deciduous tooth trauma Flashcards
aetiology
falls
bumping into objects
non-accidental
which injury is commonest?
luxation (soft bones)
most common tooth affected
upper central incisors
pt management
reassure history exam diagnosis emergency tx advise parent of sequelae to permanent teeth further tx and review
injury history
when where how any other symptoms lost teeth/fragments
MH
RF
immunosuppressed/compromised
congenital heart defects
DH
prev trauma
tx experience
parent and child attitude
EO exam
laceration haematoma haemorrhage/CSF subconjunctival haemorrhage bony step deformities mouth opening
IO exam
ST (wounds, foreign bodies)
alveolar bone
occlusion - if traumatic need urgent tx
teeth
what might tooth mobility indicate?
displacement
root #
bone #
transillumination
shine curing light on teeth
may show # lines in teeth, pulpal degeneration, caries
tactile probe test
look for horizontal and vertical #s
pulpal involvement
classification
E# - uncomplicated ED# - uncomplicated EDP# - complicated CR# (pulp involved) R# alveolar # concussion/subluxation luxation - lateral, intrusive, extrusive avulsion
trauma stamp
mobility displacement colour TTP sinus p note radiograph
what might a dull p note indicate?
root #
long-term - ankylosis
why aren’t sensibility tests used?
pt factors - young child won’t understand/cooperate/may lie to please you
tooth morphology - unreliable results, less root due to resorption. blood vessels and nerves changing
immediate home management
soft diet 10-14 days
- can eat anything but chop up and eat with molars
- want some activity after couple days to stimulate PDL cells
brush teeth with soft TB after every meal
topical CHX by parent x2 daily for 1wk - CW rolls to swab
reviewing
1,3,6m
- radiographs if possible every 6m
intrusion requires monthly review for 6m then every 6m
- check it isn’t hitting permanent incisor - compare to contralateral tooth
E# tx
smooth sharp edges
OR
composite/compomer bandage/Rx - don’t use GI as won’t stay on well
ED# tx
composite/compomer bandage/Rx
don’t use GI as won’t stay on well
tx for EDP#
endo if v cooperative child - 2mm short of apex - not GP as won't resorb - use CaOH and Iodoform paste extract
CR# tx
extract coronal fragment
don’t remove any root fragments that aren’t obvious
leave to resorb physiologically
concussion and subluxation tx
observation
alveolar bone # tx
reposition
splint to adjacent teeth 3-4wks
teeth may need ext after alveolar stability has been achieved
only case where a splint would be used in management of primary trauma
- trying to immobilise bone
lateral luxation tx
no occlusal interference - leave to position spontaneously
occlusal interference - extract
what will lateral luxation show on xray?
increased PDL space apically
is localisation of intrusion parallax?
no as using one radiograph
localisation of intrusion radiographs
PA
lateral premaxilla
localisation of intrusion PA
compare to contralateral
apical tip appears shorter - displaced toward/through buccal bone
- preferable - away from developing tooth germ
apical tip indistinct and tooth elongated - towards permanent tooth germ
localisation of intrusion lat premaxilla
identified a direction of displacement as providing a lateral view
tx for intrusion
labial root displacement - leave to re-erupt
- if no progress after 6m ext - check each month that it is erupting (ankylosis - ext)
palatally - extract
tx of extrusion
extract
tx of avulsion
radiograph to confirm avulsion
do not replant
long term effects in primary teeth
discolouration
discolouration and infection
delayed exfoliation
delayed exfoliation
primary tooth may not resorb normally after trauma
extraction necessary or permanent successor will erupt ectopically
discolouration +/- infection : vital
no tx
discolouration +/- infection : non-vital and sinus/PAP
RCT or ext
discolouration +/- infection : non-vital and no sinus/PAP
leave and review
discolouration +/- infection : opaque
no tx
tertiary dentine laid down in pulp chamber, opacity has changed
discolouration and vitality
immediate - may maintain vitality
intermediate (weeks) - non-vital
injuries to permanent teeth
related to age of trauma to primary teeth
younger child = bigger chance of damage to permanent teeth - tell parent and record in notes
long term effects in permanent teeth
enamel defects 44% abnormal tooth/root morphology 8% - C/R dilaceration - C/R duplication delayed eruption 1% ectopic tooth position arrest in tooth formation complete failure of tooth to form odontome formation
enamel defects
type of defect depends on age hypomineralisation - white/yellow spot - normal E thickness hypoplasia - yellow/brown areas - less than normal thickness
hypomineralisation tx options
leave composite mask localised removal and restore composite external bleaching (microabrasion) ICON - resin infiltration
hypoplasia tx options
composite Rx
porcelain veneer when gingival level stabilised (20yrs)
tx of C dilaceration
surgical exposure
ortho realignment
improve appearance
tx of R dilaceration/duplication/angulation
combined surgical and ortho
tx of arrest of root development
RCT or extract
odontome tx
surgical removal
tx of undeveloped tooth germ
may sequestrate spontaneously or require removal
delayed eruption of permanent teeth
premature loss of a primary tooth can result in delayed eruption of about 1yr due to thickened mucosa (protect itself)
take radiograph if >6m delay compared to contralateral
surgical exposure and ortho may be required if abnormal morphology
- normally spontaneous eruption within 18m of uncovering
- if older sometimes use ortho and chain
discolouration - immediate/days after
pink
blood in dentine tubules
tends to be transient as pulp is still alive and vital tissue repairs itself
discolouration - few weeks after
grey/brownish
indicates tooth non-vital
happens a few weeks after pulp dies/becomes non-vital
- breakdown of necrotic pulp e.g. haemosiderin, eosin
- leaches into dentinal tubules
discolouration - several months after
yellow/opaque
pulp canal obliteration - sclerosis
tertiary dentine formation
pulp reacts (odontoblasts) to protect itself
long-term complications of primary incisor trauma
loss of vitality
abscess risk
may require extraction
delayed exfoliation
complications to permanent incisors following primary incisor trauma
delayed eruption ectopic eruption damage to crown development - hypoplasia - hypomineralisation damage to root development - dilaceration
