Paediatric trauma aetiology and classification Flashcards
What is the prevalence of paediatric trauma in the permanent dentition in children?
%
Peak incidence
Ratio
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
What is the difference in prevalence of in primary detition in girls and boys?
boys 31-40%
Girls 16-30%
What is the prevalence for primary teeth aetiology?
Falls and collisions Contact sports others: bicycle, swimming, car accidents, skiing, trampolining Assault Non-accidental injury
What are the predisposing factors to trauma in children?
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
What can be done for prevention of paediatric trauma?
Mouthguards for sports Seatbelts Safety straps in wheelchiars early orthodontic intervention Playground design
what are the classifications of tooth fractures and treatment for each one?
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
What are the different dentoalveolar injuries?
Concussion
Subluxation
Luxation - intrusion or extrusion or lateral or avulsion
What is concussion?
injury to tooth supporting structures without abnormal loosening or displacement of the tooth
What is subluxation?
On examination it is mobile
Injury to tooth supporting tissues with abnormal loosening but without displacement of the tooth
What is luxation?
Displaced and moved position
Can be intrusion, extrusion, lateral, and avulsion
What is intrusion?
tooth has moved up into the bone
What is extrusion?
Moved out of the tooth socket will be mobile and sore
What is lateral luxation?
Buccal or palatal - sounds like dull noise
What is avulsion?
completely lost from socket
What do you do if theres avulsion to a primary tooth?
Nothing, dont put back in
What is the clinical appearance of alveolar injuries?
Groups of teeth move together
What are the different alveolar injuries?
Crushing/compression of alveolar wall
Fracture of alveolar socket wall
Fracture of alveolar process
Fracture of maxilla +/- mandible
What is the most common injury to a permanent tooth?
enamel fracture
What is the prognostic factor of the primary management of tooth?
Time
If fractured want to cover teeth as soon as possible
Luxation want to reposition tooth as soon as possible
What is included in a history for presenting with tooth trauma?
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
What needs to be included on an E/O examination on pt that attends with trauma?
Bony; step deformities, unable to open/close jaw
Soft tissues: take x-ray on soft tissue exposure; swelling, bruising, lacerations
Can include diagram/photos
What needs to be included on an I/O examination on pt who attends with trauma?
Soft tissues, lacerations, haematoma, torn fraenum
What needs to be done when examining teeth of patient that presents with trauma?
Charting Fractures/pulpal Discolouration Mobility - luxation or root fracture Displacement - check visually, occlusion, buccal tenderness Tender to pressure? Sound on percussion - ankylosis
What needs to be checked on a radiograph of a pt that attends with trauma?
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
What tests can be done to check vitality?
Clinically discolouration /sinus
Ethyl chloride
Electric pulp testing
When do you not need to do sensibility testing?
Don’t need to do sensibility testing for acute injury hen tooth is obviously vital
Why may you get a false negative for the vitality test?
If tooth is concussed/luxation injury, nerve damage may not recover for 3 months
