Dental injuries in children Flashcards
What are the most commonly affected teeth wrt dental injuries?
Max incisors
What are the most common injuries?
Primary dentition - luxation injuries
Permanent dentition - enamel fractures
What ages do peak incidences occur?
2-4 years - primary incisors
7-10 - perm incisors
m>f (2:1)
Injuries in babies
Highly unlikely - non accidental injury
Injuries in infants
Due to trips and falls as cognitive and motor skills develop
Injuries in childhood
Falls and accidents
Injuries in adolescence
Sporting, fights, assults
What are the predisposing factors towards dental injury
Class 2 div 1 - proclined incisors
lack of soft tissue coverage
increased overjet (3-6mm 2x freq)(>6mm = 3x freq)
medical or physical impairment (cerebral palsy, autism, epilepsy)
Accident prone children, aggressions ADHD and lack of parental supervision
MH questions to check
Bleeding disorders
Reduced immunity
Allergies
Medications
Immunisation status (check tetanus)
Dental history questions to ask
Previous injury to the dentition and management
Past dental experience
Anxiety
Trauma history questions
What happened
When did it happen
How did it happen
Where did it happen
Loss of consciousness/ head injuries/ other injuries
Immediate management
EOE in dental injuries
Observe injuries elsewhere in body
Facial asymmetry
Observe from above and behind pt
Palpation of the facial skeleton
Facial injuries: swellings, lacerations, abrasions, contusions (bruises)
IOE in dental injuries
ST:
Lips, all mucosa palate, tongue, FOM
Check irregularities in occlusion
Teeth:
Position
Mobility
Loss of tooth tissue, i.e. fracture of parts of the tooth or loss of whole tooth
Radiographic examinations to take
PA
Occlusal
DPT
ST views
What is included on a trauma grid?
Colour
Mob
TTP
Vitality
Radiograph
What are you checking for in TTP?
Damage to the PDL (pain)
Percussion tone - if there is a change, the tooth could be locked into the bone due to an intrusive injury - metallic sound on tapping
What we checking with mobility?
Pulp vascularity changes with mobility
If there is a group of teeth that are mobile = alveolar bone fracture
What does transillumination check for?
Infractions of enamel (microcracks)
What tissues can be damaged in a dent-alveolar injury?
Hard tissues and pulp
Periodontal tissues
Supporting bone
Gingival or oral mucosa
What are the least to most severe dental injuries
Infraction, enamel fracture, enamel-dentine fracture, compl crown fracture, crown root fracture, root fracture
What the type of injury to the periodontal tissues
concussion
subluxation
extrusive luxation
lateral luxation
intrusive luxation
avulsion
What are the types of injury to the supporting bone?
Comminuition of the socket wall (crushing of the bone in intrusive/lateral luxation)
fracture of socket wall
fracture of alveolar process
fracture of mandible or maxilla
Injuries to gingivae or oral mucosa
Laceration
Contusion
Abrasion
Degloving injury
Signs of non accidental injury
Delayed presentation of dental trauma
Injuries that do not match the given history
inconsistencies in stories
Multiple injuries of different ages
Bruising of soft tissues not overlying bony prominences
injuries taking the shape of a recognisable object
Any oral injury in a newborn or pre-walking infant
What are the pulpal healing outcomes of fractured teeth?
Survival
Obliteration
Necrosis
How long does it take for the radiographic obliteration of pulp to occur?
3m - deposition of mineralised tissue in the pulp chamber walls
Causes yellow discolouration
What are the factors that influence the outcome of pulp?
Initial pulp status
Status of the apex - open apex, survival/obliteration
Time since injury - more time passes = necrosis
Concurrent injuries - PDL damage = necrosis
Luxation injuries of permanent teeth
Concussion and subluxation are unlikely to cause damage to pulp
Extrusive luxation
Palatal luxation
Intrusion
Avulsion
What is extrusive luxation
Partial displacement of tooth from socket
Identify if pulp, PDL or gingivae have been injured
Will pulp revascularise
Is there rupture of neurovascular bundle around tooth
Gingivae - will fibres reorganise
What is palatal luxation?
Displacement of tooth from the socket in a way other than axially
Is tooth locked in new position of bone
Compression zones
Complicated by bony damage
SPLINT
What is intrusive luxation?
Displacement of socket in to the alveolar bone
What is an avulsion?
Complete displacement of tooth from socket
minimise time that tooth is out of the socket. Tissues deteriorate due to dehydration, bacteria, cleaning products
What are the pulpal healing outcomes of luxation injuries?
Survival
Obliteration
Internal resorption
Necrosis
What are the factors that influence healing?
Status of apex - open/wide neuromuscular bundle - larger diameter = more likely to revascularise
Extent of injury - damage to PDL causes root resorption
Concomitant damage to the PDL
What is internal resorption?
Confused healing
Response to pulpal inflammation - needs to be connected to an apical blood supply
can look normal/pink in coronal/cervical area
continuous pulp chamber and canal outline (smooth)
What happens during necrosis of the pulp?
Asymptomatic or signs of irreversible pulpitis/necrotic pulp. TTT, discolouration, mobility.
Failure of revascularisation
Inflammatory resorption - damage to PDL and root surface. Irregular loss of tooth surface structure and surrounding alveolar bone.
Irregular appearance over root canal and misdiagnosed for internal resorption.
When does external inflammatory resorption occur?
damage to PDL and root surface
toxins and bacteria progress and travel via dentine tubules to root surface
Which teeth have zero chance of survival if they sustain these injuries?
intrusion and avulsion of teeth with closed apex
What is surface resorption?
Short resorpative phase
repair related and traumata related
transient apical breakdown at root and adjacent bone
discolouration - no sensitivity
widening of PDL space and lamina dura
Apical radiolucency
due to an inflammatory change rather than bacteria.
Non infective pressure resorption of underlying cementum and dentine. self limiting and transient BUT pulp is vital.
What is inflammatory resorption?
Post avulsion/luxation
Influenced by pulp vitality
Infection, necrosis related surface resorption
pathognomic pulpal necrosis
more likely with a mature apex
What is replacement resorption?
When ankylosis occurs
related to death of the PDL
Progressive
What is replacement resorption?
When ankylosis occurs
related to death of the PDL
Progressive
Cells attach to root surface before cementum can - resorption
Necrotic pulp
Loss of vitality
Endo may or may not stop resorption - no successful tx
What is apexogenesis?
stimulation of the pulp tissue to encourage completion of root development in a previously healthy pulp after pulpal exposure
What is the goal of apexogenesis?
maintain pulp vitality
support root development
Which teeth should apexogenesis be used for?
Maintain pulp vitality
Support root development
Immature non vital tooth
Extirpate
Apexification - establish calcific apical barrier - MTA plug at apex instead of biodentine
Goal - to facillitate endo obturation
