Primary dental trauma and trauma assessment

Question 0

how can the age of bruise be determined?

Answer 0

0-2 days - swollen and tender
2-5 days - red and blue
5-7 days - green
7-9 days - yellow
9+ days - brown then clearing

Question 1

what are some indicators of abuse?

Answer 1

• lip burns and bruises
• torn frenum
• oral syphillis
• bite marks
• palatal erythema
• bruises in various stages of healing

Question 2

Deescribe a general plan when treating primary dental trauma

Answer 2

1) reduce anxiety
2) good histories (trauma, medical, dental)
3) assess level of co-operation
4) examination
5) radiographs + photos
6) discussion
7) management/ referral
8) follow-up

Question 3

how can injuries affecting the primary dentition be classified broadly?

Answer 3

1) crown fractures
2) root fractures
3) Periodontal tissue injury (luxations)
4) Injury to soft tissues
5) Injury to supporting bone

Question 4

How do injuries in the primary dentition differ to that of the permanent dentition?

Answer 4

1) thinner and more elastic alveolar bone
2) Teeth more likely to be displaced with alveolar bone fracture (1-3 yrs)
3) Physiological root resorption (4-6 yrs) also predispposes to displacement or avulsion

Question 5

what are some predisposing factors to injuries to the primary dentition?

Answer 5

1) malocclusion (increased overjet)
2) Physical/ medical conditions (physical and intellectual ddisabbilities)
3) Accident prone children

Question 6

what steps should be carried out during the assessment and diagnosis stage?

Answer 6

1) ascertain reason for visit
2) take histories (medical, dental, social, family)
3) trauma history (when, where, how, how was it managed at the time)
4) examination (i/o + e/o)
5) investigations

Question 7

what investigations should be carried out during the assessment stage?

Answer 7

radiographs
pulp asessment (?? reliability in small cchildren)
ttp
mobility
displacement
colour

Question 8

what are the signs of a closed head injury?

Answer 8

1) altered or loss of consciousness
2) bleeding from ears or head
3) disorienntation, nausea, vomiting, ammnesia
4) altered vision, unilateral dilated pupil
5) seizures or convulsions
6) speech difficulties

Question 9

how should lacerations/ abrasions be treated?

Answer 9

check for tooth remnants
debris needs to be scrubbed off with antiseptic
avoid skin closure unless competent
perioperative IV antibiotics, check tetanus status

Question 10

how should degloving injuries be managed?

Answer 10

1) careful debridement and antiseptic preparation
2) tight resorbable suturing and pressure dressing (lower arch)
3) perioperative IV Ab and check tetanus status
4) consider oral Ab
5) soft diet 7 days

Question 11

What are the 5 types of crown fractures of the primary dentition and how are they managed?

Answer 11

1) Enamel only: restore
2) Enamel and dentine: restore with adhesive restoration
3) Enamel, dentine and cementum: extract or restore with adhesive restoration
4) Enamel, dentine and pulp: extract or restore with pulpotomy/pulpectomy and extracoronal adhesive restoration
5) enamel, dentine, cementum and/or pulp: exttract

Question 12

how should a root fracture of a primarry tooth be managed?

Answer 12

check level of fracture and mobility

1) coronal third and mobile: extract
2) apical third and minor mobility: leave and monitor closely. if coronal segment becomes non-vital, extract this segment and allow remaining root to resorb physiologically

Question 13

What is a concussion injury and how should it be managed?

Answer 13

Injury to the tooth and ligament without dissplacement or mobility
-> no invasive treatment, PA, reassurance, soft diet for a week, advise on sequelae, follow up

Question 14

What is subluxationi and how should this be managed?

Answer 14

Tooth has mobility but is not displaced. There is injury to PDL.
-> No invasive tx necessary. PA’s. Reassurance. Soft diet for a week. advise on sequelae, follow up

Question 15

What is a lateral luxation and how should this be managed?

Answer 15

Displacement of tooth other than along its long axis.
Management:
- Unually no invasive Tx. If severe (into crossbite), exttract.
- PA’s, soft diet 7 days, advise on sequalae and follow up.

Question 16

What is extrusive luxation and how is this managed?

Answer 16

Displacement of the tooth coronally, partially out of its socket.
Management:
- Usually extraction (repositioning may damage permanent successor)
- PA’s, soft diet 7 days, advise on sequalae and follow up

Question 17

What is an intrusive luxation and how is this best managed?

Answer 17

Displacement of the tooth apically into alveolar bone
Mangement:
- assessment, radiographs, extent of intrusion
1) crown visible: leave and monitor
2) crown not visible: extract
3) apex perforates buccal plate: extract
4) dento-alveolar/ soft tisssue trauma: extract
- advise on ssequalae and follow-up

Question 18

what is an avulsion and how is this best managed?

Answer 18

complete ddisplacement of tooth out off its socket coronally
Managemtn:
DO NOT REPLANT! (may damage permanent successor)
- PA’s, soft diet 7 days, advise on seaqualae and follow-up
- check that tooth has not been aspirated or swallowed

Question 19

What are the possible sequelae to trauma to the primary dentition?

Answer 19

1) discolouration of the tooth (may subside)
2) Calcification of the pulp chamber and rroot
3) Loss of vitality which may lead to a chronic apical infection and development of buccal sinus and facial cellulitis
4) Internal or pathologguical eternal resorption
5) Ankylosis of primary tooth

Question 20

How can damage to the permanent successor from trauma to primary teeth be classified?

Answer 20

Direct: Root of ddeciduous tooth impinges on the ccrown of the permanent succcesor
Indirect: when the deciduous tooth becomes non-vital, peri-apical infectiion damages the permanent tooth