Trauma to the primary dentition

Question 1

Peak incidence

Answer 1

2-4 years

Question 2

More common in which gender

Answer 2

Males

Question 3

Prevalence by age of 5 yrs

Answer 3

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

Question 4

Aetiologies

Answer 4

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

Question 5

Most common injury

Answer 5

Luxation

Question 6

Teeth most involved

Answer 6

Upper incisors

Question 7

Non-accidental injury prevalence

Answer 7

0.1-10%

1 per 1000 under 4yos in UK

Question 8

Children most at risk of severe non-accidental injury

Answer 8

Under 2

Can’t defend themselves

Question 9

Risk factors for non-accidental injury

Answer 9

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

Question 10

Non-accidental injury - be alert if

Answer 10

 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 Withdrawn child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

Question 11

Be aware of differential diagnosis but if suspicious of NAI

Answer 11

Inform appropriate agencies

• impetigo
• birthmarks
• conjunctivitis

Question 12

Management of dental trauma

Answer 12

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

Question 13

Clinical management: complicating factors

Answer 13

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

Question 14

Clinical management of crown fractures

Answer 14

• 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!)

Question 15

Prevalence of crown fractures

Answer 15

4-38% of injuries

Question 16

Clinical management of crown/ root fractures

Answer 16

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

Question 17

Clinical management: crown/ root fractures prevalence

Answer 17

2% of injuries

Question 18

Clinical management of root fractures

Answer 18

• 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

Question 19

Prevalence of root fractures

Answer 19

Uncommon

Question 20

Clinical management of luxation injuries

Answer 20

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

Question 21

Prevalence of luxation injuries

Answer 21

62-69%

Question 22

Trauma follow up: rationale

Answer 22

1. Because of sequelae to the injured primary tooth

2. Because of sequelae involving the developing permanent successors

Question 23

Primary tooth sequalae

Answer 23

 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

Question 24

Permanent tooth sequelae

Answer 24

 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

Question 25

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

Answer 25

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

Question 26

Highest prevalence of damage to permanent

tooth follows luxation injuries to primary teeth

Answer 26

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

Question 27

Failure of eruption of upper left permanent incisors

Answer 27

Be suspicious

-take radiograph before space loss occurs