Primary Dentition Trauma

Question 1

injuries to baby teeth are most common at what age

Answer 1

1.5-2.5 years of age

Question 2

most commonly injured primary tooth

Answer 2

upper central incisor

Question 3

treatment for concussion of primary tooth

Answer 3

soft diet

monitor

Question 4

follow up for concussion of primary tooth

Answer 4

1 week, 6-8 weeks

radiograph only when clinical findings suggestive of pathosis

Question 5

what are the unfavourable outcomes to warn parents of after concussion of primary tooth

Answer 5

symptomatic

pulpal necrosis – persistent dark grey infection + sinus tract/gingival swelling/increased mobility

no further root development of teeth

negative impact on development/eruption of permanent successor

Question 6

clinical presentation of subluxation of primary tooth

Answer 6

tender to touch, no displacement increased mobility, sulcular bleeding

Question 7

treatment for subluxation of primary tooth

Answer 7

soft diet
analgesics
parent/patient education: eat carefully so as to not further traumatise while encouraging return to normal function, keep area clean to encourage gingival healing

Question 8

follow up for subluxation of primary tooth

Answer 8

1 week, 6-8 weeks, every year until eruption of permanent teeth if unfavourable outcome likely

Question 9

radiographic findings for lateral luxation of primary tooth

Answer 9

slightly to significantly widened PDL space, best seen on occlusal exposure

Question 10

when to leave and when to extract laterally luxated primary tooth

Answer 10

leave alone if no occlusal interference, stable, can be spontaneously repositioned

extract is occlusal interference, tooth pushed into developing tooth bud, excessive mobility hence risk of aspiration

Question 11

how to do immediate repositioning after lateral luxation of primary tooth

Answer 11

clean with water spray/saline/chlorhex
apply LA
reposition with even labial and palatal pressure
flexible split for 4 weeks if tooth unstable

Question 12

treatment for delayed presentation of lateral luxaiton of primary tooth

Answer 12

cannot be repositioned anymore

if no occlusal interference, no pain, no signs of infection/swelling, no treatment needed

Question 13

Suspected intrusion injury of primary tooth, take pa/occlusal to rule out

Answer 13

aspiration
avulsion
embedding into soft tissues

Question 14

foreshortened vs elongated image of luxated primary tooth (radiography)

Answer 14

foreshortened imply root apex labial

elongation suggestion displacement palatally towards follicle, higher risk of injury to permanent tooth

Question 15

treatment for intrusion of primary tooth

Answer 15

leave alone unless infection or failure to re erupt

Question 16

how long does it take for intruded primary tooth to spontaneously reposition itself

Answer 16

usually occurs within 6 months, may take up to 1 year

Question 17

follow up for intrusion of primary tooth

Answer 17

1 week
6-8 weeks
6 months
1 year
further follow up at 6 years old for severe intrusion to monitor eruption of permanent teeth

Question 18

treatment for extrusion of primary tooth

Answer 18

1-2mm extrusion with no occlusal interference, leave alone

> 3mm or occlusion affected –> extract

Question 19

what kind of radiographs do you want to take for an avulsed primary tooth

Answer 19

PA or occlusal radiograph to ensure missing tooth has not been intruded. can also provide baseline assessment to see if developing permanent tooth affected

chest x ray if tooth aspirated

Question 20

treatment of avulsed primary tooth

Answer 20

do not re implant as risk injuring permanent tooth

Question 21

what to do if coronal segment of primary tooth with root fracture is unstable

Answer 21

extract the coronal segment and leave the apical segment, do not dig around for apical segment as close to permanent successor. when permanent successor erupts, spontaneous resorption of root segment

Question 22

what to do in crown fracture of primary tooth with no pulp exposure

Answer 22

leave alone
smoothen sharp edges
restore with CR eg strip crown, cover expised dentine with GIC
extract if unrestorable

Question 23

what to do when there is alveolar fracture in a young child

Answer 23

in most cases, alveolar fracture can be manually manipulated bakc to original position

stabilise segment with flexible splinting for 4 weeks

monitor teeth in fracture line to see if they become non vital

Question 24

positions for examination of child

Answer 24

knee to knee
seated on parent
restraint and sedation eg inhalation, im ketamine, GA

Question 25

instructions to parents after treatment for trauma

Answer 25

soft diet to prevent further trauma to injured tooth

oral hygiene measures to encourage gingival healing and prevent bacterial accumulation. support tooth when brushing. clean with soft bursh or cotton swab for first few days. alcohol free 0.1% chlorhex gluconate mouth rinse applied twice a day topically for one week

Advise about possible complications, what to look out for and when to bring child in for treatment before scheduled appointment eg signs and symptoms of loss of vitality

Question 26

yellow tooth discolouration following trauma is a sign of

Answer 26

pulp canal obliteration

Question 27

effect of early loss of primary incisor

Answer 27

no effect on speech or occlusion, stabilises with eruption of permanent incisor

Question 28

injury that is more likely to cause damage to permanent successor and at what age

Answer 28

intrusion, avulsion

below 2 years old 63% vs 25% > 5 years old. higher risk in younger child

Question 29

what damage can occur to permanent successor following trauma to permanent tooth

Answer 29

white or brown discolouration

odontome like malformation, may have hypoplastic areas

dilaceration of crown or root

failure of tooth development, sequestration of permanent tooth germ