Paediatric trauma injury to the primary dentition

Question 1

What is the ages of peak incidence of trauma to the primary dentition? Why?

Answer 1

2-4 year olds

No sense of danger, same height as household objects

Question 2

What is the prevalence in boys and girls at 5 years onle?

Answer 2

Girls 16-30%

Boys 31-40%

Question 3

What is the aetiology of trauma to the primary dentition?

Answer 3

Falls and collisions
Non-accidental injury
Prolonged intubation - taped firmly to face, get luxation problem to upper incisors

Question 4

What is the most common injury to the primary dentition and which teeth involved?

Answer 4

Luxation - upper incisors

Question 5

What is the prevalence of non-accidental injury?

Answer 5

0.1-10%
1 per 1000 under 4 year olds in UK
Children <2 years most at risk

Question 6

What are the risk factors for NAI?

Answer 6

Poverty
Parents of low intelligence
Alcohol
Drug use
Single mother

Question 7

What are the signs of NAI?

Answer 7

Delay seeking treatment 
Inconsistent history 
Abnormal child reaction and interaction with parent 
Withdrawn child
50% injuries involve orofacial region 
multiple injuries of different vintage
burns 10% of injuries 
Fraenum tears
Bite marks

Question 8

What is the triangle of safety?

Answer 8

shouldnt have any bruises in the area as it shouldnt have contact to anything

Question 9

What are the possible differentials?

Answer 9

Impetigo
Birthmarks
Conjunctivitis

Question 10

What is the management of dental trauma?

Answer 10

Full history 
Intra and extra oral examination 
Special investigations 
Diagnosis and primary treatment
Review

Question 11

What are the complicating factors for clinical management of trauma?

Answer 11

Young age limited co-operation
Have large pulp:tissue ratio
Concerns regarding developing permanent dentition

Question 12

What is the clinical management of different crown fractures?
Infarctions
Enamel fractures
Enamel/dentine fractures
Complicated enamel/dentine fractures

Answer 12

infarctions - monitor
Enamel fracture - grinding if necessary
Enamel/dentine fractures - grinding or adhesive restoration
Complicated enamel/dentine fractures - pulp cap, pulpotomy, pulpectomy, extraction (most likely)

Question 13

What is the prevalence of crown fracture injuries?

Answer 13

4-38%

Question 14

What is the clinical management of crown/root fractures? with or without pulp involvement?

Answer 14

Extract

Question 15

What is the prevalence of crown/root fractures?

Answer 15

2%

Question 16

At which point are root fractures more unlikely?

Answer 16

before physiological root resorption started 3-4 years

Question 17

How does root fracture appear clincally?

Answer 17

Tooth slightly extruded - mobility dependent on fracture sight - radiograph required

Question 18

How can a root fracture be managed?

Answer 18

May do extraction of coronal segment only

Chlorhexidine mouthwash and soft sponges encourage to keep the area of the mouth clean

Question 19

What is the % of luxation injuries?

Answer 19

62-69%

Question 20

What are the different luxation injuries?

Answer 20

Concussion
Subluxation 
Intrusion
Lateral luxation 
Avulsion

Question 21

What is concussion and management?

Answer 21

Tooth tender
not mobile
give supportive advice and review

Question 22

What is subluxation and management?

Answer 22

Tooth tender and mobile
Not displaced
May be gingival haemorrhage
Supportive advice and review

Question 23

What is intrusion and its management?

Answer 23

X-ray to confirm presence of severely intruded tooth and relation to permanent successor
Leave to re-erupt 2-4 months
Supportive advice and regular clinical and radiographic review
Or
extraction if tooth displaced into follicle of the permanent successor

Question 24

What is the lateral luxation management?

Answer 24

Treatment depends on direction of root displacement
If crown displaced palatally can leave providing not in traumatic occlusion
If crown displaced labially reposition or extract
Splinting not necessary
If mobile tooth in danger of being inhaed

Question 25

What do you not do in avulsion in primary tooth?

Answer 25

Re-implant!!!

Question 26

What is the rationale for follow up for the primary tooth?

Answer 26

Because of sequelae to the injured primary tooth

Because of sequelae involving the developing permanent successors

Question 27

What is the primary tooth sequalae following trauma?

Answer 27

Change in colour - pink/grey, not an indication for interventive treatment in absence of ther signs/symptoms
Loss of vitality
Internal/external inflammatory root resorption
Canal obliteration/sclerosis
Failure to exfoliate normally

Question 28

What are the signs of loss of vitality of the tooth?

Answer 28

pain, extra-oral swelling, sinus formation, pathological mobility

Question 29

In how many cases to the primary dentition does it cause injury to the permanent dentition?

Answer 29

12-69%

Question 30

What does the type and severity of squelae in the permanent tooth depend on?

Answer 30

type of injury to the primary tooth and age that it occured

Question 31

What does sequelae to permanent tooth occur due to

Answer 31

Disturbances in mineralisation or morphology of developing tooth germ

Question 32

increased prevalence of damage to permanent tooth with…

Answer 32

younger age of primary tooth trauma

Question 33

What is the % of affected secondary teeth at these ages:
0-2
3-4
5-6
7-9

Answer 33

0-2 63%
3-4 53%
5-6 24%
7-9 25%

Question 34

Highest prevalence of damage to permanent tooth follows which type of injuries?

Answer 34

Luxation

Question 35

Which type of luxation injury causes the most damage to secondary teeth?

Answer 35

Intrusion 69%
Avulsion 52%
Extrusion 34%
Subluxation 27%

Question 36

What is the permanent tooth sequelae?

Answer 36

Enamel opacities (white/yellow/brown)
Enamel hypoplasia +/- opacity
Crown dilaceration - forming in one direction and goes off in another 
Odontoma 
Root duplication or dilaceration 
Partial/complete arrest of root formation 
Sequestration of permanent tooth germ 
Disturbance in eruption

Question 37

if 6 months after tooth exfoliated and still no tooth through what should you do?

Answer 37

if have failure of eruption of a tooth take radiograph before have space colosure