9. Trauma management in primary dentition Flashcards
How does the primary dentition differ from the secondary dentition?
- 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
What percentage of traumatic dental injuries affect primary dentition?
22.7%
What is the most common age that dental trauma affects?
2-6 years
What is the most common dental injury?
Periodontal tissue injuries
What are parental instructions that you need to give to a child after trauma?
- 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
What is pulp tests in primary teeth like?
They are generally unreliable and so not recommended
What radiographs can you use for trauma teeth?
- parallel technique- get a parent to hold size 0 film behind traumatised tooth
- USO- generally size 2 film
What can happen to the colour of the crown in trauma?
Crown discolouration
May fade
May remain asymptomatic
What does a yellow tooth mean?
The yellow colour often means you have tertiary dentine being laid down.
Pulp canal obliteration is likely to occur.
What does it mean when you have a red tooth?
Internal bleeding and internal resorption
Why is it important to extract apical periodontitis tooth?
Will affect the successor
What are sites of accidental injury?
Forehead, nose, chin, palm of hand, elbows, knees, shins, parietal bone, occiput
Where are sites of non-accidental injury?
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
What is the triangle of safety?
Ears, side of face, neck, top of shoulders
What do social services do?
Check the child protection register
What is concussion?
- 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
What is the treatment for concussion?
Monitor, OHI, soft diet and analgesia
What is subluxation?
Injury to the tooth supporting structures with abnormal loosening but without displacement
- may be bleeding in the gingival sulcus
- radiographic appearance is normal
What is the treatment for subluxation?
Monitor, OHI, soft diet, analgesia
Review 1 week and 6-8 weeks.
Maybe review longer if concerns
What is extrusive luxation?
Partial displacement of tooth out of socket
- tooth appears elongated
- mobile
What does the treatment of extrusive luxation depend on?
- degree of displacement
- mobility- too mobile may inhale
- root formation
- cooperation from pt
What is the treatment for extrusive luxation if it is small?
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
What is the treatment for extrusive luxation if it is severe?
If it is more than 3mm, and occlusion is affected then consider extracting
What is lateral luxation?
Lateral displacement of the tooth in its socket, accompanied by comminution or fracture of the alveolar bone
What are the features of lateral luxation?
- 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
What does the radiograph of lateral luxation show?
Apical displacement
What is the tx for lateral luxation when there is no occlusal interference?
The tooth is allowed to reposition spontaneously
What is the tx for lateral luxation whrn there is minor occlusal interference?
Slight occlusal grinding
What is the tx for lateral luxation when there is more severe occlusal interference?
Tooth can be gently repositioned and splinted and best to seek specialist care
How often should you review lateral luxation?
1 week, 6-8 weeks, 6 months, 1 year
When may you need to extract a tooth with lateral luxation?
When there is severe displacement, when the crown is dislocated in a labial direction
What is intrusive luxation?
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.
What does a foreshortened image of luxated tooth imply?
That the root apex is labial so shorter distance to the x ray source
What does an elongated image of a luxated tooth imply?
Displacement towards the follicle so longer distance to x ray source
What is the treatment for luxation?
If the apex is displaced, then allow for spontaneous re-eruption.
Refer if concerned.
When may you need to extract a intrusive luxation?
If there is severe displacement of the root into the developing tooth germ
When do you review intrusive luxation?
1 week, 6-8 weeks, 6 months, 1 year
Then age 6 years on monitor the eruption of the permanent successor pathway
What is avulsion?
Tooth is completely out of socket
What is the tx for avulsion?
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
What is the treatment for uncomplicated enamel fracture?
Monitor or smooth
What is the treatment for uncomplicated enamel and dentine fracture?
Monitor
Smoothen sharp edges
Depending on cooperation, restore with GIC or composite
What is the treatment for complicated tooth fracture?
- if possible preserve pulp vitality by partial pulpotomy
- the treatment is depending on the child’s maturity and ability to cope
- or XLA
What is the success rate of root treated primary teeth?
- 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
What is the treatment for crown/root fracture?
- 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
What is the treatment of root fracture?
None or Mild displacement- monitor
- modeate/severe displacement- extraction of the coronal fragment, leave apical fragment to resorb
What are the complications of trauma to primary teeth?
Discolouration
Pulp obliteration
Pulpal necrosis- swelling/sinus
Resorption- internal/external
Ankylosis- intruded teeth
Cyst formation
Damage to successor
What are common discolourations of primary teeth?
- yellowish
- grey/blue-black- necrotic pulp
- pink- internal resorption
What is the likelihood of getting trauma in secondary dentition dependent on?
- 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
What are sequalae to the secondary dentition?
Hypomineralisation of enamel
Crown dilacerations
Root dilacerations
Partial/complete arrest of root formation
Disturbance in eruption
What things do you include in a referral latter?
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
