Dental Trauma of Primary teeth Flashcards
1
Q
What is the epidemiology of primary tooth trauma?
A
- Prevalence is 16-40%
- Male > Female
- Peak incidence 2-4years
- Max primary incisors
2
Q
What is the aetiology of primary tooth trauma?
A
- Falls
- Bumping into objects
- Non-accidental (child abuse)
3
Q
What are the types of “dental hard tissues and pulp” injury?
A
- Enamel # (uncomplicated crown #)
- Enamel and dentine # (uncomplicated crown #)
- Enamel, dentine and pulp # (complicated crown #)
- Crown-root #
- Root #
4
Q
What is a crown root fracture?
A
- Fracture involves enamel, dentine and root
- Pulp may or may be involved
- Complicated or uncomplicated
5
Q
What are the types of supporting tissue injury?
(periodontal tissue + bone)
A
- Concussion
- Subluxation
- Lateral luxation
- Intrusion
- Extrusion
- Avulsion
- Alveolar fracture
6
Q
What is a concussion injury?
A
- PDL injury
- Tooth TTP but not displaced from arch
- Normal mobility
- No bleeding from gingival sulcus
7
Q
What is subluxation injury?
A
- Tooth tender to touch
- Has increased mobility but not been displaced from line of arch
- Bleeding from gingival crevice
- tooth appears elongated
8
Q
what are the 3 types of luxation injury
A
- lateral luxation
- intrusion
- extrusion
9
Q
What is lateral luxation injury, clinical findings?
A
- Tooth displaced usually in palatal/lingual or labial direction (but not axially)
- with alveolar bone plate #
- tooth immobile
- high ankylotic percussion note
- root apex maybe palpable in sulcus
- bleeding from gingival sulcus
10
Q
What is intrusion injury and clinical findings ?
A
- Displacement of tooth into alveolar bone and locked in bone
- with alveolar socket #
- Tooth usually displaced through labial bone plate
- or can impinge on permanent tooth bud
- tooth immobile
- ankylotic high, metallic percussion note
- bleeding from gingivae
- ## shortened crown
11
Q
What is an extrusion injury?
A
- Type of luxation injury
- Partial displacement of tooth out its socket
12
Q
What is an avulsion injury and clinical findings?
A
- Tooth completely out of the socket
- Tooth totally displaced from socket
Clinical findings;
- Socket empty or filled with coagulum
13
Q
how to manage avulsion with tooth missing
A
- Location of missing tooth should be determined in history taking
- Risk of being embedded into soft tissues or more seriously inhaled
- If tooth not found send child for medical assessment in A&E department, esp if child has respiratory issues
14
Q
What is alveolar fracture injury?
A
- Fracture involved alveolar bone (labial and palatal/lingual
- May extend to adjacent bone
15
Q
what is common finding of alveolar fracture
A
- Mobility and dislocation of segment with several teeth moving together
- Occlusal interference
16
Q
What is the injury prevalence of different types of injury in primary dentition?
A
Luxation - 62-69%
Avulsion and ED fracture - 7-13%
Root fracture - 2-4%
Crown root fracture - 2%
17
Q
What are the steps when managing a patient with trauma?
A
- Reassurance
- History
- Examination
- Diagnosis
- Emergency treatment
- Important info
- Further treatment and review
18
Q
What is included in a trauma history?
A
Injury
- When?
- Where?
- How?
- Any other symptoms or injuries?
- Lost teeth/fragments?
Medical History
- Congenital heart disease (for infection risk)
- History of rheumatic fever or immunosuppression (for infection risk)
- Bleeding disorders (haematology team contact)
- Allergies (short course of antibiotics may be required)
- Tetanus immunisation status (may need booster - contact health advisor)
- (Liase with GP)
-
Dental History
- Previous trauma (may raise concerns about physical abuse or neglect)
- Treatment experience
- Legal guardian/child attitude
19
Q
What is included in the extraoral part of trauma examination?
A
Extraoral
- Lacerations/ swelling/ bruising (may require suturing or debridement
- Haematoma
- Haemorrhage / CSF
- Subconjunctival haemorrhage
- Bony step deformities
- Mouth opening (may be jaw #/ dislocation)
20
Q
What is included in the intraoral part of trauma examination?
A
- Soft tissues (laceration/bruises/foreign bodies etc)
- Alveolar bone #
- Occlusion (traumatic occlusion demands urgent treatment)
- Teeth (mobility may indicate displacement, root or bone fractures)
- Transillumination may show lines in teeth (crazing), pulpal degeneration, caries
- Tactile test with probe may help detect horizontal and or vertical #, pulpal involvement
- Percussion (duller note indicate root #)
21
Q
What special investigations can be used in a trauma examination?
A
- Trauma stamp x6
22
Q
What radiographs can you request in trauma examination?
A
- Periapical
- Anterior occlusal
- Lateral pre-maxilla (extra -oral)
- OPT
- Soft tissue
23
Q
What are the possible diagnosis’ that can be made for each traumatic tooth?
A
Fracture
- Enamel (Uncomplicated crown fracture)
- Enamel-Dentine (Uncomplicated crown fracture)
- Enamel-Dentine-Pulp (Complicated crown fracture)
- Crown-Root (Uncomplicated or complicated)
- Root
- Alveolar
Concussion
Subluxation
Luxation
Lateral / Intrusive / Extrusive
Avulsion
24
Q
What to do during an emergency situation?
A
- Observation is often most appropriate option in emergency situation
- Provision of dental treatment depends on child’s maturity and ability to cope - don’t want to make child more anxious
25
When to interfene/ treat in emergency situation?
when there's risk of
- aspiration
- ingestion
- occlusal interference
26
What important info do you need to tell parent/carer ?
- Analgesia - pain relief
- Soft diet for 10-14days (can be normal diet but cut everything small, chew with molars)
- Ensure good **oral hygiene**
- Brush teeth with soft toothbrush after every meal
- **Topical chlorhexidine gluconate 0.12% mouthrinse** applied topically twice daily for one week
- Warn about signs of infection
27
How to manage an enamel fracture (primary tooth)?
- Smooth sharp edges using Sof Lex disc
28
How to manage an enamel-dentine fracture (primary )?
- Best to cover all exposed dentine with glass ionomer/composite
- Lost tooth structure can be restored immediately with composite resin or at a later visit
-( Gold standard material: composite)
29
How to manage enamel-dentine-pulp fracture (primary)?
Options
* **Partial pulpotomy** (LA, non setting CaOH on pulp, thin layer of GI cement, restored with comp)
* **Extraction**
Both options involve LA and depend on child's ability to manage treatment
- Discuss options with parent/carer
- Can cause dental anxiety
30
How to manage a crown-root fracture (primary)?
- Remove loose fragment and determine if crown can be restored
If restorable
- No pulp exposed, cover exposed dentine with GI
- Pulp exposed: pulpotomy or endodontic treatment
If Unrestorable
- Extract loose fragments
- Don't dig
31
How to manage a root fracture (primary)?
**If coronal fragment not displaced**
* no tx indicated
**If coronal fragment displaced but not excessively mobile**
* Leave fragment to spontaneously reposition even if some occlusal interference
**If coronal fragment displaced, excessively mobile and interfering with occlusion**
* Option A - Extract only loose coronal fragment
* Option B - Reposition loose coronal fragment with flexible splint
32
How to manage a concussion injury(primary)?
- No treatment
- Observation
33
How to manage a subluxation injury(primary)?
- No treatment
- Observation
34
How to manage lateral luxation injury(primary)?
**If minimal / no occlusal interference**
- allow to reposition spontaneously
**If severe displacement**
- Extraction (preferred)
- Reposition with flexible splint (1 tooth either side for 4 weeks )
35
How to manage an intrusion injury(primary)?
- Allow to **spontaneously reposition** (appear in 6mo - 1yr), irrespective of direction of displacement
36
what radiographs should be taken in intrusion injury?
-PA or
- lateral premaxilla (extra-oral film)
37
Based on radiographs what are the two scenarios of intrusion with respect to direction of displacement?
**Scenario 1**
- Apical tip of intruded tooth can be seen
- Tooth appears shorter (aka **foreshortened**) compared to contralateral tooth
- Apex displaced towards/through labial bone plate
- Less likely to impinge on permanent successor
**Scenario 2**
- Apex of intruded tooth can't be visualised
- Tooth appears elongated compared to contralateral
- Suggest Apex displaced toward permanent tooth germ and increased risk of damage to permanent tooth developing
38
How to manage extrusion injury (primary)?
If not interfering with occlusion
- Spontaneous repositioning
Excessive mobility or extruded **>3mm**
- Extract
39
How to manage avulsion injury (primary)?
- Radiograph to confirm avulsion
- In primary dentition a primary tooth should NOT be reimplanted
40
How to manage an alveolar fracture?
- Reposition segment that is mobile or causing occlusal interference
- Stabilised with flexible splint to adjacent uninjured teeth for **4 weeks**
- Teeth may need to be extracted after alveolar stability has been achieved
41
Which guideline to follow for paeds trauma
- Dental Trauma UK
- Dental Trauma Guide
- IADT
**International Association of Dental Traumatology Guidelines**
42
What are the 3 sequelae of trauma to primary tooth?
1. Discolouration
2. Discolouration and infection
3. Delayed exfoliation
43
what does mild grey discoloration tell?
- intra-pulpal bleeding
- pulp vital
- immediate discoloration may maintain vitality
-discolor may recede
44
what does opaque/ yellow discoloration tell?
- pulp obliteration
- response of vital pulp
- laying down more dentine for protection
45
how to manage traumatic primary tooth with discoloration only (no infection)?
- no tx
- review
46
What is pulp obliteration?
- response of vital pulp,
- deposition of more dentine along internal walls of root canal that fills pulp
- pulp narrowed and restricted
47
What to do when traumatic tooth presents with **discolouration and infection** ?
- Extract or endodontic treatment
- caution: time of exfoliation
（Tooth is symptomatic and non-vital）
48
what are the signs and symptoms assoc. with a traumatised non-vital tooth?
- sinus/ abscess
- gingival swelling
- tenderness to pressure
- increased mobility
- radiographic evidence of periapical pathology
49
Consequences of delayed exfoliation?
- ectopic eruption of permanent successor,
- delay / prevent eruption,
- Have consequences on **occlusion** and **aesthetics** and **confidence** of child
50
which type of dental trauma causes most disturbance to permanent successor?
intrusion
51
How are injuries to permanent teeth related to age of trauma in primary teeth?
**0-2 yo has 63%** chance of injury to permanent
3-4 yo = 58%
5-6 yo= 24%
7-8 yo= 25%
52
What injuries can occur to permanent successor following trauma in primary dentition x7?
- Enamel defects (most common)
- Abnormal crown/root morphology (duplication/ dilaceration)
- Delayed eruption
- Ectopic tooth position
- Arrested development
- Complete failure of tooth to form
- Odontome formation
53
what are the 2 types of enamel defects?
- enamel hypomineralisation
- enamel hypoplasia
54
What is enamel hypomineralisation, presentation and how to treat?
- **Qualitative defect** of enamel i.e. normal thickness but poorly mineralised
- White/ yellow defect
Treatment
- No treatment
- Composite masking +/- localised removal
- Tooth whitening
55
What is enamel hypoplasia, presentation and how to treat it?
- Quantitative defect of enamel i.e. **reduced thickness** but **normal mineralisation**
- Yellow/brown defect
Treatment
- No treatment
- Composite masking
56
What is Dilaceration?
- **Abrupt deviation** of **long axis** of crown or root portion of the tooth
57
What are **crown** dilaceration management options?
- Surgical exposure and orthodontic realignment
- Improve aesthetics restoratively
58
What are **root** dilaceration/angulation/duplication management options?
- Combined surgical and orthodontic approach
59
what can lead to delayed eruption?
- premature loss of primary tooth
- around 1 year
(due to thickened mucosa)
60
How to manage delayed eruption due to traumatic primary dentition?
- Radiograph if > 6 month delay compared to contralateral tooth
- Surgical exposure and orthodontic alignment may be required
- (gold chain attach, flap reposition, ortho bracket and arch wire incorportated )
61
cause of ectopic tooth position
- retention of primary tooth
- primary tooth trauma displacing permanent tooth
62
How to manage ectopic tooth position?
- Surgical exposure and orthodontic realignment
- Extraction
63
How to manage arrested development due to traumatic primary dentition?
- Endodontic treatment (with favourable root length)
- Extraction
64
How to manage complete failure of tooth to form due to traumatic primary dentition?
- Tooth germ may **sequestrate** spontaneously
- Or require removal
65
What is an odontome?
- tumour formed by overgrowth or transitory of dental tissue
66
tx option of odontome
surgical removal
67
What does complicated and non complicated mean?
Complicated - pulp involved
Non-complicated - pulp not involved
68
