Primary dental trauma and trauma assessment Flashcards
how can the age of bruise be determined?
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
what are some indicators of abuse?
- lip burns and bruises
- torn frenum
- oral syphillis
- bite marks
- palatal erythema
- bruises in various stages of healing
Deescribe a general plan when treating primary dental trauma
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
how can injuries affecting the primary dentition be classified broadly?
1) crown fractures
2) root fractures
3) Periodontal tissue injury (luxations)
4) Injury to soft tissues
5) Injury to supporting bone
How do injuries in the primary dentition differ to that of the permanent dentition?
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
what are some predisposing factors to injuries to the primary dentition?
1) malocclusion (increased overjet)
2) Physical/ medical conditions (physical and intellectual ddisabbilities)
3) Accident prone children
what steps should be carried out during the assessment and diagnosis stage?
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
what investigations should be carried out during the assessment stage?
radiographs pulp asessment (?? reliability in small cchildren) ttp mobility displacement colour
what are the signs of a closed head injury?
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
how should lacerations/ abrasions be treated?
check for tooth remnants
debris needs to be scrubbed off with antiseptic
avoid skin closure unless competent
perioperative IV antibiotics, check tetanus status
how should degloving injuries be managed?
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
What are the 5 types of crown fractures of the primary dentition and how are they managed?
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
how should a root fracture of a primarry tooth be managed?
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
What is a concussion injury and how should it be managed?
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
What is subluxationi and how should this be managed?
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
What is a lateral luxation and how should this be managed?
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.
What is extrusive luxation and how is this managed?
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
What is an intrusive luxation and how is this best managed?
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
what is an avulsion and how is this best managed?
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
What are the possible sequelae to trauma to the primary dentition?
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
How can damage to the permanent successor from trauma to primary teeth be classified?
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
