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Paediatrics > Primary Tooth Trauma > Flashcards

Primary Tooth Trauma Flashcards

1
Q

Most common aetiologies for primary tooth trauma

A
  • Falls
  • 0-4 year old infants learning to walk
  • Bumping into objects
  • Non-accidental injury
  • Patients with disability eg epilepsy, CP
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2
Q

Predisposing factors to primary tooth trauma

A
  • Epilepsy
  • Hyperactivity
  • Protrusion of upper incisors
  • Increased overate and insufficient lip cover
  • Poor motor coordination
  • Anterior open bite
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3
Q

What teeth are most commonly affected during primary tooth trauma

A

-Maxillary centrals

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4
Q

What type of trauma is most common

A

Luxation most common

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5
Q

Name the different types of injuries in order of most common to least common

A
  • Luxation- 65%
  • Avulsion- 10%
  • ED#- 10%
  • EDP#- 10%
  • CR#- 10%
  • Root #- 4%
  • Enamel infraction- 2%
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6
Q

How to manage a patient as they walk into clinic with a primary tooth fracture

A
  • History
  • Examination
  • Diagnosis
  • Emergency treatment
  • Advise parent of sequelae to permanent teeth
  • Further treatment and review
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7
Q

What types of questions should be answered in the history of trauma

A
  • Presenting complaint
  • When,
  • How
  • Where
  • Who
  • Has tx been provided elsewhere
  • Has there been previous trauma
  • Are teeth/frsgments all accounted for
  • If avulsed how long in storage medium and what storage medium
  • Previous dental trauma
  • MH
  • Any systemic signs
  • Swallow?
  • MEchanism of injury (fall, bicycle, sport, assault)
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8
Q

What should you look for during the extra oral examination

A
  • General appearance
  • Facial asymmetry
  • Laceration
  • Contrusion (crowding)
  • Bruising
  • Abrasion
  • Swelling
  • TMJ Assymmetry
  • Fracture of facial skeleton
  • Foreign body/tooth fragment
  • Palpate bony borders of both maxillae and mandible
  • Soft tissue lesions
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9
Q

What should be looked for during intra oral examination

A
  • Gingival injury
  • OH
  • Tooth missing
  • Type of injury
  • Crown fracture (E/D/P)
  • Discolouration
  • Sinus/swelling
  • Percussion
  • Mobility
  • TTP
  • Response to EC
  • Response to EPT
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10
Q

What should be looked for during rx of primary trauma case

A
  • Root fracture
  • Root development
  • Permanent successor
  • Crown fracture proximity to pulp
  • Foreign body
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11
Q

What should you always be suspicious about and why

A
  • Orofacial signs such as bruises and abrasions from non accidental injuries
  • Discrepency between trauma history provided by parents and injuries found on examination or delay in presentation should arouse suspicions
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12
Q

What social history must you consider

A
  • Living with parents
  • Age
  • FrankL score
  • Type of school
  • Behaviour
  • Siblings
  • Habits eg. use of dummies
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13
Q

What medical history points are important

A

-Loss Of consciousness , cardiac conditions, bleeding disorders and allergies

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14
Q

What special investigations would you ideally like to do in children trauma cases?
But what realistically can you actually do

A

Ideally:

  • Colour
  • TTP
  • EPT
  • EC
  • Percussion
  • Sinus
  • Mobility

Realistically:

  • Colour
  • Sinus
  • Mobility
  • TTP
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15
Q

Classify types of dental trauma injuries

A
  • Avulsion
  • Alveolar fracture
  • Root fracture
  • Extrusion
  • Lateral luxation
  • Intrusion
  • Subluxation
  • Concussion
  • Crown-Root fracture
  • Crown fracture
  • None
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16
Q

Describe how you could diagnose a intrusion injury

A
  • Partial displacement of tooth from socket
  • No mobility
  • Tooth appears intruded rather than proclaimed/retroclined
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17
Q

Describe how you could diagnose a crown fracture

A
  • No displacement of the tooth
  • No loosening/mobility
  • Not TTP
  • Fracture does not go beyond the gingival margin
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18
Q

Describe how you could diagnose a extrusion injury

A
  • Partial displacement of tooth from socket
  • Mobility on a single tooth
  • No X ray signs of a root fracture
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19
Q

Describe how you could diagnose a lateral luxation injury

A
  • Partial displacement of tooth from socket
  • No mobility
  • Procliniation/retroclination of tooth
20
Q

Describe how you could diagnose an avulsion injury

A

-Complete displacement of tooth from socket

21
Q

Describe how you could diagnose a crown root fracture

A
  • No displacement of tooth from socket
  • No mobility or loosening
  • Not TTP
  • Fracture below gingival margin
22
Q

Describe how you could diagnose a concussion injury

A
  • No displacement of tooth from socket
  • No loosening of tooth
  • TTP
23
Q

Describe how you could diagnose a subluxation

A
  • No displacement of tooth

- Loosening of tooth

24
Q

Describe how you could diagnose an alveolar fracture

A
  • Displacement of tooth

- Mobility of multiple teeth as a unit on palpation

25
Q

Describe how you could diagnose a root fracture

A
  • Partial displacement of tooth from socket
  • Mobility of tooth
  • X ray evidence of root fracture
26
Q

Aims of treatment planning

A
  • Relieve pain
  • Maintain vitality
  • Prevent infection
  • Prevent damage to permanent successor
  • Maintain function, aesthetics, speech and mastication
  • Maintain arch space- prevent tilting/drifting/over-eruption
  • Maintain tooth in the arch
27
Q

Common advice to all types of dental injuries

A
  • Soft diet
  • Pain relief
  • OHI- tooth cleaning
  • Topical chlorhexidine by parent twice daily for one week
  • After initial treatment review 1,3 or 6 monthly taking rx if possible 6 monthly
28
Q

Treatment for enamel or enamel dentine fractures

A
  • Smooth sharp edges
  • Restore with composite
  • Cover exposed dentine
  • Consider GIC if compliance is poor for composite
29
Q

What is a complicated crown fracture and how would you treat

A
  • EDP fracture
  • Treatment dependent on behaviour
  • Pulp therapy (partial pulpotomy or RCT) is very difficult
  • Extract possible
30
Q

Treatment for a crown root fracture and root fracture

A
  • Monitor
  • If tooth is reasonably firm then leave it
  • If the tooth and there is risk of infection, extract it
  • Extract the coronal fragment potentially
  • Do not Dig for apical portion of root as can cause damage to successor
  • Should resorb physiologically
31
Q

Treatment for an alveolar fracture

A
  • Manual repositioning or repositioning using forceps of the displaced segment
  • General anaesthesia often indicated
  • Usually managed in a hospital setting
  • Stabilize segment with flexible splinting for 4 weeks
  • Monitor the teeth in the fracture line
32
Q

Difference between subluxation and concussion and treatment for each

A
  • Neither are displaced
  • Concussion is more of a shock. There is no mobility or discolouration. May be TTP. No Tx required
  • Subluxation may present with gingival bleeding at the sulcus. Discoloration may also be present. It may be tender and mobile

-For both, just monitor

33
Q

Rx evidence of lateral location and tx

A
  • Increased PDL space apically
  • If no occlusal interference, allow to position spontaneously
  • If occlusal interference, reposition
  • Otherwise, extract the tooth
34
Q

Rx and description for intrusion

A
  • Tooth is usually displaced through the labial bone
  • Can impinge upon permanent tooth bud
  • USO or PA required
  • If apical tip appears shorter than its contralateral then it has been displaced towards or through the buccal plate
  • If apical tip is indistinct and the tooth appears elongated then apex is displaced towards permanent tooth germ
35
Q

Tx guideline for intrusion

A
  • If labial, away from the tooth germ. Leave to re-erupt. If no progress after 6 months then extract
  • If palatal towards the permanent tooth germ then extract
36
Q

Tx plan for extrusion

A

-Extract

37
Q

Tx plan for avulsion

A
  • Rx to confirm complete avulsion

- Do not replant

38
Q

What does prognosis of primary tooth fracture depend on

A
  • Age of child
  • Mature or immature tooth
  • Type and severity of injury
  • Associated injuries
  • Time between injury and treatment
  • Presence of infection
39
Q

Long term effects of primary dental trauma on primary and permanent successors

A

Primary Teeth:

  • Discolouration
  • Infection
  • Delayed exfoliation

Permanent teeth

  • Enamel defects
  • Abnormal tooth/root morphology
  • Delayed eruption possible
40
Q

How would discolouration progress from immediate to long term colour changes of the tooth

A

Immediate:
-Reddish colour, may regress/remain and maintain vitality

Intermediate (weeks)
-Brown/black pulp breakdown products in tubules- non-vital

Long term (months)
-yellow/opaque, pulp calcification
41
Q

What does the time of discolouration tell you about vitality

A
  • If immediate discolouration then it may still be vital

- If intermediate (weeks) then non vital

42
Q

Problems in terms of exfoliation after primary tooth trauma

A
  • May not resorb normally after trauma
  • XLA may be necessary or permanent successor will erupt ectopically
  • Premature loss of a primary tooth can result in delayed eruption of about 1 year due to thickened mucosa
43
Q

When should you worry about a delay in tooth eruption

A

-if greater than 6 month delay compared with contralateral

44
Q

Correlation between age of trauma and risk to permanent successor anomalies

A

-Higher percentage of anomalies on permanent teeth is observed when trauma occurred at an age less than 36 months

45
Q

Read last 4 slides of ppt

A

Read it

Paediatrics (16 decks)

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