, Az. 213 C 26442/14). “Since a piece of meat is a product of animal origin, the average consumer must be aware that it cannot be completely avoided during the manufacturing process that pieces of bone can also be present in a steak that is actually bone-free . "..." In the case of an injury caused by small stones in a salad, for example, the courts assumed liability, since a guest does not have to expect something like that. On the other hand, shotgun pellets must be expected in game dishes and the resulting injuries do not entitle to compensation. A lawsuit was also dismissed in which a cherry stone had damaged teeth. The cake that was eaten was a so-called “cherry thaler” and it was argued by the deciding court that a consumer should then not assume that all the cherries are completely pitted. ”When eating an Epiphany cake, the person concerned knows that it is a firm one Component (bean, porcelain figurine, coin) can be in it, and must chew accordingly carefully.

Shotgun Effect

The shotgun effect is a reflective protective mechanism that starts when the chewing surfaces hit a hard object shortly before the jaw closes: The mouth-opener muscles ( digastric muscles , mylohyoid muscles , geniohyoid muscles , pterygoid muscles ) act reflexively and compensate for the lateral force Mouth-closing muscles ( masseter , temporalis , medial pterygoid muscles ) to prevent damage to the teeth.

Web links

Wiktionary: shotgun fracture  - explanations of meanings, word origins, synonyms, translations
Wiktionary: shotgun effect  - explanations of meanings, word origins, synonyms, translations

Remarks

  1. ↑ The term biting force does not denote a force in the physical sense, but a pressure and should therefore correctly be called bite pressure or jaw closing pressure .

Individual evidence

  1. ↑ Gert-Horst Schumacher: Functional morphology of the masticatory muscles . G. Fischer, 1961. , p. 214.
  2. ↑ Karl Sochurek: Alternatives to amalgam .: A guide for practice. . Urban & Schwarzenberg, 1995, ISBN 978-3-541-17411-9 . , P. 96.
  3. ↑ Lorenz Hupfauf, David Haunfelder: Praxis der Zahnheilkunde. 6. Partial dentures . Urban & Schwarzenberg, 1988, ISBN 978-3-541-15260-5 . , P. 19.
  4. ↑ Michael Mair, food wear in the chewing simulator , dissertation 2002, Ludwig Maximilians University, Munich. P. 108.
  5. ↑ Gottlieb Port, Hermann Euler: Textbook of Dentistry . Springer-Verlag, December 11, 2013, ISBN 978-3-662-40967-1 , p. 200.
  6. ↑ R. Trushkowsky: Restoration of a cracked tooth with a bonded amalgam. In: Quintessence international. Volume 22, Number 5, May 1991, pp. 397-400, PMID 1924694 .
  7. ^ ST Talim, KS Gohil: Management of coronal fractures of permanent posterior teeth. In: The Journal of prosthetic dentistry. Volume 31, Number 2, February 1974, pp. 172-178, PMID 4520665 .
  8. Jump up teeth , Endodontics Master Club. Retrieved January 27, 2019.
  9. ↑ Pellet in wild hare fillet - restaurant guests are entitled to compensation and compensation for pain and suffering, Waldkirch district court, judgment of January 27, 2000 - 1 C 397/99. Retrieved January 4, 2019.
  10. ↑ Wilhelm Braun: Product Liability - Producer Liability: A Guide for Practice . Books on Demand, September 29, 2016, ISBN 978-3-8423-1734-5 , pp. 90-92.
  11. ↑ tooth off to cherry confectionery: Insurance must pay , Federal Court decision 9C_553 /, 2013. Retrieved January 4, 2019.
  12. ↑ Liability for foreign bodies in food when visiting a restaurant . Retrieved January 5, 2019.
  13. ↑ pellet effect in: dental knowledge lexicon, Sa-Sm. Retrieved January 6, 2019.
  14. ↑ Stefanie Morlok: Holistic dentistry: your teeth, your body, the connections . BoD - Books on Demand, November 4, 2015, ISBN 978-3-7386-4843-0 , p. 23.
  15. ↑ Alex Motsch: Function-oriented grinding technique for natural teeth . Hanser, 1978, ISBN 978-3-446-12665-7 . , P. 22.