paeds trauma

Question 1

What is the prevalence of trauma in permanent dentition?

Answer 1

12% of 12 years and 10% of 15 years had visible injury to a permanent incisor
~2013

But there’s been a decline over the decades
Peak incidence- 8-10 years
2:1 male:female

Question 2

What is the prevalence of trauma in primary dentition?

Answer 2

Peak incidence- 2-3 years
Boys- 31-40%
Girls- 16-30%

Question 3

What is the aetiology of trauma?

Answer 3

Falls and collisions
Assault
Non accidental injury

Question 4

What are predisposing factors to trauma?

Answer 4

Increased overjet (2x risk if >6mm)
Poor lip coverage
Previous trauma
Epilepsy
Poor motor control
Obesity
Poor life circumstances
ADHD

Question 5

How can you prevent trauma?

Answer 5

Mouthguards for sports
Seatbelts
Safety straps in wheel chairs
Early ortho intervention
Playground design

Question 6

What are the classifications of injuries?

Answer 6

HARD TISSUE/FRACTURES
-infraction (crack w/o loss of tooth structure)
-enamel fracture (most common injury to permanent)
-enamel-dentine fracture (un/complicated)
-root fracture (horizontal, or oblique- crown-root, or vertical)
-crown-root fracture
-dento-alveolar fracture
-alveolar fracture

LUXATION (most common to primary)
-concussion
-subluxation
-lateral/intrusion/extrusion luxation
-avulsion

Question 7

What is a concussion?

Answer 7

Injury to tooth supporting structures w/o abnormal loosening or displacement of the tooth

Bleeding, tenderness

Question 8

What is subluxation?

Answer 8

Injury to tooth supporting tissues with abnormal loosening but w/o displacement of the tooth

Bleeding, tenderness

Question 9

What is luxation?

Answer 9

INTRUSION- moved apically, May look avulsed, should take radiograph, complications w healing
EXTRUSION- moved out of socket, gingival lacerations? Appears longer, usually mobile, interferes w occlusion
LATERAL- tipping, may be able to palpate root

Question 10

What is avulsion?

Answer 10

Should reimplant a permanent tooth ASAP (within 15 mins) but NOT a primary tooth as it may affect development of successor

Pick up from crown, place it back in and splint (or hold in position til you get to a dentist)

Question 11

What are alveolar injuries?

Answer 11

Crushing/compression of alveolar wall
# of alveolar socket wall
# of alveolar process
# of maxilla/mandible

Haematoma in FOM
Laceration
Place a plate to fix

Question 12

Where could the tooth go?

Answer 12

Inhaled
Swallowed
In a laceration
Accounted for

Question 13

How do you do an examination?

Answer 13

EO- step deformities, unable to open/close jaw, swelling, bruising, lacerations, wound contamination

Helps to clean the pt up

Should include a diagram, take clinical photos

IO- lacerations, haematoma, torn fraenum

Can take a soft tissue exposure by reducing the exposure and taking X-ray of lip/cheek

Discolouration (old injury)

Sound on percussion (dull tone indicated ankylosis, old injury)

Does occlusion feel different?

Question 14

Why should you take radiographs?

Answer 14

Assist initial diagnosis
Basis for comparison to later films
Size of pulp (larger=more blood supply=better healing)
Development of apex
Presence of root # (needs 2 angles)
State of PA region
Lip lacerations
Jaw #
Relation to permanent successor

Question 15

Why should you do sensibility testing?

Answer 15

Ethyl chloride
Electric pulp testin
Nerve damage may not recover for 3 months
It tooth is obviously vital don’t do
Unreliable for kids- they can’t explain esp EPT
Discolouration/sinus- clinically

Question 16

What are non accidental injury statistics?

Answer 16

0.1-10%
<2 years most at risk
Risk factors- poverty, parents abused/low intelligence, alcohol, drug abuse, single mother

Question 17

What are indicators of non accidental injuries?

Answer 17

Delay in seeking tx
Inconsistent hx
Abnormal child reaction/interaction w parent
Withdrawn child
50% involve orofacial region
Hx doesn’t match presentation of injury

Question 18

What are clinical signs of non-accidental injury?

Answer 18

Multiple injuries of different vintages
Burns (10%)
Bizarre lesions, odd sites
Fraenum tears
Bite marks
Facial injuries in soft areas
Hand prints
Cigarette burns

Ears (pinch marks)
Triangle of safety (ears, side of face, neck, top of shoulders)
Black eyes (esp bilateral)
Intra oral

Question 19

How should you manage fractures?

Answer 19

Infraction- monitor

Enamel#- grind if necessary

Enamel/dentine#- grind/adhesive restoration

Complicated- pulp cap, pulpotomy, pulpectomy, extraction

Crown/root- extraction

Root# (unlikely)- apical and unproblematic- leave to heal, extraction

Question 20

How should you manage luxations?

Answer 20

Concussion and subluxation- supportive advice and review

Intrusion- relate to successor, if displaced into follicle, extract, otherwise allow to re erupt, supportive advice and review

Lateral- relate to successor again, if placed buccally, root is palatal so probably extract, or if tooth is v mobile extract

NEVER REIMPLANT A PRIMARY

Question 21

What is supportive advice?

Answer 21

Soft diet for 2 weeks
OHI
Signs to be aware of that the tooth is non vital

Question 22

Why is it important to follow up?

Answer 22

1. Due to sequelae to injured primary
2. Sequelae involving permanent successor

Question 23

What are signs of non vitality in primary teeth?

Answer 23

Change in colour- pink/grey (however may just indicate interventive tx)
Pain
Swelling
Sinus
Mobility
Failure to exfoliate
Root resorption
Canal obliteration/sclerosis

Question 24

What is permanent tooth sequelae?

Answer 24

12-69% of injury to primary
Type and severity depends on type of injury and age
Disturbance in mineralisation/morphology of developing tooth germ

Question 25

What is the prevalence of damage to permanent teeth w a primary injury?

Answer 25

0-2 yrs- 63%
3-4 yrs- 53%
5-6 yrs- 24%

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

Question 26

What could happen to a permanent tooth after an injury to the primary?

Answer 26

Enamel opacities (white/brown/yellow)
Hypoplasia
Crown dilaceration
Odontoma like malformation
Root duplication/dilaceration
Partial/complete arrest of root formation
Sequestration of permanent tooth germ
Disturbance in eruption