Paediatric Trauma II Flashcards
What is the prevalence of non-accidental injury?
Prevalence 0.1-10%
Children under 2 most at risk severe NAI
RF: poverty, parents abused, parent low intelligence, substance abuse
How to spot sign NAI?
Delay seeking tx
Inconsistent hx
Abnormal child reaction/interaction w/ parents
Withdrawn child
What injuries may be suggestive NAI?
Injuries of different vintage Burns account 10% Bizarre lesions in odd sites Frenum tears Bite marks
What is the triangle of safety?
Area unlikely to have contact/ injuries - accidental injury
Ears, side of face and neck
What makes clinical management in children more complicated?
Young age - limited co-operation
Large pulp:tooth tissue ratio
Concerns regarding developing permanent dentition
How common are crown factors and how manage?
4-38% injuries
- Infractions - monitor
- Enamel fracture - grinding in ncessary
- Enamel/ dentine - adhesive restorartion
- Complicated - pulp-cap/ pulpectomy, XLA
How common are crown/ root fractures and how to manage?
2% injuries
Tx choice = XLA
How common are root fractures and how to manage?
Uncommon
Unlikely before physiological root resorption started
Supportive advice , XLA coronal fragment
What in included in supportive advice?
Analgesia, soft diet, OHI - chlorhexidine if too sore
How common are luxation injuries?
62-69%
How manage concussion?
Tooth tender, not mobile = supportive advice and review
How manage subluxation?
Tooth tender and mobile but not displaced = supportive advice and review
How to manage intrusion?
X-ray to confirm presence is severe intrusion and relation to permanent successor
Leave to re-erupt 2-4 months
Supportive advice and regular clinical/ radiographic examination
XLA if displaced into follicle of perm successor
How to manage lateral lunation?
Depend direction of displacement
- Palatal (root labially positioned) - leave providing not in traumatic occlusion
- Labially - reposition or extract
If tooth mobile and danger of inhaling - XLA
How to manage avulsion?
Do not reimplant primary teeth
Why must trauma cases be followed up?
Sequelae to injured primary tooth and also developing permanent successor
What might you see with primary tooth following trauma?
Change in colour - pink/grey - not indication for interventive tx in absence other sign/symptoms Loss vitality External/internal root resorption Canal obliteration/ sclerosis Failure to exfoliate
How often are permanent successors damaged following primary trauma?
12-69% cases
Type and severity dependent type of injury and the age at which it occurred (increased prevalence w/ younger age of primary tooth trauma)
Which luxation injuries cause most damage to permanent successors?
Intrusion> avulsion> extrusion > subluxation
What changes may you seen to permanent successor?
Enamel opacities Enamel hypoplasia Crown dilaceration Odontoma-like malformation Partial/ complete arrest root formation Disturbance in eruption
What problem worried about if teeth fail to erupt?
Space closure - take radiograph to confirm presence before space closes
