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Paediatrics > 9. Trauma management in primary dentition > Flashcards

9. Trauma management in primary dentition Flashcards

1
Q

How does the primary dentition differ from the secondary dentition?

A
  • allows some displacement without fracture (the resilient bone allows a degree of bounce)
  • tooth discolouration is more common
  • root fractures are rare
  • underlying successors must be considered
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2
Q

What percentage of traumatic dental injuries affect primary dentition?

A

22.7%

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3
Q

What is the most common age that dental trauma affects?

A

2-6 years

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4
Q

What is the most common dental injury?

A

Periodontal tissue injuries

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5
Q

What are parental instructions that you need to give to a child after trauma?

A
  • use soft bristle tooth brush
  • use gauze or muslin cloth to make sure there are no plaque deposits on the area of healing
  • alcohol free CHX
  • soft diet initially
  • look for signs of infection like sinus, swelling
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6
Q

What is pulp tests in primary teeth like?

A

They are generally unreliable and so not recommended

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7
Q

What radiographs can you use for trauma teeth?

A
  • parallel technique- get a parent to hold size 0 film behind traumatised tooth
  • USO- generally size 2 film
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8
Q

What can happen to the colour of the crown in trauma?

A

Crown discolouration
May fade
May remain asymptomatic

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9
Q

What does a yellow tooth mean?

A

The yellow colour often means you have tertiary dentine being laid down.
Pulp canal obliteration is likely to occur.

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10
Q

What does it mean when you have a red tooth?

A

Internal bleeding and internal resorption

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11
Q

Why is it important to extract apical periodontitis tooth?

A

Will affect the successor

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12
Q

What are sites of accidental injury?

A

Forehead, nose, chin, palm of hand, elbows, knees, shins, parietal bone, occiput

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13
Q

Where are sites of non-accidental injury?

A

Ears, inner aspects of arms, back and side of trunk, black eyes, soft tissues of cheeks, forearms when raised, chest and abdomen, groin/genital, inner aspect of thighs, soles of feet

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14
Q

What is the triangle of safety?

A

Ears, side of face, neck, top of shoulders

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15
Q

What do social services do?

A

Check the child protection register

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16
Q

What is concussion?

A
  • Injury to the tooth supporting structures without abnormal loosening or displacement of tooth
  • Usually TTP
  • Radiograph not normally indicated unless there is clinical signs of pathology
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17
Q

What is the treatment for concussion?

A

Monitor, OHI, soft diet and analgesia

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18
Q

What is subluxation?

A

Injury to the tooth supporting structures with abnormal loosening but without displacement
- may be bleeding in the gingival sulcus
- radiographic appearance is normal

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19
Q

What is the treatment for subluxation?

A

Monitor, OHI, soft diet, analgesia
Review 1 week and 6-8 weeks.
Maybe review longer if concerns

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20
Q

What is extrusive luxation?

A

Partial displacement of tooth out of socket
- tooth appears elongated
- mobile

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21
Q

What does the treatment of extrusive luxation depend on?

A
  • degree of displacement
  • mobility- too mobile may inhale
  • root formation
  • cooperation from pt
22
Q

What is the treatment for extrusive luxation if it is small?

A

If extrusive luxation is smaller than 3mm and there is no occlusal interference then observe
Then review in 1 week, 6-8 weeks, 1 year

23
Q

What is the treatment for extrusive luxation if it is severe?

A

If it is more than 3mm, and occlusion is affected then consider extracting

24
Q

What is lateral luxation?

A

Lateral displacement of the tooth in its socket, accompanied by comminution or fracture of the alveolar bone

25
Q

What are the features of lateral luxation?

A
  • Tooth is usually displaced palatally so the root normally goes labially or buccally, and the tip of the apex is moved away from the permanent successor
  • immobile due to locked position
  • high ankylotic tinny percussion tone
  • may be bleeding in sulcus
26
Q

What does the radiograph of lateral luxation show?

A

Apical displacement

27
Q

What is the tx for lateral luxation when there is no occlusal interference?

A

The tooth is allowed to reposition spontaneously

28
Q

What is the tx for lateral luxation whrn there is minor occlusal interference?

A

Slight occlusal grinding

29
Q

What is the tx for lateral luxation when there is more severe occlusal interference?

A

Tooth can be gently repositioned and splinted and best to seek specialist care

30
Q

How often should you review lateral luxation?

A

1 week, 6-8 weeks, 6 months, 1 year

31
Q

When may you need to extract a tooth with lateral luxation?

A

When there is severe displacement, when the crown is dislocated in a labial direction

32
Q

What is intrusive luxation?

A

The tooth has moved in an apical direction, and usually displaced through the labial bone plate.
Can be impinging upon the successor bud.
Record the length of tooth visible.

33
Q

What does a foreshortened image of luxated tooth imply?

A

That the root apex is labial so shorter distance to the x ray source

34
Q

What does an elongated image of a luxated tooth imply?

A

Displacement towards the follicle so longer distance to x ray source

35
Q

What is the treatment for luxation?

A

If the apex is displaced, then allow for spontaneous re-eruption.
Refer if concerned.

36
Q

When may you need to extract a intrusive luxation?

A

If there is severe displacement of the root into the developing tooth germ

37
Q

When do you review intrusive luxation?

A

1 week, 6-8 weeks, 6 months, 1 year
Then age 6 years on monitor the eruption of the permanent successor pathway

38
Q

What is avulsion?

A

Tooth is completely out of socket

39
Q

What is the tx for avulsion?

A

Do not replant as can damage follicle underneath
- radiographic examination necessary if tooth lost and unsure if intruded or aspirated
- review in 6-8 weeks
- then age 6 years monitor eruption pathway of permanent successor

40
Q

What is the treatment for uncomplicated enamel fracture?

A

Monitor or smooth

41
Q

What is the treatment for uncomplicated enamel and dentine fracture?

A

Monitor
Smoothen sharp edges
Depending on cooperation, restore with GIC or composite

42
Q

What is the treatment for complicated tooth fracture?

A
  • if possible preserve pulp vitality by partial pulpotomy
  • the treatment is depending on the child’s maturity and ability to cope
  • or XLA
43
Q

What is the success rate of root treated primary teeth?

A
  • 64%
  • Of these, 60% of permanent successors had a disturbance of enamel formation
  • Traumatised teeth without pulp treatment- only 21% have enamel disturbances in successors
44
Q

What is the treatment for crown/root fracture?

A
  • if uncomplicated, try to remove the fragment and restore if tooth is stable and no pulp exposure
  • all other cases, and if the pulp is involved then consider XLA
45
Q

What is the treatment of root fracture?

A

None or Mild displacement- monitor
- modeate/severe displacement- extraction of the coronal fragment, leave apical fragment to resorb

46
Q

What are the complications of trauma to primary teeth?

A

Discolouration
Pulp obliteration
Pulpal necrosis- swelling/sinus
Resorption- internal/external
Ankylosis- intruded teeth
Cyst formation
Damage to successor

47
Q

What are common discolourations of primary teeth?

A
  • yellowish
  • grey/blue-black- necrotic pulp
  • pink- internal resorption
48
Q

What is the likelihood of getting trauma in secondary dentition dependent on?

A
  • age of child- 66% if less than 3 years old and 24% if more than 3 years old
  • type of trauma
  • developmental stage of permanent successor
49
Q

What are sequalae to the secondary dentition?

A

Hypomineralisation of enamel
Crown dilacerations
Root dilacerations
Partial/complete arrest of root formation
Disturbance in eruption

50
Q

What things do you include in a referral latter?

A

Practice address and telephone number
Letter date (+/- clinic date)
Name and address of consultant patient is to be referred to
Name and date of birth (age) of patient Patient’s address and telephone number Reason for referral/patient’s complaint
Degree of urgency of referral
General medical history
Relevant dental and social history Looked after child? Clinical/unusual features Provisional diagnosis
Legible signature of referring practitioner and printed name

51
Q
A

Paediatrics (8 decks)

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