Trauma IV Flashcards
What is the aetiology of primary tooth trauma
falls
bumping into objects
non accidental
What is the most commonly effected primary teeth
max centrals
What is the prevalence between genders of primary tooth trauma
- Unlike permanent tooth trauma, the prevalence is equal among males and females
- 2-4 years is the peak incidence
What is the commonest injury
luxation
What is patient management made up of
- Reassurance
- History
- Examination
- Diagnosis
- Emergency treatment
- Advise parent of sequelae to permanent teeth and talk about and record the possibility of damage
- Further tx and review
What does the trauma history consist of
history of injury
medical history
dental history
What do we ask about for medical history
○ Anything such as rheumatic fever
○ Congenital heart defects
Immunosuppression
What do we ask for for the dental history
○ Any previous trauma? Maybe it is not part of a new injury
○ Treatment experience
○ Parent and child attitude
What does the trauma examination consist of
extra and intra oral exam
What do we look for in the extra oral exam
○ Laceration ○ Haematomas ○ Haemorrhage/CSF ○ Subconjunctival haemorrhage ○ Bony step deformities ○ Mouth opening
What do we look at for intra oral exam
○ Soft tissue
○ Alveolar bone (ensure not broken)
○ Occlusion (ensure no change)
○ Teeth
What about the soft tissue do we look at for a detailed intra oral exam
• Soft tissue damage e.g penetrating wounds, foreign bodies (may have to do something about it)
If we find tooth mobility in the intra oral exam what can this mean
• Tooth mobility - may indicate, displacement, root fracture, bone fracture
What do we do in transillumination
• Transillumination (can be done with a curing light - may show)
○ Fracture lines in teeth
○ Pulpal degeneration
○ Caries
What do we look at in a tactile test using a probe
○ Horizontal fractures
○ Vertical fractures
○ Pulpal involvement
What do we look at with percussion
duller note may indicate root fracture or it may sound different from adjacent teeth
What do we look at with the occlusion
traumatic occlusion demands urgent treatment and in the primary dentition that usually involves removal of the primary tooth
What radiographs are useful
○ Intra oral (periapicals) or anterior occlusal
○ Lateral pre-maxilla
○ OPT
○ Soft tissue
What does the trauma stamp consist of for primary teeth
• Tooth (notation) • Mobility (- or +) • Colour (description) • TTP (- or +) • Sinus (- or +) • Percussion note (norm/dull) Radiograph (- or +)
Why can we not do an EPT or thermal test on primary teeth
EPT/thermal testing is missing as it is not useful for children because if the tooth is resorbing then you may get different readings and if the child is small and not understanding what is being asked of them, you may just get a child saying something to please you, not what is right
What is the classification of trauma
· Enamel fracture - uncomplicated · Enamel dentine fracture - uncomplicated · Enamel-dentine-pulp - complicated · Crown-root (pulp involved) · Root fracture · Alveolar fracture · Concussion/subluxation · Luxation - lateral, intrusive, extrusive · Avulsion
What is the classification for crown fractures
· Enamel only
· Enamel and dentine
· Enamel dentine and pulp
What is the immediate home treatment for all injuries
· Soft diet for 10-14 days (normal diet just cut everything small and chew with molars)
· Brush teeth with soft toothbrush after every meal
· Topical chlorhexidine by parent twice daily for one week (cotton wool or some gauze rolls for swabbing as until 4 they cant spit)
· After initial treatment review 1, 3, 6 monthly taking radiographs if possible 6 monthly
· Intrusion requires more frequent review (see guidelines) as we want to monitor the eruption