Paeds - Trauma to Baby Teeth

Question 1

what is the most common injury to deciduous teeth?

Answer 1

luxation injuries (PDL injury)

Question 2

what would you examine in an intra-oral assessment? (5)

Answer 2

Check for damage to soft tissues - penetrating wounds and foreign bodies

Assess the alveolar bone

Assess Tooth mobility

Fractures/lines

Check the occlusion - traumatic occlusion must be treated urgently

Question 3

what advice do we give for home management to all patients?

Answer 3

Soft diet 10-14 days - cut all food into small bites and chew with molars

Brush teeth with a soft bristled brush after every meal

Apply topical chlorhexidine 2x a day for 1 week (parent applies)

Question 4

how do we manage enamel only fractures to deciduous teeth?

Answer 4

Smooth off the sharp edges

Question 5

how do we manage enamel dentine fractures to deciduous teeth?

Answer 5

Cover the exposed dentine by placing a composite bandage/compomer

Question 6

how do we manage enamel dentine pulp fractures to deciduous teeth?

Answer 6

Usually just extracted

Can consider endodontic therapy

Question 7

if you are endodontically treating a deciduous tooth what material do we use to fill the canal and why?

Answer 7

use CaOH paste - allows tooth to be resorbed

Question 8

how do we manage crown and root fractures to deciduous teeth?

Answer 8

Remove the obvious extracoronal fragment

Don’t try to remove any fragments that aren’t obvious - leave these to resorb physiologically

Question 9

how do we manage an alveolar bone fracture to deciduous teeth?

Answer 9

splint the segment for 3/4 weeks then possible extraction of the teeth on the splinted segment

Question 10

how do we manage an alveolar bone fracture to deciduous teeth?

Answer 10

splint the segment for 3/4 weeks then possible extraction of the teeth on the splinted segment

Question 11

how do we manage concussion to deciduous teeth?

Answer 11

observe

Question 12

how do we manage lateral luxation to deciduous teeth? (3)

Answer 12

Preferably - allow to Spontaneously reposition

Consider repositioning
If theres occlusal interference - extract!

Question 13

how do we manage intrusion to deciduous teeth?

Answer 13

Monitor for re-eruption:

If no re-eruption after 6 months consider extraction to prevent problems with the permanent successor.

Question 14

how can we tell which direction the apex of the root has been intruded on a radiograph? (palatal/labial)

Answer 14

If apical tip appears short compared to the contralateral tooth = displaced towards/through the buccal plate.

If apical tip appears indistinct and the tooth looks elongated = displaced towards the tooth germ (unfavourable!!)

Question 15

how do we manage extrusion to deciduous teeth?

Answer 15

extract

Question 16

why do we not reposition extruded deciduous teeth?

Answer 16

can cause damage to the permanent successor

Question 17

how do we manage avulsion to deciduous teeth?

Answer 17

Take a radiograph to confirm it’s not intrusion (if no tooth brought alongside the child)

Do not replant

Question 18

what are the long term affects on the permanent teeth after trauma to the primary dentition? (10)

Answer 18

Discolouration
Discolouration and infection
Delayed exfoliation 
Enamel defects (most common) 
Abnormal morphology of crown/root of permanent tooth 
Delayed eruption 
Ectopic position 
Arrest in formation 
Failure to form 
Odontome formation

Question 19

how do we treat discolouration and infection of a PRIMARY tooth after trauma? (2)

Answer 19

If tooth discolours immediately = may maintain vitality and will improve over time

If tooth discolours after a few weeks = non-vital and its the necrotic pulp thats causing the discolouration so we can either leave (if no sinus), RCT or extract

Question 20

how do we prevent delayed exfoliation of a primary tooth after trauma?

Answer 20

extract to prevent ectopic teeth

Question 21

what is the most common long term affect of traumatised primary teeth?

Answer 21

enamel defects

Question 22

how do we treat hypomineralisation of permanent teeth after trauma to the primary dentition? (4)

Answer 22

Leave
Restore to mask the colour
Localised removal and then restore
External bleaching

Question 23

how do we treat hypoplasia of teeth after trauma to the primary dentition? (2)

Answer 23

Restore with composite

> 16 years = porcelain veneer (when gingival levels stabilise)

Question 24

how can trauma to the primary dentition cause delayed eruption? how long does it delay it by? (2)

Answer 24

Premature loss = delay eruption of the permanent successor by 1 year due to the thickened mucosa.

Question 25

how do we treat delayed eruption after trauma to the primary dentition? (3)

Answer 25

Palpate

Take a radiograph if its 6 months more delayed than the contralateral tooth

Then surgically expose the tooth and use orthodontics (if abnormal morphology)

Question 26

how do we treat crown dilaceration after trauma to the primary dentition? (2)

Answer 26

Surgical exposure

Orthodontic realignment

Question 27

how do we treat root dilaceration after trauma to the primary dentition? (2)

Answer 27

Surgical exposure

Orthodontic realignment

Question 28

how do we manage an odontome after trauma to the primary dentition?

Answer 28

Surgical removal

Question 29

what is an odontome?

Answer 29

A ball of compact dentine enamel and cementum

Question 30

how do we manage arrested root development after trauma to the primary dentition?

Answer 30

extraction

RCT

Question 31

how do we manage an undeveloped tooth germ after trauma to the primary dentition? (2)

Answer 31

Monitor as it may sequestrate spontaneously

surgical removal