Traumatic dental injuries (TDIs) in children Flashcards
Prevalence in permanent dentition
12% 12yos & 10% 15yos had sustained visible injury to one or more permanent incisors (UK child dental health survey 2013)
Decline over past 4 decades for 15yos: 26% in 1983; 17% in 1993; 13% in 2003
Peak incidence 8-10yrs
M:F ratio 2:1
Prevalence in primary dentition
Boys 31-40%
Girls 16-30%
Why such a wide range?
Aetiology
Falls and collisions Contact sports Assault Non-accidental injury Other activitis: bicycle injuries, swimming, car accidents, skiing, horse riding, trampolining
Contact sports
Rugby Football Karate/ judo Hockey Boxing
Predisposing factors
> overjet (2x risk if iverjet >6mm) Poor lip coverage Previous trauma (> risk of 4-30%) Epilepsy (poorly controlled) Poor motor control Obesity Poor life circumstances ADHD
Prevention
- Mouthguards for sports
- Seatbelts
- Safety straps in wheelchairs
- Early orthodontic
intervention - Playground design
Classification
Enamel infraction
Enamel fracture - uncomplicated crown fracture
Enamel - dentine fracture - uncomplicated crown fracture
Complicated crown fracture
Root fracture (coronal 1/3, middle 1/3 or apical 1/3; horizontal or oblique)
Dentoalveolar injuries
Concussion
Subluxation
Luxation
Concussion
-injury to tooth supporting structures without abnormal loosening or displacement of tooth
Subluxation
Injury to tooth supporting tissues with abnormal loosening, but without displacement of the tooth
Luxation
- Intrusion (inwards)
- Extrusion (outwards)
- Lateral (buccal, lingual) - tipping (percussion - can sound dull)
- Avulsion (comes out)
Alveolar injuries
- Crushing/ compression of alveolar wall
- Fracture of alveolar socket wall
- Fracture of alveolar process
- Fracture of maxilla +/- mandible
Epidemiology - most common type of injury to permanent tooth?
Enamel fracture
Primary management
Time important for all
- e.g. cover with GIC or composite quickly
- put back in place quickly
History
• Patient details
• Attended with?
• C/O
• HPC
When?
Where? (could have swallowed it)
How?
lost tooth or tooth fragment accounted for?
• Head injury? Other associated injuries?
• Treatment already received elsewhere?
• Past medical history
Cardiac, Diabetes, Epilepsy, Bleeding disorder,
Allergies, Tetanus?
• Past dental history
• Safeguarding concerns (Child Protection Plan)
Examination
E/O Bony: step deformities, unable to open/close jaw Soft tissues: swelling, bruising, lacerations (wound contamination?) Tip - clean the patient up first! Include a diagram if helpful and take good clinical photos (importance medico-legally) I/O Soft tissues -lacerations -haematoma -torn fraenum
Examination of teeth
Charting Fractures/ pulpal exposures Discoloration (old injuries) Mobility (luxation or root fracture?) Displacement – visual/ occlusion/ Buccal tenderness Tender to pressure? Sound on percussion (ankylosis, old injury)
Examination of occlusion
Can the patient bite together, does it feel
normal?
Radiographs
- Assist initial diagnosis
- Basis for comparison with later films
- Size of pulp
- State of development of apex
- Presence of root fractures (may need to take 2 x-rays at different angles)
- State of periapical region
- Lip lacerations – tooth/ glass fragments
- Jaw fracture
- Relation to permanent successor
Vitality (sensibility) testing
• Clinically – discoloration, sinus
• Ethyl chloride
• Electric pulp testing
• If tooth is concussed/ luxation injury, nerve
damage may not recover for 3 months
• Don’t need to do sensibility testing for acute
injury when tooth is obviously vital
IADT guidelines
IADT guidelines
