Primary Dentition Trauma Flashcards
injuries to baby teeth are most common at what age
1.5-2.5 years of age
most commonly injured primary tooth
upper central incisor
treatment for concussion of primary tooth
soft diet
monitor
follow up for concussion of primary tooth
1 week, 6-8 weeks
radiograph only when clinical findings suggestive of pathosis
what are the unfavourable outcomes to warn parents of after concussion of primary tooth
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
clinical presentation of subluxation of primary tooth
tender to touch, no displacement increased mobility, sulcular bleeding
treatment for subluxation of primary tooth
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
follow up for subluxation of primary tooth
1 week, 6-8 weeks, every year until eruption of permanent teeth if unfavourable outcome likely
radiographic findings for lateral luxation of primary tooth
slightly to significantly widened PDL space, best seen on occlusal exposure
when to leave and when to extract laterally luxated primary tooth
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
how to do immediate repositioning after lateral luxation of primary tooth
clean with water spray/saline/chlorhex
apply LA
reposition with even labial and palatal pressure
flexible split for 4 weeks if tooth unstable
treatment for delayed presentation of lateral luxaiton of primary tooth
cannot be repositioned anymore
if no occlusal interference, no pain, no signs of infection/swelling, no treatment needed
Suspected intrusion injury of primary tooth, take pa/occlusal to rule out
aspiration
avulsion
embedding into soft tissues
foreshortened vs elongated image of luxated primary tooth (radiography)
foreshortened imply root apex labial
elongation suggestion displacement palatally towards follicle, higher risk of injury to permanent tooth
treatment for intrusion of primary tooth
leave alone unless infection or failure to re erupt
how long does it take for intruded primary tooth to spontaneously reposition itself
usually occurs within 6 months, may take up to 1 year
follow up for intrusion of primary tooth
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
treatment for extrusion of primary tooth
1-2mm extrusion with no occlusal interference, leave alone
> 3mm or occlusion affected –> extract
what kind of radiographs do you want to take for an avulsed primary tooth
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
treatment of avulsed primary tooth
do not re implant as risk injuring permanent tooth
what to do if coronal segment of primary tooth with root fracture is unstable
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
what to do in crown fracture of primary tooth with no pulp exposure
leave alone
smoothen sharp edges
restore with CR eg strip crown, cover expised dentine with GIC
extract if unrestorable
what to do when there is alveolar fracture in a young child
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
positions for examination of child
knee to knee
seated on parent
restraint and sedation eg inhalation, im ketamine, GA
instructions to parents after treatment for trauma
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
yellow tooth discolouration following trauma is a sign of
pulp canal obliteration
effect of early loss of primary incisor
no effect on speech or occlusion, stabilises with eruption of permanent incisor
injury that is more likely to cause damage to permanent successor and at what age
intrusion, avulsion
below 2 years old 63% vs 25% > 5 years old. higher risk in younger child
what damage can occur to permanent successor following trauma to permanent tooth
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
