Primary tooth trauma Flashcards
Aetiology of primary tooth trauma
- Falls
- Bumping into objects
- Non-accidental trauma
Predisposing factors to trauma
- Protrusion of upper incisors with insufficient lip cover
- AOB
- Medical issues - epilepsy, cerebral palsy
- Hyperactivity
List the types of injuries to teeth
- E #, ED # or EDP #
- Crown-root #
- Subluxation
- Lateral luxation
- Intrusion
- Extrusion
- Avulsion
What is the most common type of trauma to primary teeth? What % ?
Luxation
62-69%
History taking for traumatised primary teeth
When, where, how? Any treatment provided already Any loss of consciousness Any previous trauma Do you have all the teeth/fragments
When should non-accidental injury be suspected?
Delay on presentation
Discrepancy between trauma history and the presenting injuries
Other signs of neglect?
EO examination following trauma
- Symmetry
- Any soft tissue lesions - assess for tooth fragments
- Palpate bony borders of mandible and maxilla
- Assess TMJ for deviations
Special IX for primary tooth trauma
- Radiographs
- colour, tpp, pathological mobility and sinus
Define: concussion/subluxation injuries
Trauma to perio tissue without displacement out of the socket
Subluxation = loosening of tooth in socket
Concussion is ttp without loosening
Define: Luxation injury
What are the types?
Dislodgement from normal position
Lateral, intrusion and extrusion
Define: Lateral luxation
Displacement of tooth in socket in any direction other than apically
Define: Intrusion
Apical displacement of tooth into alveolar bone
Define: Extrusion
Partial displacement of tooth out of the socket
Define: Avulsion
Tooth completely extruded from the socket
Define: Crown-root fracture
Fracture extending below the gingival margin
Tx aims for traumatised primary tooth
- Pain relief
- Maintain vitality
- Prevent infection
- Prevent damage to permanent successor
- Maintain tooth in the arch (Function, aesthetics and space maintainer)
Post op advice
- Pain relief with OTC analgesics
- Soft diet 2 weeks
- OHI - gentle and use of CHX
- Avoid sports
Tx options for subluxation
Monitor if mild
Splint for 2 weeks to reduce discomfort
Tx options for lateral luxation
If no occlusal interference = leave to spontaneously reposition, monitor
If occlusal interference = reposition with LA
If severe = extract
Tx options for intrusion
- If intruded TOWARDS tooth germ = remove
- If AWAY from tooth germ = retain and monitor for 6 months, if it hasn’t spontaneously extruded then extract
Radiographic signs the tooth is intruded towards tooth germ -
What direction is it?
The apical tip is indistinct and tooth appears elongated
Palatal/lingual
What direction is away from the tooth germ
Labially
Management of extrusion
- If minor (<3mm) or immature tooth primary tooth - reposition or allow spontaneous alignment
- If severe or mature primary tooth - extract
Management of avulsed primary tooth
DO NOT REIMPLANT AS IT WILL DAMAGE PERMANENT TOOTH
What should be discussed with the parent
Long term sequelae on both the primary and permanent teeth
Long term effects of traumatised primary teeth
- Discolouration
- Infection
- Delayed exfoliation
Long term effects to permanent teeth following trauma to primary tooth
- Enamel defects - white, yellow or brown lesions (44%) or hypoplasia
- Abnormal tooth/root morphology - dilaceration
- Delayed eruption
Describe discolouration changes to traumatised primary teeth
- Immediate - red/brown
- Weeks - brown/black
- Months - yellow/opaque
What ages are more susceptible to damage to the permanent successor? Why?
0-36 months as permanent teeth are still developing
Most important long term sequelae for permanent teeth
Hypomineralisation +/- hypoplasia
Management of subluxation
Monitor
If discolouration occurs, check for signs of infection and treat appropriately
Management of root fracture
If no displacement of coronal fragment - leave and monitor but extract if signs of infection
If coronal fragment displaced, extract coronal segment and allow apical segment to resorb
Why shouldn’t the apical fragment be removed
The permanent successor can be damaged in the process of removal
Treatment of EDP fracture of a primary tooth
Restorable - Partial pulpotomy or pulpectomy
Extract if uncooperative or unrestorable
Signs of crown-root fracture
Tooth loose but attached
Minimal to moderate displacement
RG may indicate the presence of a fracture line
Signs of root fracture
Coronal fragment mobile and displaced
RG showing mid-root or apical third fracture
Signs of concussion
Tender to touch
No mobility, sucular bleeding or RG abnormalities
Signs of subluxation
Increased mobility but no displacement
Sucular bleeding
No RG abnormalities
Signs of lateral luxation
Tooth displaced palatally or labially
Immobile
RG shows increased PDL space apically
What view is important in lateral luxation
Occlusal to assess proximity of tooth to the successor
Signs of extrusion
Elongated tooth
Excess mobility
RG showing incr PDL space apically
Why should a radiograph be taken following avulsion of primary tooth
To ensure there has not been severe intrusion
