Paediatric trauma aetiology and classification

Question 1

What is the prevalence of paediatric trauma in the permanent dentition in children?
%
Peak incidence
Ratio

Answer 1

12% of 12 year olds
10% of 15 year olds have sustained a visible injury to one or more permanent incisors
Peak incidence 8-10 years
Male : female 2:1

Question 2

What is the difference in prevalence of in primary detition in girls and boys?

Answer 2

boys 31-40%

Girls 16-30%

Question 3

What is the prevalence for primary teeth aetiology?

Answer 3

Falls and collisions
Contact sports 
others: bicycle, swimming, car accidents, skiing, trampolining 
Assault
Non-accidental injury

Question 4

What are the predisposing factors to trauma in children?

Answer 4

Increased overjet 2x risk if >6mm
Poor lip coverage 
Previous trauma - increased risk of 4-30%
Epilepsy
Poor motor control
Obesity 
Poor life circumstances 
Attention deficit and hyperactivity disorder

Question 5

What can be done for prevention of paediatric trauma?

Answer 5

Mouthguards for sports 
Seatbelts 
Safety straps in wheelchiars
early orthodontic intervention 
Playground design

Question 6

what are the classifications of tooth fractures and treatment for each one?

Answer 6

Enamel infarction - hairline crack, dont do anything
Enamel fracture - uncomplicated crown fracture - put composite
Enamel-dentine - uncomplicated GIC or composite
Enamel-dentine - complicated = pulp exposed RCT
Root fracture - need to take radiograph in 2 planes - OPT and USO

Question 7

What are the different dentoalveolar injuries?

Answer 7

Concussion
Subluxation
Luxation - intrusion or extrusion or lateral or avulsion

Question 8

What is concussion?

Answer 8

injury to tooth supporting structures without abnormal loosening or displacement of the tooth

Question 9

What is subluxation?

Answer 9

On examination it is mobile

Injury to tooth supporting tissues with abnormal loosening but without displacement of the tooth

Question 10

What is luxation?

Answer 10

Displaced and moved position

Can be intrusion, extrusion, lateral, and avulsion

Question 11

What is intrusion?

Answer 11

tooth has moved up into the bone

Question 12

What is extrusion?

Answer 12

Moved out of the tooth socket will be mobile and sore

Question 13

What is lateral luxation?

Answer 13

Buccal or palatal - sounds like dull noise

Question 14

What is avulsion?

Answer 14

completely lost from socket

Question 15

What do you do if theres avulsion to a primary tooth?

Answer 15

Nothing, dont put back in

Question 16

What is the clinical appearance of alveolar injuries?

Answer 16

Groups of teeth move together

Question 17

What are the different alveolar injuries?

Answer 17

Crushing/compression of alveolar wall
Fracture of alveolar socket wall
Fracture of alveolar process
Fracture of maxilla +/- mandible

Question 18

What is the most common injury to a permanent tooth?

Answer 18

enamel fracture

Question 19

What is the prognostic factor of the primary management of tooth?

Answer 19

Time
If fractured want to cover teeth as soon as possible
Luxation want to reposition tooth as soon as possible

Question 20

What is included in a history for presenting with tooth trauma?

Answer 20

C/O
HPC
When
Where 
How
Lost tooth or fragment accounted for
Head injury or other associated injuries 
Treatment elsewhere
PMH: cardiac/diabetes/epilepsy/bleeding disorder/allergies/tetanus
PDH
Safeguarding concerns

Question 21

What needs to be included on an E/O examination on pt that attends with trauma?

Answer 21

Bony; step deformities, unable to open/close jaw
Soft tissues: take x-ray on soft tissue exposure; swelling, bruising, lacerations
Can include diagram/photos

Question 22

What needs to be included on an I/O examination on pt who attends with trauma?

Answer 22

Soft tissues, lacerations, haematoma, torn fraenum

Question 23

What needs to be done when examining teeth of patient that presents with trauma?

Answer 23

Charting 
Fractures/pulpal 
Discolouration
Mobility - luxation or root fracture 
Displacement - check visually, occlusion, buccal tenderness
Tender to pressure?
Sound on percussion - ankylosis

Question 24

What needs to be checked on a radiograph of a pt that attends with trauma?

Answer 24

Basis for comparison with later films
Size of pulp
State of development of apex
Presence of root fractures
State of periapical region
Lip lacerations - tooth/glass fragments
Jaw fracture
Relation to permanent successor

Question 25

What tests can be done to check vitality?

Answer 25

Clinically discolouration /sinus
Ethyl chloride
Electric pulp testing

Question 26

When do you not need to do sensibility testing?

Answer 26

Don’t need to do sensibility testing for acute injury hen tooth is obviously vital

Question 27

Why may you get a false negative for the vitality test?

Answer 27

If tooth is concussed/luxation injury, nerve damage may not recover for 3 months