trauma : classification and types Flashcards
what is the incidence of trauma in children?
> 31-40% of 5-year-old boys
> 16-30% of 5-year-old girls
> 12-33% of at 12-years-old boys
> 4-19% of at 12-years-old girls
what are the predisposing factors for dental trauma?
> 2M: 1F
> Overjet
> Lip competency
> Age –peak = 2-4 years and 8-10 years
what are the causes of dental injuries in children?
> Simple falls
> Blow
> Cycle accidents
> Water slides / trampolines
> Sport
> Road traffic -pedestrian / passenger
> Quad motor bikes
what are the incidence of different tooth fractures in children?
> Enamel 31%
> Dentine 45%
> Pulp 5%
> Root 0.5%
what are the incidence of different displacement injuries in children?
> Concussed / Loose / Displaced = < 10%
> Avulsion = 0.5%
when carrying out a dental history or trauma what important things must you find out?
> history of accident and the person
> Accompanying adult/guardian
> When -If delay why?
> Where -Future litigation
> How –Direct / Indirect
> Other injuries = Head injury –headache, vomiting, amnesia, dehydration, Medical assessment indicated?
> Lost teeth or fragments = Chest X-Ray, Soft tissues
> History of previous trauma?
> Age of child = state of eruption, previous position of teeth
> Fasting?
> Previous dental experience
when carrying out a medical history what important things must you find out?
> Cardiac
> Bleeding disorders
> Allergies –Penicillin
> HIV, Hepatitis
> Tetanus vaccination
when carrying out an extra oral exam of a child with trauma what are the key things to check for?
> Swellings
> Asymmetry
> Bones-zygoma (eye signs), mandible (ROM)
> Skin
when carrying out an intraoral examination on a child with trauma what are the key things to check?
> Soft Tissues = Lacerations, Haematoma
> Hard Tissues = Supporting structures, Haematoma, tenderness, deformity, opening
> Teeth = Fractures, displacements, number, occlusion, mobility, TTP
what are the ellis trauma classification 1-7?
- Enamel fracture
- Enamel and dentine fracture
- Pulpal exposure
- Non-vital
- Avulsion
- Root-fracture
- Displacement
what does the WHO classify as dental trauma?
> injuries to the hard dental tissues and the pulp
> Injuries to the periodontal tissues
> Injuries to supporting bone
> Injuries to the skin, gingiva or oral mucosa
what classifies as injuries to hard dental tissues and pulp?
> infraction
> enamel fracture
> enamel dentine fracture - uncomplicated crown fracture
> enamel dentine fracture - complicated crown fracture
> uncomplicated crown root fracture
> complicated crown root fracture
> root fracture
> displaced root
what is infraction? and how do you diagnose?
> incomplete crack of enamel - no loss of tooth substance
> diagnosis = trans illumination may be useful |(bright light)
what is an enamel fracture? and how do you diagnose?
> loss of tooth substance confined to enamel
> diagnosis = visual examination, normal mobility, not ttp, sensibility test - positive
what is an enamel dentine fracture - uncomplicated crown fracture ? and how do you diagnose?
> loss of tooth substance confined to enamel and dentine, not involving the pulp
> diagnosis = visual examination, normal mobility, not ttp, sensibility test - positive but may have transient negative response
what is an enamel dentine fracture - uncomplicated crown fracture? and how do you diagnose?
> fracture of enamel and dentine, exposing the pulp
> diagnosis - visual examination, normal mobility, not ttp, sensibility test - usually positive, lack of response initially indicate increased chance of pulp necrosis
what is an uncomplicated crown root fracture?
> fracture of enamel, denote and cementum, but not involving the pulp
what is a complicated crown root fracture?
> fracture of enamel, dentine and cementum, exposing the pulp
how do you diagnose uncomplicated and complicated crown root fractures?
> visual - crown fracture extending below the gingiva margin
> tender to percuss
> coronal fragment mobile
what is a root fracture?
> involve dentine, cementum and pulp
> can be apical (most common) , middle (2nd) or coronal third
> can be displaced or undisplaced
how do you diagnose displaced root fracture?
> Visual examination - Coronal fragment may be mobile
and possibly displaced
> Tooth may be tender to percuss
> Sensibility test–often negative
what classifies as injuries to the periodontal tissue?
> concussion
> subluxation
> extrusive luxation
> lateral luxation
> intrusion
> avulsion
what is concussion? and how do you diagnose it?
> no abnormal loosing or displacement but TTP
> diagnosis = visual – undisplaced, No increased mobility, Tender to touch, Usually positive sensibility test, No radiographic abnormalities
what is subluxation? and how is it diagnosed?
> tooth has increased mobility but no displacement
> diagnosis = Visual - no displacement, Increased mobility, Tender to percuss, Sensibility may be negative, No abnormal radiological findings
what is extrusive luxation? and how do you diagnose?
> partial displacement of the tooth from the socket
> diagnosis = Tooth appears elongated, Tender to percuss, Significant increased mobility, Often negative sensibility test, Radiograph – Tooth appears displaced,
apical portion of socket empty
what is lateral luxation? and how do you diagnose?
> displacement other than axially
> Along with comminution or fracture of alveolar plate
> diagnosis = Displaced usually palatally or labially, Percussion test may give a high sound, No mobility, Often negative sensibility test, Radiograph – Widened PDL space
what is intrusion? and how do you diagnose?
> displacement into bone, with communication or fracture of the alveolar plate
> diagnosis = Tooth is displaced axially up into the bone with no mobility, Percussion gives a high metallic tone, Sensibility – usually negative, Radiographs = tooth appears displaced, obliteration of pdl space
what is avulsion and how do you diagnose?
> complete displacement of the tooth from socket
> diagnosis = visual (no tooth present), check not severe intrusion
what classifies as injuries to supporting bones?
> Comminution / fracture of alveolar socket wall
> Fracture of mandibular or maxillary alveolar process
> Fracture of mandible or maxilla
what classifies as injuries to the skin, gingiva or oral mucosa?
> laceration
> contusion
> abrasion
what is a laceration?
> wound resulting from a tear
> check for through and through lacerations
> explore for missing fragments (broken teeth)
> degloved lacerations - degloved gingiva = rolled appearance
what is contusion ?
> bruise, no break in mucosa
> usually submucosal haemorrhage
what is abrasion?
> superficial wound produced by scraping or rubbing of surface
what baseline investigations are important to carry out on teeth after your examinations?
> Position
> Colour
> Mobility
> Percussion
> Sensibility
– Thermal – Electrical
(Include adjacent teeth)
what radiographic investigations would you take for a child with trauma?
> Periapicals
> Anterior occlusal
> DPT
> E/O views as indicated
> Soft tissue view if missing fragments + laceration
> Clinical Photographs
when would you consider it a non accidental injury?
> Delay in presentation
> inconsistent or changing history
> Other bruising (different ages)
> Torn labial frenum
> Burns
> Bitemarks
> Relationship with parents
what should you record when a patient comes in with trauma ?
> a dental trauma review
> helps with treatment of patient
what is a way of preventing trauma in children?
> mouthguard for contact sports
> custom fit or sports shop alternatives
> Fully extended and occlusal accommodated
Sufficient thickness in critical areas
Crowns, alveolus and roots and soft tissues protected > Retentive and comfortable
