PAEDIATRIC TRAUMA I - INTRODUCTION / EPIDEMIOLOGY / DIAGNOSIS

Question 1

incidence of trauma in children

Answer 1

31-40% boys
16-30% girls
peaks at 2/3 yrs

Question 2

aetiologies

Answer 2

falls and collisions
climbing
contact sports
bikes ect
car accidents

assault
non accidental injury

Question 3

predisposing factors

Answer 3

increased overjet
poor lip coverage
previous trauma
epilepsy
poor motor control
obesity 
poor life circumstances
ADHD

Question 4

prevention

Answer 4

mouthgaurds
seatbelts
early otho interention
playground desgin

Question 5

classificaiton of injuries

Answer 5

hard tissue/fractures

luxation

Question 6

types of fractures/hard tissue

Answer 6

Infraction
Enamel fracture
Enamel-dentine (complicated or uncomplicated) fracture
Root fracture
Crown-root fracture
Dento-alveolar Fracture
Alveolar fracture

Question 7

types of luxations

Answer 7

Concussion
Subluxation
Luxation – lateral, intrusion, extrusion
Avulsion

Question 8

enamel infraction

Answer 8

crack/hairline fracture of the enamel

no loss of tooth structure

Question 9

uncomplicated crown fracture enamel

Answer 9

complete fracture

some enamel lost but not extended to dentine

Question 10

uncomplicated crown fracture enamel and dentine

Answer 10

loss into the dentine and crown
can be sensitive
can see outline of adj

Question 11

complicated crown fracture

Answer 11

involves the pulp

Question 12

root fracture

Answer 12

described by posotion apical 1/3, mid 1/4 and coronal 1/4
bleeding from socket, tooth mobile, interference with occlusion

• can be oblique, or horizontal

Question 13

crown root fracture

Answer 13

sub and supra gingival

Question 14

concussion

Answer 14

injury to tooth without abnormal loosening or displacement of the tooth

Question 15

subluxation

Answer 15

injury to tooth supporting tissues with abnormal loosening but without displacement of tooth

Question 16

intrusion

Answer 16

tooth moved inwards towards socket/apically

often complicaitons with healing

Question 17

extrusion

Answer 17

tooth has moved out of socket
may have gingivial lacerations
may appear longer
often mobile

Question 18

lateral luxation

Answer 18

rotation
ie crown moved palatally root moved labially
can fracture socket

Question 19

avulsion

Answer 19

tooth lost from socket
reimplant a permanent asap
dont reimplant a primary tooth

Question 20

how to reimplant

Answer 20

pick up by crown

place and splint in place

Question 21

alveolar injuries

Answer 21

crushing/compression of alvelar wall
fracture of alveolar socket wall
fracture of alveolar process
fracture of mx /md

Question 22

most common injury to permanent tooth

Answer 22

enamal fracture

luxation in primary tooth as bone is less dense

Question 23

examination

Answer 23

Teeth Charting
Fractures/ pulpal exposures
Discoloration (old injuries)
Mobility (luxation or root fracture?)
Displacement – visual/ occlusion/ Buccal tenderness
Tender to pressure?
Sound on percussion (ankylosis, old injury)
Occlusion Can the patient bite together, does it feel normal?

Question 24

radiographs

Answer 24

Assist initial diagnosis
Basis for comparison with later films
Size of pulp
State of development of apex
Presence of root fractures (2 x-rays at different angles)
State of periapical region
Lip lacerations – tooth/ glass fragments
Jaw fracture
Relation to permanent successor

Question 25

vitality testing

Answer 25

Clinically – discoloration, sinus
Ethyl chloride
Electric pulp testing
If tooth is concussed/ luxation injury, nerve damage may not recover for 3 months
Don’t need to do sensibility testing for acute injury when tooth is obviously vital