Primary Trauma Flashcards
Do you feel confident you can identify all 3?
a: E - ED - EDP (complicated crown fracture)
Yes or no
Crown root fracture
Involves crown and root and is either complicated or uncomplicated (pulp involved or not)
Concussion
Tooth tender to touch but has not been displaced
Subluxation
Tooth tender to touch, has increased mobility, but has not been displaced
Lateral luxation
Tooth displaced
Usually in a; palatal/lingual or labial direction
Intrusion
Tooth usually displaced through the labial bone plate or it can impinge on the permanent tooth bud
Extrusion
Partial displacement of tooth out its socket
Avulsion
Tooth completely out of socket
Alveolar fracture
Fracture involves the alveolar bone and may extend to the adjacent bone
Most common injury in primary dentition
Luxation injury
Trauma management
- Reassurance
- History
a. Injury
- when, where, how
-any other symptoms/injuries
-any lost teeth/fragments
b. Medical History
(not CI but may need appropriate extra management)
-congential heart disease
-rheumatic fever or immunosuppression
-bleeding disorders
-allergies
-tetanus immunisation status
c. Dental Hx
-previous trauma
-treatment experience
-legal guardian
-child attitude/cooperation - Examination (rule out facial/jaw fractures!)
-E/O; lacerations, haematoma, haemorrhage, subconjunctival haemorrhage, bony step deformities, mouth opening
-I/O; soft tissues, alveolar bone, occlusion, teeth - SI
-trauma stamp
-radiographs; periapical, anterior occlusal, lateral pre-maxilla, panoramic, soft tissue - Diagnosis; soft tissue and hard tissue diagnosis
Supporting tissue injuries
Concussion
Subluxation
Lateral luxation
Intrusion
Extrusion
Avulsion
Alveolar fracture
Hard tissue injuries
E
ED
EDP
C-R
R # (fracture)
Emergency tx homecare advice
Analgesia
Soft diet 10-14 days
Brush teeth with soft toothbrush after every meal
Topical chlorhexidine gluconate 0.12% mouthrinse applied topically twice daily for one week
Warn against signs of infection; (swelling, pain, discoloration)
E fracture
Smooth sharp edges
ED fracture
Cover exposed dentine with GI or composite
Restore lost tooth structure with composite (immediately or at later visit)
EDP fracture
Partial pulptotomy
Or
Extract
C-R fracture
Remove any loose fragments and then determine if crown can be restored
A: if restorable
-no pulp exposed: cover exposed dentine with GI
-pulp exposed: pulpotomy or endodontic treatment
B: If unrestorable
- Extract loose fragments
- Don’t dig
R fracture
Coronal fragment not displaced
- no treatment
Coronal fragment displaced but not excessively mobile
- leave Coronal fragment to spontaneously reposition even if some occlusal interference
Coronal fragment displaced, excessively mobile and interfering with occlusion
Option A: Extract only the loose Coronal fragment
Option B: reposition the loose Coronal fragment (+/- splint)
Concussion tx
No treatment
Just observation
Subluxation
No treatment
Just observation
Lateral luxation
(If) minimal/ no occlusal interference: allow to reposition spontaneously
(If) severe displacement: extraction or reposition (+/- splint)
Intrusion
Allow to spontaneously reposition irrespective of direction of displacement
Intrusion radiograph
Periapical or lateral premaxilla (extra-oral film)
To determine direction of displacement, assess danger to permanent tooth and thus allow better counselling re - prognosis
Displacement is one of two ways:
Apex toward labial bone plate
(Tooth appears shorter compared to contralateral tooth and apical tip can be seen)
Apex toward permanent tooth germ
(Apex of intruded tooth cannot be visualised and tooth appears elongated compared to contralateral)
Extrusion tx
If not interfering with occlusion, allow spontaneous repositioning
If there’s excessive mobility or the tooth is extruded >3mm
Then extract
Avulsion tx
Take radiograph to confirm avulsion
Do not replant! (primary)
Alveolar fracture tx
-Reposition segment
-Stabilise with a flexible splint to the adjacent uninjured teeth for 4 weeks
-teeth may need to be extracted after alveolar stability has been achieved
Review trauma
Up to at least 5 years
(IADT guidelines for each)
Trauma complications
Warn parents of possible pathology to; traumatised primary tooth and the permanent successor
Primary tooth; discoloration, discoloration and infection, delayed exfoliation
Discoloration + asymptomatic (vital or non-vital)
mild grey, yellow (pulp obliteration)
No signs of pulp necrosis/infection then no treatment and review
Discoloration and infection (symptomatic, non-vital):
-sinus
-gingival swelling
-abscess
-increased mobility
-radiographic evidence of periapical pathology
-TX: extract or endo tx
Delayed exfoliation; consequences to developing occlusion
-intrusion causes most disturbances
Developing permanent tooth injuries; enamel defects, dilaceration, delayed eruption, ectopic tooth position, arrested development, complete failure of tooth to form, odontome formation
Enamel hypomineralisation (+ tx)
Normal thickness but poorly mineralised
Nothing, tooth whitening or composite masking +/- localised removal
Enamel hypoplasia (+ tx)
Reduced thickness but normal mineralisation
No treatment/ composite masking
Dilaceration
Abnormal crown/root morphology
Crown/root does not follow long axis of the tooth
Dilaceration management
Crown dilaceration options: surgical exposure and orthodontic realignment or improve aesthetics restoratively
Root dilaceration options: combined surgical and orthodontic approach
Delayed eruption
Take a radiograph if >6 months compared to contralateral tooth
Surgical exposure and orthodontic alignment may be required
Premature loss of a primary tooth can result in delayed eruption of around 1 year due to thickened mucosa
Ectopic tooth position
Options:
- Surgical exposure and orthodontic realignment
- Extraction
Dull percussion note
May indicate root fracture
Traumatic occlusion
Demands urgent tx
Trauma sensibility testing
For at least 2 years after an injury
Trauma prognosis factors
Stage of root development
(Mature/immature)
Presence of infection
(Yes/no)
Type of injury
(Hard and supporting tissue)
Is PDL damaged aswell
(Yes or no)
Time between injury and tx
Emergency trauma case principles
-aim to retain vitality
-treat exposed pulp tissue
-reduction and immobilisation of displaced teeth
-tetanus prophylaxis
-antibiotics?
Intermediate aims of trauma cases
+/- pulp treatment
Restore hard tissues
