8. Trauma in the paediatric patient Flashcards
What resources can you use for trauma guidelines?
the british society of paediatric dentistry, dentaltraumaguide.org, dentaltrauma.co.uk, 2020 IADT guidelines
At 12 years of age, how many boys and girls suffer trauma?
16% boys and 8% girls
At 15 years of age how many boys and girls suffer trauma?
11% boys and 8% girls
What ages are children most prone to accident?
Between 2-4 years and 7-10 years
What is the most common injuries in the primary teeth?
Concussions, subluxations and luxations
What are the most common injuries in secondary teeth?
Uncomplicated crown fractures
What activities most likely cause injuries in the permanent dentition?
Horse riding accidents, bicycle accidents sports injuries, collisions at play
How does overjet affect trauma?
The more teeth involved in the overjet, the more number of affected teeth
What questions do you need to ask in trauma assessment?
How, what, when, where
Why is it important to ask how the trauma occured?
Assess if it is accidental or non-accidental. It may raise safeguarding concerns.
Why is it important to ask what occurred in the accident?
To see if any other symptoms need to be treated first like amnesia, loss of consciousness, headaches, vomiting
Why is it important to ask when the accident occured?
To see if there was a delay in receiving tx, to assess the prognosis of tx
Why is it important to ask where it occurred?
Medico-legal implications, if it was somewhere dirty or muddy then due to tetanus
What ages does a person get tetanus injection?
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.
What disorders are important to look for in the medical history?
- 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
What do you look for in the extra oral exam with trauma?
- asymmetries
- bony vision
- paraesthesia and vision- hold pen infront of eye and ask how many they see
- contusions, abrasions and lacerations
What do you look for in intra-oral exam with trauma?
- Hard/soft tissue injuries
- changes in occlusion
- changes in colour
- mobility
- tender to percussion
How does the WHO classify trauma injuries? (into 4)
- soft tissues (extra-oral)
- bony injuries
- associated- gingivae/oral mucosa- periodontium
- dental- crown/root
What are the 3 extra oral soft tissues injuries?
Contusion
Abrasion
Laceration
What is contusion?
Bruising
What is abrasion?
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.
What is laceration?
Cuts which go deep beyond the skin layer and potentially into muscles or other structures like facial nerve.
What is an illness/syndrome which may look like trauma?
Slapped cheek syndrome
Caused by parvovirus B19
also get temperature and lethargy
What are the 2 bony injuries you can have?
Communition and fracture
What is communition?
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.
Where can fractures occur in the bone?
Alveolar socket/process
Mandible/maxilla
Nasal complex
What are the 4 periodontal injuries?
Concussion
Subluxation
Luxation
Avulsion
What is concussion?
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.
What is subluxation?
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.
What is luxation and what can it be split into?
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
What is extrusive luxation?
Tooth appears more elongated and is excessively mobile
What is intrusive luxation?
Tooth has moved axially into the alveolar bone. It is non-mobile.
Metallic sound on tapping.
What is lateral luxation?
Tooth has been displaced palatally/lingually or labially.
It is immobile and has metallic sound on tapping.
What is avulsion?
Tooth is completely dislodged from its socket
What are the types of dental injuries?
- 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
What investigations can you do for trauma assessment?
- transillumination- hold light up to look for infractions
- radiographs
- sensibility tests- mechanical stimulation, EPT, ethyl chloride, doppler flowmetry
Where can root fractures occur on the root?
- apical third
- mid third
- gingival third
- important to know if it is with open or closed apex
How else can you sub-classify horizontal root fractures?
- number- single or multiple
- position of coronal fragment- displaced or not displaced
- extent- partial or total
How else can you classify vertical root fractures?
- fragment separation- complete or incomplete
- fracture position- supraosseous or intraosseous
