Paediatric Trauma I - Introduction / Epidemiology / Diagnosis

Question 1

What is the peak incidence for injury to the permanent dentition?

Answer 1

8-10 years od

Question 2

Prevalence for boys and girls for primary dentition damage?

Answer 2

Boys 21-40%

Girls 16-30%

Question 3

Aetiology of tooth damage in children?

Answer 3

Falls and collisions
Contact sports - rugby, football, judo, hockey, boxing
Skiing
RTA
Swimming
Horse riding
Trampolining

Assault
Non-accidental injury

Question 4

Predisposing factors to tooth damage?

Answer 4

Increased overjet (twice the risk if overjet >6mm)
Poor lip coverage
Previous trauma
Epilepsy (poorly controlled)
Poor motor control
Obesity
Poor life circumstances
Attention deficit and hyperactivity disorder

Question 5

Prevention of tooth damage?

Answer 5

Mouthguards for sports
Seatbelts
Safety straps in wheelchairs
Early ortho intervention
Playground design

Question 6

Name of tooth injuries (from mild to severe)

Answer 6

Enamel infraction - incomplete crack/fracture in enamel (hairline crack)

Enamel fracture - uncomplicated crown fracture

Dentine fracture - Uncomplicated crown fracture
= Loss of dentine and enamel

Enamel-dentine pulp fracture
- Complicated crown fracture

Root fractures

• Apical 1/3
• Middle 1/3
• Coronal 1/3

Question 7

Dento-alveolar injuries?

Answer 7

Concussion
Subluxation
Luxation

Question 8

Define concussion

Answer 8

Injury to tooth supporting

structures without abnormal loosening or displacement of the tooth

Question 9

Define subluxation

Answer 9

Injury to tooth supporting tissues with
abnormal loosening, but without
displacement of the tooth

Question 10

Types of luxation?

Answer 10

• Intrusion (moved up into bone)
• Extrusion (moved out - mobility likely)
• Lateral (buccal, lingual)
• Avulsion (tooth loss)

Question 11

Types of alveolar injuries?

Answer 11

• Crushing/ compression of alveolar wall
• Fracture of alveolar socket wall
• Fracture of alveolar process
• Fracture of maxilla +/- mandible

Question 12

Most common type of injury to permanent teeth?

Answer 12

Enamel fracture

Question 13

Primary management of tooth injury?

Answer 13

History

• Pt details
• Attended with
• C/O
• HPC - when, where, how, loss tooth or tooth fragment accounted for?
• Where is the tooth?
• Head injury? Other injuries?
• Tx already received elsewhere?
• PMH
• PDH
• Safeguarding concerns (child protection plan)

Exam

• E/O - trismus, can open jaw?, soft tissues - lacerations, swelling, bruising (clean pt up first)
• Draw a diagram of extraoral features
• I/O - soft tissues, lacerations, haematoma, torn fraenum
• Teeth - charing, pulpal exposures, discolouration, mobility, displacement, TTP, sound on percussion
• Occlusion - biting feel normal?

Question 14

What to consider with radiographs?

Answer 14

Assess initial diagnosis
Basis for comparison with later films
Size of pulp
State of development of apex
Presence of root fractures
State of apical region
Lip lacerations - tooth/glass fragments
Jaw fracture
Relation to permanent successor

Question 15

What to consider with vitality testing?

Answer 15

Clinically - discolouration, sinus
Ethyl chloride
EPT
If tooth concussed/luxation injury, nerve damage may not recover for 3 months
Dont need to do sensibility testing for acute injury when tooth is obviously vital

Question 16

What to do for any acute trauma case if child is bleeding, distressed, avulsion?

Answer 16

Limit initial assessment to brief history, med history and brief exam
Carry out immediate care prior to obtaining fuller history