deciduous tooth trauma Flashcards by Becky Wall

aetiology

falls
bumping into objects
non-accidental

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which injury is commonest?

luxation (soft bones)

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most common tooth affected

upper central incisors

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pt management

reassure
history
exam
diagnosis
emergency tx
advise parent of sequelae to permanent teeth
further tx and review

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injury history

when 
where
how
any other symptoms
lost teeth/fragments

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RF
immunosuppressed/compromised
congenital heart defects

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prev trauma
tx experience
parent and child attitude

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EO exam

laceration
haematoma
haemorrhage/CSF
subconjunctival haemorrhage
bony step deformities
mouth opening

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IO exam

ST (wounds, foreign bodies)
alveolar bone
occlusion - if traumatic need urgent tx
teeth

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what might tooth mobility indicate?

displacement
root #
bone #

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transillumination

shine curing light on teeth

may show # lines in teeth, pulpal degeneration, caries

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tactile probe test

look for horizontal and vertical #s

pulpal involvement

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classification

E# - uncomplicated
ED# - uncomplicated
EDP# - complicated
CR# (pulp involved)
R#
alveolar #
concussion/subluxation
luxation - lateral, intrusive, extrusive
avulsion

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trauma stamp

mobility
displacement
colour 
TTP
sinus
p note
radiograph

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what might a dull p note indicate?

root #

long-term - ankylosis

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why aren’t sensibility tests used?

pt factors - young child won’t understand/cooperate/may lie to please you
tooth morphology - unreliable results, less root due to resorption. blood vessels and nerves changing

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immediate home management

soft diet 10-14 days
- can eat anything but chop up and eat with molars
- want some activity after couple days to stimulate PDL cells
brush teeth with soft TB after every meal
topical CHX by parent x2 daily for 1wk - CW rolls to swab

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reviewing

1,3,6m
- radiographs if possible every 6m
intrusion requires monthly review for 6m then every 6m
- check it isn’t hitting permanent incisor - compare to contralateral tooth

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E# tx

smooth sharp edges
OR
composite/compomer bandage/Rx - don’t use GI as won’t stay on well

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ED# tx

composite/compomer bandage/Rx

don’t use GI as won’t stay on well

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tx for EDP#

endo if v cooperative child
 - 2mm short of apex
 - not GP as won't resorb
 - use CaOH and Iodoform paste
extract

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CR# tx

extract coronal fragment
don’t remove any root fragments that aren’t obvious
leave to resorb physiologically

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concussion and subluxation tx

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observation

alveolar bone # tx

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reposition
splint to adjacent teeth 3-4wks
teeth may need ext after alveolar stability has been achieved
only case where a splint would be used in management of primary trauma
- trying to immobilise bone

lateral luxation tx

no occlusal interference - leave to position spontaneously | occlusal interference - extract

what will lateral luxation show on xray?

increased PDL space apically

is localisation of intrusion parallax?

no as using one radiograph

localisation of intrusion radiographs

PA | lateral premaxilla

localisation of intrusion PA

compare to contralateral apical tip appears shorter - displaced toward/through buccal bone - preferable - away from developing tooth germ apical tip indistinct and tooth elongated - towards permanent tooth germ

localisation of intrusion lat premaxilla

identified a direction of displacement as providing a lateral view

tx for intrusion

labial root displacement - leave to re-erupt - if no progress after 6m ext - check each month that it is erupting (ankylosis - ext) palatally - extract

tx of extrusion

extract

tx of avulsion

radiograph to confirm avulsion | do not replant

long term effects in primary teeth

discolouration discolouration and infection delayed exfoliation

delayed exfoliation

primary tooth may not resorb normally after trauma | extraction necessary or permanent successor will erupt ectopically

discolouration +/- infection : vital

no tx

discolouration +/- infection : non-vital and sinus/PAP

RCT or ext

discolouration +/- infection : non-vital and no sinus/PAP

leave and review

discolouration +/- infection : opaque

no tx | tertiary dentine laid down in pulp chamber, opacity has changed

discolouration and vitality

immediate - may maintain vitality | intermediate (weeks) - non-vital

injuries to permanent teeth

related to age of trauma to primary teeth | younger child = bigger chance of damage to permanent teeth - tell parent and record in notes

long term effects in permanent teeth

``` enamel defects 44% abnormal tooth/root morphology 8% - C/R dilaceration - C/R duplication delayed eruption 1% ectopic tooth position arrest in tooth formation complete failure of tooth to form odontome formation ```

enamel defects

``` type of defect depends on age hypomineralisation - white/yellow spot - normal E thickness hypoplasia - yellow/brown areas - less than normal thickness ```

hypomineralisation tx options

``` leave composite mask localised removal and restore composite external bleaching (microabrasion) ICON - resin infiltration ```

hypoplasia tx options

composite Rx | porcelain veneer when gingival level stabilised (20yrs)

tx of C dilaceration

surgical exposure ortho realignment improve appearance

tx of R dilaceration/duplication/angulation

combined surgical and ortho

tx of arrest of root development

RCT or extract

odontome tx

surgical removal

tx of undeveloped tooth germ

may sequestrate spontaneously or require removal

delayed eruption of permanent teeth

premature loss of a primary tooth can result in delayed eruption of about 1yr due to thickened mucosa (protect itself) take radiograph if >6m delay compared to contralateral surgical exposure and ortho may be required if abnormal morphology - normally spontaneous eruption within 18m of uncovering - if older sometimes use ortho and chain

discolouration - immediate/days after

pink blood in dentine tubules tends to be transient as pulp is still alive and vital tissue repairs itself

discolouration - few weeks after

grey/brownish indicates tooth non-vital happens a few weeks after pulp dies/becomes non-vital - breakdown of necrotic pulp e.g. haemosiderin, eosin - leaches into dentinal tubules

discolouration - several months after

yellow/opaque pulp canal obliteration - sclerosis tertiary dentine formation pulp reacts (odontoblasts) to protect itself

long-term complications of primary incisor trauma

loss of vitality abscess risk may require extraction delayed exfoliation

complications to permanent incisors following primary incisor trauma

``` delayed eruption ectopic eruption damage to crown development - hypoplasia - hypomineralisation damage to root development - dilaceration ```

deciduous tooth trauma Flashcards

(56 cards)