9. Trauma management in primary dentition

Question 1

How does the primary dentition differ from the secondary dentition?

Answer 1

• allows some displacement without fracture (the resilient bone allows a degree of bounce)
• tooth discolouration is more common
• root fractures are rare
• underlying successors must be considered

Question 2

What percentage of traumatic dental injuries affect primary dentition?

Answer 2

22.7%

Question 3

What is the most common age that dental trauma affects?

Answer 3

2-6 years

Question 4

What is the most common dental injury?

Answer 4

Periodontal tissue injuries

Question 5

What are parental instructions that you need to give to a child after trauma?

Answer 5

• use soft bristle tooth brush
• use gauze or muslin cloth to make sure there are no plaque deposits on the area of healing
• alcohol free CHX
• soft diet initially
• look for signs of infection like sinus, swelling

Question 6

What is pulp tests in primary teeth like?

Answer 6

They are generally unreliable and so not recommended

Question 7

What radiographs can you use for trauma teeth?

Answer 7

• parallel technique- get a parent to hold size 0 film behind traumatised tooth
• USO- generally size 2 film

Question 8

What can happen to the colour of the crown in trauma?

Answer 8

Crown discolouration
May fade
May remain asymptomatic

Question 9

What does a yellow tooth mean?

Answer 9

The yellow colour often means you have tertiary dentine being laid down.
Pulp canal obliteration is likely to occur.

Question 10

What does it mean when you have a red tooth?

Answer 10

Internal bleeding and internal resorption

Question 11

Why is it important to extract apical periodontitis tooth?

Answer 11

Will affect the successor

Question 12

What are sites of accidental injury?

Answer 12

Forehead, nose, chin, palm of hand, elbows, knees, shins, parietal bone, occiput

Question 13

Where are sites of non-accidental injury?

Answer 13

Ears, inner aspects of arms, back and side of trunk, black eyes, soft tissues of cheeks, forearms when raised, chest and abdomen, groin/genital, inner aspect of thighs, soles of feet

Question 14

What is the triangle of safety?

Answer 14

Ears, side of face, neck, top of shoulders

Question 15

What do social services do?

Answer 15

Check the child protection register

Question 16

What is concussion?

Answer 16

• Injury to the tooth supporting structures without abnormal loosening or displacement of tooth
• Usually TTP
• Radiograph not normally indicated unless there is clinical signs of pathology

Question 17

What is the treatment for concussion?

Answer 17

Monitor, OHI, soft diet and analgesia

Question 18

What is subluxation?

Answer 18

Injury to the tooth supporting structures with abnormal loosening but without displacement
- may be bleeding in the gingival sulcus
- radiographic appearance is normal

Question 19

What is the treatment for subluxation?

Answer 19

Monitor, OHI, soft diet, analgesia
Review 1 week and 6-8 weeks.
Maybe review longer if concerns

Question 20

What is extrusive luxation?

Answer 20

Partial displacement of tooth out of socket
- tooth appears elongated
- mobile

Question 21

What does the treatment of extrusive luxation depend on?

Answer 21

• degree of displacement
• mobility- too mobile may inhale
• root formation
• cooperation from pt

Question 22

What is the treatment for extrusive luxation if it is small?

Answer 22

If extrusive luxation is smaller than 3mm and there is no occlusal interference then observe
Then review in 1 week, 6-8 weeks, 1 year

Question 23

What is the treatment for extrusive luxation if it is severe?

Answer 23

If it is more than 3mm, and occlusion is affected then consider extracting

Question 24

What is lateral luxation?

Answer 24

Lateral displacement of the tooth in its socket, accompanied by comminution or fracture of the alveolar bone

Question 25

What are the features of lateral luxation?

Answer 25

- Tooth is usually displaced palatally so the root normally goes labially or buccally, and the tip of the apex is moved away from the permanent successor - immobile due to locked position - high ankylotic tinny percussion tone - may be bleeding in sulcus

Question 26

What does the radiograph of lateral luxation show?

Answer 26

Apical displacement

Question 27

What is the tx for lateral luxation when there is no occlusal interference?

Answer 27

The tooth is allowed to reposition spontaneously

Question 28

What is the tx for lateral luxation whrn there is minor occlusal interference?

Answer 28

Slight occlusal grinding

Question 29

What is the tx for lateral luxation when there is more severe occlusal interference?

Answer 29

Tooth can be gently repositioned and splinted and best to seek specialist care

Question 30

How often should you review lateral luxation?

Answer 30

1 week, 6-8 weeks, 6 months, 1 year

Question 31

When may you need to extract a tooth with lateral luxation?

Answer 31

When there is severe displacement, when the crown is dislocated in a labial direction

Question 32

What is intrusive luxation?

Answer 32

The tooth has moved in an apical direction, and usually displaced through the labial bone plate. Can be impinging upon the successor bud. Record the length of tooth visible.

Question 33

What does a foreshortened image of luxated tooth imply?

Answer 33

That the root apex is labial so shorter distance to the x ray source

Question 34

What does an elongated image of a luxated tooth imply?

Answer 34

Displacement towards the follicle so longer distance to x ray source

Question 35

What is the treatment for luxation?

Answer 35

If the apex is displaced, then allow for spontaneous re-eruption. Refer if concerned.

Question 36

When may you need to extract a intrusive luxation?

Answer 36

If there is severe displacement of the root into the developing tooth germ

Question 37

When do you review intrusive luxation?

Answer 37

1 week, 6-8 weeks, 6 months, 1 year Then age 6 years on monitor the eruption of the permanent successor pathway

Question 38

What is avulsion?

Answer 38

Tooth is completely out of socket

Question 39

What is the tx for avulsion?

Answer 39

Do not replant as can damage follicle underneath - radiographic examination necessary if tooth lost and unsure if intruded or aspirated - review in 6-8 weeks - then age 6 years monitor eruption pathway of permanent successor

Question 40

What is the treatment for uncomplicated enamel fracture?

Answer 40

Monitor or smooth

Question 41

What is the treatment for uncomplicated enamel and dentine fracture?

Answer 41

Monitor Smoothen sharp edges Depending on cooperation, restore with GIC or composite

Question 42

What is the treatment for complicated tooth fracture?

Answer 42

- if possible preserve pulp vitality by partial pulpotomy - the treatment is depending on the child's maturity and ability to cope - or XLA

Question 43

What is the success rate of root treated primary teeth?

Answer 43

- 64% - Of these, 60% of permanent successors had a disturbance of enamel formation - Traumatised teeth without pulp treatment- only 21% have enamel disturbances in successors

Question 44

What is the treatment for crown/root fracture?

Answer 44

- if uncomplicated, try to remove the fragment and restore if tooth is stable and no pulp exposure - all other cases, and if the pulp is involved then consider XLA

Question 45

What is the treatment of root fracture?

Answer 45

None or Mild displacement- monitor - modeate/severe displacement- extraction of the coronal fragment, leave apical fragment to resorb

Question 46

What are the complications of trauma to primary teeth?

Answer 46

Discolouration Pulp obliteration Pulpal necrosis- swelling/sinus Resorption- internal/external Ankylosis- intruded teeth Cyst formation Damage to successor

Question 47

What are common discolourations of primary teeth?

Answer 47

- yellowish - grey/blue-black- necrotic pulp - pink- internal resorption

Question 48

What is the likelihood of getting trauma in secondary dentition dependent on?

Answer 48

- age of child- 66% if less than 3 years old and 24% if more than 3 years old - type of trauma - developmental stage of permanent successor

Question 49

What are sequalae to the secondary dentition?

Answer 49

Hypomineralisation of enamel Crown dilacerations Root dilacerations Partial/complete arrest of root formation Disturbance in eruption

Question 50

What things do you include in a referral latter?

Answer 50

Practice address and telephone number Letter date (+/- clinic date) Name and address of consultant patient is to be referred to Name and date of birth (age) of patient Patient’s address and telephone number Reason for referral/patient’s complaint Degree of urgency of referral General medical history Relevant dental and social history Looked after child? Clinical/unusual features Provisional diagnosis Legible signature of referring practitioner and printed name