Primary Tooth Trauma

Question 1

What is on the trauma stamp

Answer 1

• colour
• TTP
• mobility
• sinus

Question 2

After initial tx, review when?

Answer 2

1,3,6 monthly
- take radiographs 6 monthly if possible

Question 3

Enamel or ED fracture

Answer 3

• smooth sharp edges
• cover exposed dentine
• restore with composite
• if compliance poor for composite, consider GIC

Question 4

EDP fracture

Answer 4

• tx depending on behaviour
• pulp therapy (partial pulpotomy or RCT) DIFFICULT!!!
• extract

Question 5

Crown root fracture and root fracture tx

Answer 5

• monitor root, if tooth reasonably firm leave it
• if tooth loose and there is a risk of infection EXTRACT
• extract coronal fragment - don’t dig for apical portion, can damage permanent tooth, should resorb normally

Question 6

Alveolar fracture tx

Answer 6

• manual reposition or with forceps
• GA often indicated
• usually managed in hospital
• stabilise segment with flexible splint for 4 weeks
• monitor teeth in fracture line

Question 7

Lateral luxation

Answer 7

• NO OCCLUSAL INTERFERENCE - allow to reposition spontaneously
• OCCLUSAL INTERFERENCE - reposition

OTHERWISE
- extract

Question 8

Intrusion tx and what you’d see on X-ray depending on Position.

Answer 8

• take X ray, USO or PA (tooth usually displaced through labial bone, can impinge on permanent tooth bud)
• if apical tip = shorter than contra lateral, = buccal plate displaced
• if apical tip indistinct + tooth looks elongated then apex = displaced toward tooth germ

ALLOW SPONTANEOUS ERUPTION, irrespective of displacement

• usually within 6 months, sometimes = 1 year

Question 9

Extrusion tx

Answer 9

No occlusal interference = spontaneous repositioning

Excessively mobile, or extruded >3mm, extract under LA

Question 10

Side effects of trauma to primary teeth

Answer 10

• white or yellow discolouration (hypo mineralisation)
• discolouration + hypoplasia
• odontome like malformation
• root duplication
• crown dilaceration
• root dilaceration
• arrest of development

Question 11

How long can premature loss of primary tooth delay permanent by

Answer 11

• about 1 year due to thickened mucosa
• take x ray if greater than 6 month delay compared with contra lateral