Trauma to the primary dentition Flashcards
State what the main treatment option is for children who go through trauma?
- Splinting may be extremely difficult for a traumatised child
- To extract or maintain without any extensive treatment
- A primary incisor should always be removed if its maintenance will jeopardize the developing permanent tooth bud, or is interfering with the bite
State the 5 types of injuries to dental tissues (WHO Classification)
- Enamel Infraction: An incomplete fracture of the enamel without loss of tooth substance
- Uncomplicated crown fracture: A fracture with loss of tooth substance confined to the enamel or dentin, but not involving pulp
- Complicated crown fracture: a fracture involving enamel, dentin & exposing the pulp
- Crown-root Fracture: a fracture involving enamel, dentine and cementum. It may or may not expose the pulp (uncomplicated and complicated crown-root fracture
- Root fracture: a fracture involving dentine, cementum and the pulp.
State the immediate care given to:
- Enamel - dentine fractures
- Complicated crown fracture - Crown - root fracture
Enamel - dentine fractures
· Smoothen it out or restoration
Complicated crown fracture
· Extraction
Crown - root fracture
· Extraction
Explain what the treatment option is for a root fracture involving the coronal portion
· If the coronal fragment is severely dislocated: Extraction
· No effort should be made to remove the apical fragment because it may damage the underlying permanent tooth
· After removal of coronal fragment, uncomplicated resorption of the apical fragment should be expected
· With little or no displacement and mobility no immediate extraction is required. However during the follow up, sometimes necrosis develops in the coronal fragment, whereas the apical portion nearly always remains vital. In this case, extract the coronal fragment only.
State the 5 types of injuries to periodontal tissues
· Concussion
· Subluxation
· Extrusive luxation
· Lateral luxation (fracture of alveolar process)
· Intrusive luxation (fracture of alveolar process)
Explain the management for: - concussion
- subluxation
- extrusive luxation
- lateral luxation
Concussion
• Most concussions are not seen by a dental professional at the time of the accident
• Parent becomes aware when the tooth discolours
Subluxation
• Keep the traumatized area as clean as possible
• Soft diet for a few days
• Advise parents of possibly sequelae, such as pulp necrosis and infection, possible tooth discolouration over time
• Mobility reduces within 1-2 weeks
Extrusive luxation
• Will show considerable mobility
• Immediate extraction is the best treatment option
Lateral luxation
• Treatment is dependent on the mobility and the extent of the displacement
• If there is excessive mobility or interfering with the occlusion: extraction
Explain the management for intrusive luxation in terms of:
- Palatal displacement
- Buccal displacement
- When re- eruptiuon fails to occur
- Often shows severe displacement – it may even be completely intruded into the alveolar process and mistakenly assumed to be lost. It is essential to clarify if the root is palatally or buccally forced
- Usually a palatal and superior displacement of the crown, which means that the apex of the tooth is forced away from the permanent follicle
Palatal displacement
• monitor, wait and watch approach
• More damage to permanent tooth bud if attempt made to remove the completely intruded tooth
Buccal displacement
• Most often allows the tooth to re-erupt
• Clean with 0.1% chlorhexidine
• See patient every week for the first 3-4 weeks to check for signs of infection (if so: extraction and antibiotics)
• Without signs of re-infection re-eruption will take place within 2-4 months
When re-eruption fails to occur
• If re-eruption fails to occur - ankylosis should be suspected
• If the ankylosed tooth interferes with eruption of the permanent successor, it must be extracted
Explain how to determine whether a root is buccally or palatally displaced
· Due to the buccal curve of the apex, the primary roots tends to be displaced through the buccal bone plate
· To locate: palpate the buccal sulcus fold and look at crown to find the tooth axis
· Radiographs: foreshortened appearance implies buccal displacement – away from permanent tooth follicle
· An elongated image suggests palatal displacement towards the permanent follicle.
Explain the treatment for avulsion in the primary dentition and discuss the potential side effects of treatment
· A radiographic exam is essential to eliminate the missing tooth is not intruded, unless the parent has the tooth/teeth with them
· Re-implantation is CONTRA-INDICATED
· There is a further risk of damage to the permanent tooth bud
· The coagulum from the socket may be forced into the permanent tooth follicle
· Do not re-implant no matter how much the parents want this and explain why. At this point priority is to protect the permanent tooth
· There is no evidence that occlusal problems, even tongue thrust acquired by the need to fill the gap during swallowing, have any long-term effects on the permanent dentition
· EATING: Loss of 1 or 2 incisors: minimal effect on mastication
· SPEECH: If only one or 2 incisors were missing, minimal chance of articulatory speech problems. Eventual eruption of the permanent incisors would eliminate tooth-related effects on articulation.
Define the three types injuries to gingiva and state the general treatment for soft tissue injuries
Definitions
· Contusion of gingiva or oral mucosa: bruise usually produced by impact with a blunt object, usually not accompanied by a break in the mucosa
· Abrasion of gingiva or oral Mucosa: superficial wound produced by rubbing or scraping of the mucosa, leaving a raw bleeding surface
· Laceration of gingiva or oral Mucosa: shallow or deep wound in the mucosa resulting from a tear; usually produced by a sharp object
Treatment
· Chlorhexidine and cotton swabs (twice daily) for 1-2 weeks
· Normally the soft tissue heals quickly
· Swelling will usually subside within a week
List some common sequelae to dental trauma (7)
· Pulp necrosis and /or grey discolouration
· If pulp does become necrotic, then it may subsequently become infected, leading to an apical abscess
· Yellow colour: possible pulp canal obliteration (90% resorb normally, tx not indicated)
· Premature root resorption (caused by inflammatory resorption. Subsequent to luxations, related to necrotic pulp and inflamed PDL
· Ankylosis (rare)- extract if causing delay in or ectopic eruption of a developing permanent tooth
· If injury occurs during the development of perm tooth crown, can lead to enamel hypoplasia, or hypocalcification. Before the age of 4, calcification of permanent teeth is still happening
· Can alter the path of eruption, cause root dilaceration.
Explain how pulp necrosis is diagnosed if pulp sensitivity tests cannot be used on a child (4)
· Colour
· Percussion (Not TTP)
· Palpation of the tooth and dento-alveolar ridge
· Radiographic observation of the peri-apical condition
Explain the colour indications for pulp necrosis
· A pinkish discolouration shortly after a trauma frequently reflects intra-pulpal bleeding
· Often this colour disappears gradually and returns to almost normal. In this case the pulp remains vital
· If a grey colour arises, pulp necrosis should be suspected and the tooth should be examined at 3 monthly intervals to disclose periapical inflammation as soon as possible. Any signs of severe peri-apical infection, extraction is the treatment of choice to prevent sequelae to the permanent dentition
· Some cases return back to normal colour with time.
Explain the sequalae of pulp obliteration
· The pulpal cavity reveals a partial or total mineralization
· Clinically the crown will assume a yellowish hue
· Most of these teeth remain unaffected until shedding
· A small % turn necrotic
Explain root resorption and the proposed treatments for it
· External root resorption is usually seen after intrusive luxation
· Internal resorption may develop as a result of subluxation and luxation injuries
· Extraction is the treatment choice with all types of pathologic root resorption, along with other symptoms such as pain and abscess
