Primary Trauma: Examination and Classification

Question 1

What primary tooth is most affected with trauma?

Answer 1

Maxillary primary incisors

Question 2

What is the peak age of primary tooth trauma?

Answer 2

2-4

Question 3

What is the prevalence of primary tooth trauma at 5 years old?

Answer 3

16-40%

Question 4

What are the most common causes of primary tooth trauma?

Answer 4

Falls - most common
Bumping into objects
Non-accidental

Question 5

What are the different injuries to dental hard tissues and pulp?

Answer 5

Enamel fracture (uncomplicated crown fracture)
Enamel and dentine fracture (uncomplicated crown fracture)
Enamel, dentine and pulp fracture (complicated crown fracture)
Crown-root fracture
Root fracture

Question 6

What are the different injures to supporting tissues?

Answer 6

Concussion
Subluxation
Lateral luxation
Intrusion
Extrusion
Avulsion
Alveolar fracture

Question 7

What is concussion?

Answer 7

PDL injury
Tooth tender to touch but has not been displaced
Normal mobility and no bleeding into gingival sulcus

Question 8

What is subluxation?

Answer 8

Tooth tender to touch, has increased in mobility but has not been displaced
Bleeding from gingival crevice can be noticed

Question 9

What is lateral luxation?

Answer 9

Tooth displaced usually in a palatal/lingual or labial direction

Question 10

What is intrusion?

Answer 10

Tooth usually displaced through the labial bone plate, or it can impinge on the permanent tooth bud

Question 11

What is extrusion?

Answer 11

Partial displacement of tooth out its socket

Question 12

What is avulsion?

Answer 12

The tooth is completely out of the socket

Question 13

What should you do if you notice a tooth is avulsed?

Answer 13

Locate missing tooth as it could be embedded in soft tissue, ingested or inhaled
If not found, send child for medical assessment

Question 14

Describe alveolar fracture

Answer 14

Fracture that involves the alveolar bone (labial and palatal/lingual) and may extend to the adjacent bone

Question 15

What is the most common injury in the primary dentition and what is the prevalence?

Answer 15

Luxation - 62 - 69%

Question 16

What are the 7 points following traumatic injury to the primary dentition?

Answer 16

1. Reassurance
2. History
3. Examination
4. Diagnosis
5. Emergency tx
6. Important information
7. Further tx and review

Question 17

What is important to know about an injury in trauma history?

Answer 17

When, where, how, any other symptoms or injuries, any lost teeth or fragments

Question 18

What elements of medical history may influence tx so infection risk is minimised?

Answer 18

Congenital heart disease
History of rheumatic fever or immunosuppression
Bleeding disorders
Allergies
Tetanus immunisation status

Question 19

What questions should be asked in dental history for a trauma history?

Answer 19

Any previous trauma
What tx have they experienced before
Legal guardian
Childs attitude

Question 20

What should be explored extraorally in a trauma examination?

Answer 20

Lacerations
Haematoma
Haemorrhage/CSF
Subconjunctival haemorrhage
Bony step deformities
Mouth opening

Question 21

What should be explored intra orally in a trauma examination?

Answer 21

Soft tissues - penetrating wounds, foreign bodies
Tooth mobility - may indicate displacement, root or bone fractures
Transillumination - may show fracture lines in teeth, pulpal degeneration and caries
Alveolar bone
Occlusion - traumatic occlusion demands urgent tx
Teeth
Percussion - dull note may indicated root fracture
Tactile test with probe - may help detect horizontal and vertical fractures, pulpal involvement

Question 22

What is a trauma stamp?

Answer 22

Records factors which are important to monitor in a traumatised tooth

Question 23

What is recorded in a trauma stamp?

Answer 23

Mobility
Colour
TTP
Presence of a sinus
Percussion note
Radiograph

Question 24

What radiographs can be used in a trauma examination?

Answer 24

Periapical
Anterior occlusal
Lateral pre-maxilla
Panoramic
Soft tissues