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Paediatrics (IODC) > Trauma to the primary dentition > Flashcards

Trauma to the primary dentition Flashcards

1
Q

Peak incidence

A

2-4 years

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2
Q

More common in which gender

A

Males

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3
Q

Prevalence by age of 5 yrs

A

Boys: 31-40%
Girls: 16-30%

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4
Q

Aetiologies

A

falls & collisions,
non accidental injury (NAI),
prolonged intubation (prem/sick
babies)

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5
Q

Most common injury

A

Luxation

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6
Q

Teeth most involved

A

Upper incisors

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7
Q

Non-accidental injury prevalence

A

0.1-10%

1 per 1000 under 4yos in UK

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8
Q

Children most at risk of severe non-accidental injury

A

Under 2

Can’t defend themselves

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9
Q

Risk factors for non-accidental injury

A

poverty,
parents abused, parents of
low intelligence, alcohol,
drug use, single mother (new partner)

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10
Q

Non-accidental injury - be alert if

A 
 Delay in seeking treatment
 Inconsistent history
 Abnormal child reaction and interaction
with parent
 Withdrawn child
 50% of injuries involve the orofacial region
 Multiple injuries of different
vintage
 Burns account for 10% of
injuries
 Bizarre lesions in odd sites
 Fraenum tears
 Bite marks
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11
Q

Be aware of differential diagnosis but if suspicious of NAI

A

Inform appropriate agencies

  • impetigo
  • birthmarks
  • conjunctivitis
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12
Q

Management of dental trauma

A
  • full history
  • intra- and extra-oral examination
  • special investigations
  • diagnosis & primary treatment
  • review
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13
Q

Clinical management: complicating factors

A 
• young age - limited cooperation!
• large pulp:tooth tissue
ratio
• concerns regarding
developing permanent
dentition
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14
Q

Clinical management of crown fractures

A

• infractions - monitor
• enamel fractures - grinding if necessary
• enamel/dentine fractures - grinding or adhesive restoration
• complicated enamel/dentine fractures
- pulp-cap, pulpotomy, pulpectomy,
extraction (most likely!)

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15
Q

Prevalence of crown fractures

A

4-38% of injuries

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16
Q

Clinical management of crown/ root fractures

A

• may or may not be complicated
(pulp involved)
• treatment of choice is
EXTRACTION

17
Q

Clinical management: crown/ root fractures prevalence

A

2% of injuries

18
Q

Clinical management of root fractures

A 
• unlikely before physiological root resorption started (3-
4yrs)
• tooth slightly extruded -
mobility dependent on
fracture site
• radiograph/s required
• supportive advice -
extraction of coronal
fragment only - if necessary
19
Q

Prevalence of root fractures

20
Q

Clinical management of luxation injuries

A

Concussion
-tooth tender, not mobile
supportive advice (analgesia, OHI and soft diet) & review
Subluxation
-tooth tender & mobile, not
displaced, may be gingival
haemorrhage
supportive advice & review
Intrusion
-take xray to confirm presence
of severely intruded tooth and relation to permanent successor. Leave to re-erupt (2-4 months), supportive advice and regular
clinical and radiographic review. or Extraction if tooth displaced into follicle of permanent successor.
Lateral luxation
-Treatment approach depends on direction of the root displacement. If crown
displaced palatally (root will be labially positioned) can leave providing not in traumatic occlusion. If crown displaced labially (root will be palatal)
reposition or extract. Splinting not necessary for 1y teeth. If tooth so mobile in danger of inhaling - extract
Avulsion: do not reimplant

21
Q

Prevalence of luxation injuries

22
Q

Trauma follow up: rationale

A
  1. Because of sequelae to the injured primary tooth

2. Because of sequelae involving the developing permanent successors

23
Q

Primary tooth sequalae

A 
 change in colour -
pink/grey - not an
indication for interventive treatment in absence of other signs/symptoms
 loss of vitality: pain; extra
oral swelling; sinus
formation; pathological
mobility
 internal/external
inflammatory root resorption
 canal obliteration/sclerosis
 failure to exfoliate normally
24
Q

Permanent tooth sequelae

A 
 Occurs in 12-69% of cases of injury to the primary dentition
 Type and severity of sequelae dependant on
type of injury to primary tooth and age at which it occurred
 occurs due to disturbance in mineralisation or morphology of developing tooth germ
 Enamel opacities
(white, yellow,
brown)
 Enamel hypoplasia
(+/- opacity)
 Crown dilaceration
 Odontoma-like
malformation
 Root duplication or
dilaceration
 Partial/complete arrest
of root formation
 Sequestration of
permanent tooth germ
 Disturbance in eruption
25
Q

> prevalence of damage to permanent tooth with younger age of primary tooth trauma

A

0-2yo: 63% 2. teeth affected
3-4yo: 53%
5-6: 24%
7-9: 25%

26
Q

Highest prevalence of damage to permanent

tooth follows luxation injuries to primary teeth

A

Subluxation: 27% 2. teeth affected
Extrusion: 34%
Avulsion: 52%
Intrusion: 69%

27
Q

Failure of eruption of upper left permanent incisors

A

Be suspicious

-take radiograph before space loss occurs

Paediatrics (IODC) (9 decks)

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