Paediatric Trauma II

Question 1

What is the prevalence of non-accidental injury?

Answer 1

Prevalence 0.1-10%
Children under 2 most at risk severe NAI

RF: poverty, parents abused, parent low intelligence, substance abuse

Question 2

How to spot sign NAI?

Answer 2

Delay seeking tx
Inconsistent hx
Abnormal child reaction/interaction w/ parents
Withdrawn child

Question 3

What injuries may be suggestive NAI?

Answer 3

Injuries of different vintage
Burns account 10%
Bizarre lesions in odd sites
Frenum tears
Bite marks

Question 4

What is the triangle of safety?

Answer 4

Area unlikely to have contact/ injuries - accidental injury

Ears, side of face and neck

Question 5

What makes clinical management in children more complicated?

Answer 5

Young age - limited co-operation
Large pulp:tooth tissue ratio
Concerns regarding developing permanent dentition

Question 6

How common are crown factors and how manage?

Answer 6

4-38% injuries

1. Infractions - monitor
2. Enamel fracture - grinding in ncessary
3. Enamel/ dentine - adhesive restorartion
4. Complicated - pulp-cap/ pulpectomy, XLA

Question 7

How common are crown/ root fractures and how to manage?

Answer 7

2% injuries

Tx choice = XLA

Question 8

How common are root fractures and how to manage?

Answer 8

Uncommon
Unlikely before physiological root resorption started
Supportive advice , XLA coronal fragment

Question 9

What in included in supportive advice?

Answer 9

Analgesia, soft diet, OHI - chlorhexidine if too sore

Question 10

How common are luxation injuries?

Answer 10

62-69%

Question 11

How manage concussion?

Answer 11

Tooth tender, not mobile = supportive advice and review

Question 12

How manage subluxation?

Answer 12

Tooth tender and mobile but not displaced = supportive advice and review

Question 13

How to manage intrusion?

Answer 13

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

Question 14

How to manage lateral lunation?

Answer 14

Depend direction of displacement

1. Palatal (root labially positioned) - leave providing not in traumatic occlusion
2. Labially - reposition or extract

If tooth mobile and danger of inhaling - XLA

Question 15

How to manage avulsion?

Answer 15

Do not reimplant primary teeth

Question 16

Why must trauma cases be followed up?

Answer 16

Sequelae to injured primary tooth and also developing permanent successor

Question 17

What might you see with primary tooth following trauma?

Answer 17

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

Question 18

How often are permanent successors damaged following primary trauma?

Answer 18

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)

Question 19

Which luxation injuries cause most damage to permanent successors?

Answer 19

Intrusion> avulsion> extrusion > subluxation

Question 20

What changes may you seen to permanent successor?

Answer 20

Enamel opacities
Enamel hypoplasia 
Crown dilaceration 
Odontoma-like malformation
Partial/ complete arrest root formation 
Disturbance in eruption

Question 21

What problem worried about if teeth fail to erupt?

Answer 21

Space closure - take radiograph to confirm presence before space closes