8. Trauma in the paediatric patient

Question 1

What resources can you use for trauma guidelines?

Answer 1

the british society of paediatric dentistry, dentaltraumaguide.org, dentaltrauma.co.uk, 2020 IADT guidelines

Question 2

At 12 years of age, how many boys and girls suffer trauma?

Answer 2

16% boys and 8% girls

Question 3

At 15 years of age how many boys and girls suffer trauma?

Answer 3

11% boys and 8% girls

Question 4

What ages are children most prone to accident?

Answer 4

Between 2-4 years and 7-10 years

Question 5

What is the most common injuries in the primary teeth?

Answer 5

Concussions, subluxations and luxations

Question 6

What are the most common injuries in secondary teeth?

Answer 6

Uncomplicated crown fractures

Question 7

What activities most likely cause injuries in the permanent dentition?

Answer 7

Horse riding accidents, bicycle accidents sports injuries, collisions at play

Question 8

How does overjet affect trauma?

Answer 8

The more teeth involved in the overjet, the more number of affected teeth

Question 9

What questions do you need to ask in trauma assessment?

Answer 9

How, what, when, where

Question 10

Why is it important to ask how the trauma occured?

Answer 10

Assess if it is accidental or non-accidental. It may raise safeguarding concerns.

Question 11

Why is it important to ask what occurred in the accident?

Answer 11

To see if any other symptoms need to be treated first like amnesia, loss of consciousness, headaches, vomiting

Question 12

Why is it important to ask when the accident occured?

Answer 12

To see if there was a delay in receiving tx, to assess the prognosis of tx

Question 13

Why is it important to ask where it occurred?

Answer 13

Medico-legal implications, if it was somewhere dirty or muddy then due to tetanus

Question 14

What ages does a person get tetanus injection?

Answer 14

8 weeks- 1st tetanus
12 weeks- 2nd tetanus
16 weeks- 3rd tetanus
3 years 4 months- tetanus booster
13-18 years- tetanus booster
May need a tetanus injection if wound has broken skin and tetanus injections are not up to date.

Question 15

What disorders are important to look for in the medical history?

Answer 15

• Bleeding disorders- might need to discuss tx with haematologist
• Cardiac disease- may need antibiotic cover to prevent risk of bacteraemia
• epilepsy
• allergies
• tetanus status
• special care patients

Question 16

What do you look for in the extra oral exam with trauma?

Answer 16

• asymmetries
• bony vision
• paraesthesia and vision- hold pen infront of eye and ask how many they see
• contusions, abrasions and lacerations

Question 17

What do you look for in intra-oral exam with trauma?

Answer 17

• Hard/soft tissue injuries
• changes in occlusion
• changes in colour
• mobility
• tender to percussion

Question 18

How does the WHO classify trauma injuries? (into 4)

Answer 18

• soft tissues (extra-oral)
• bony injuries
• associated- gingivae/oral mucosa- periodontium
• dental- crown/root

Question 19

What are the 3 extra oral soft tissues injuries?

Answer 19

Contusion
Abrasion
Laceration

Question 20

What is contusion?

Answer 20

Bruising

Question 21

What is abrasion?

Answer 21

Superficial wearing of skin when the surface layer of skin is removed. Within the abrasions, you may see grit or tarmac that is embedded into the skin.

Question 22

What is laceration?

Answer 22

Cuts which go deep beyond the skin layer and potentially into muscles or other structures like facial nerve.

Question 23

What is an illness/syndrome which may look like trauma?

Answer 23

Slapped cheek syndrome
Caused by parvovirus B19
also get temperature and lethargy

Question 24

What are the 2 bony injuries you can have?

Answer 24

Communition and fracture

Question 25

What is communition?

Answer 25

When the bone is broken in at least 2 places, and splinters into more than 2 fragments. In children more likely to have a green stick injury where the bone moves but it is less likely to break.

Question 26

Where can fractures occur in the bone?

Answer 26

Alveolar socket/process Mandible/maxilla Nasal complex

Question 27

What are the 4 periodontal injuries?

Answer 27

Concussion Subluxation Luxation Avulsion

Question 28

What is concussion?

Answer 28

Tooth has received a blow which has not broken the tooth, caused it to be displaced out of its normal periodontal membrane space, and it is not mobile. Likely to be TTP.

Question 29

What is subluxation?

Answer 29

A tooth has been knocked, it is mobile but has not been displaced from its proper location. May see microvascular tears along. the blood supply of the root and bleeding at the gingival sites.

Question 30

What is luxation and what can it be split into?

Answer 30

A displacement of the tooth from its original position in the alveolar socket, which has led to displacement of the alveolar bone surrounding it. Extrusive, intrusive, lateral

Question 31

What is extrusive luxation?

Answer 31

Tooth appears more elongated and is excessively mobile

Question 32

What is intrusive luxation?

Answer 32

Tooth has moved axially into the alveolar bone. It is non-mobile. Metallic sound on tapping.

Question 33

What is lateral luxation?

Answer 33

Tooth has been displaced palatally/lingually or labially. It is immobile and has metallic sound on tapping.

Question 34

What is avulsion?

Answer 34

Tooth is completely dislodged from its socket

Question 35

What are the types of dental injuries?

Answer 35

- Infraction- incomplete fracture of enamel without loss of tooth structure - enamel fracture - enamel-dentine fracture - enamel-dentine-pulp fracture - crown-root fracture without pulp exposure - crown-root fracture with pulp exposure - root fracture - only ones that may be tender are if they include the root

Question 36

What investigations can you do for trauma assessment?

Answer 36

- transillumination- hold light up to look for infractions - radiographs - sensibility tests- mechanical stimulation, EPT, ethyl chloride, doppler flowmetry

Question 37

Where can root fractures occur on the root?

Answer 37

- apical third - mid third - gingival third - important to know if it is with open or closed apex

Question 38

How else can you sub-classify horizontal root fractures?

Answer 38

- number- single or multiple - position of coronal fragment- displaced or not displaced - extent- partial or total

Question 39

How else can you classify vertical root fractures?

Answer 39

- fragment separation- complete or incomplete - fracture position- supraosseous or intraosseous