Dental Trauma of Primary teeth Flashcards
What is the epidemiology of primary tooth trauma?
- Prevalence is 16-40%
- Male > Female
- Peak incidence 2-4years
- Max primary incisors
What is the aetiology of primary tooth trauma?
- Falls
- Bumping into objects
- Non-accidental (child abuse)
What are the types of “dental hard tissues and pulp” injury?
- Enamel # (uncomplicated crown #)
- Enamel and dentine # (uncomplicated crown #)
- Enamel, dentine and pulp # (complicated crown #)
- Crown-root #
- Root #
What is a crown root fracture?
- Fracture involves enamel, dentine and root
- Pulp may or may be involved
- Complicated or uncomplicated
What are the types of supporting tissue injury?
(periodontal tissue + bone)
- Concussion
- Subluxation
- Lateral luxation
- Intrusion
- Extrusion
- Avulsion
- Alveolar fracture
What is a concussion injury?
- PDL injury
- Tooth TTP but not displaced from arch
- Normal mobility
- No bleeding from gingival sulcus
What is subluxation injury?
- Tooth tender to touch
- Has increased mobility but not been displaced from line of arch
- Bleeding from gingival crevice
- tooth appears elongated
what are the 3 types of luxation injury
- lateral luxation
- intrusion
- extrusion
What is lateral luxation injury, clinical findings?
- Tooth displaced usually in palatal/lingual or labial direction (but not axially)
- with alveolar bone plate #
- tooth immobile
- high ankylotic percussion note
- root apex maybe palpable in sulcus
- bleeding from gingival sulcus
What is intrusion injury and clinical findings ?
- Displacement of tooth into alveolar bone and locked in bone
- with alveolar socket #
- Tooth usually displaced through labial bone plate
- or can impinge on permanent tooth bud
- tooth immobile
- ankylotic high, metallic percussion note
- bleeding from gingivae
- ## shortened crown
What is an extrusion injury?
- Type of luxation injury
- Partial displacement of tooth out its socket
What is an avulsion injury and clinical findings?
- Tooth completely out of the socket
- Tooth totally displaced from socket
Clinical findings;
- Socket empty or filled with coagulum
how to manage avulsion with tooth missing
- Location of missing tooth should be determined in history taking
- Risk of being embedded into soft tissues or more seriously inhaled
- If tooth not found send child for medical assessment in A&E department, esp if child has respiratory issues
What is alveolar fracture injury?
- Fracture involved alveolar bone (labial and palatal/lingual
- May extend to adjacent bone
what is common finding of alveolar fracture
- Mobility and dislocation of segment with several teeth moving together
- Occlusal interference
What is the injury prevalence of different types of injury in primary dentition?
Luxation - 62-69%
Avulsion and ED fracture - 7-13%
Root fracture - 2-4%
Crown root fracture - 2%
What are the steps when managing a patient with trauma?
- Reassurance
- History
- Examination
- Diagnosis
- Emergency treatment
- Important info
- Further treatment and review
What is included in a trauma history?
Injury
- When?
- Where?
- How?
- Any other symptoms or injuries?
- Lost teeth/fragments?
Medical History
- Congenital heart disease (for infection risk)
- History of rheumatic fever or immunosuppression (for infection risk)
- Bleeding disorders (haematology team contact)
- Allergies (short course of antibiotics may be required)
- Tetanus immunisation status (may need booster - contact health advisor)
- (Liase with GP)
-
Dental History
- Previous trauma (may raise concerns about physical abuse or neglect)
- Treatment experience
- Legal guardian/child attitude
What is included in the extraoral part of trauma examination?
Extraoral
- Lacerations/ swelling/ bruising (may require suturing or debridement
- Haematoma
- Haemorrhage / CSF
- Subconjunctival haemorrhage
- Bony step deformities
- Mouth opening (may be jaw #/ dislocation)
What is included in the intraoral part of trauma examination?
- Soft tissues (laceration/bruises/foreign bodies etc)
- Alveolar bone #
- Occlusion (traumatic occlusion demands urgent treatment)
- Teeth (mobility may indicate displacement, root or bone fractures)
- Transillumination may show lines in teeth (crazing), pulpal degeneration, caries
- Tactile test with probe may help detect horizontal and or vertical #, pulpal involvement
- Percussion (duller note indicate root #)
What special investigations can be used in a trauma examination?
- Trauma stamp x6
What radiographs can you request in trauma examination?
- Periapical
- Anterior occlusal
- Lateral pre-maxilla (extra -oral)
- OPT
- Soft tissue
What are the possible diagnosis’ that can be made for each traumatic tooth?
Fracture
- Enamel (Uncomplicated crown fracture)
- Enamel-Dentine (Uncomplicated crown fracture)
- Enamel-Dentine-Pulp (Complicated crown fracture)
- Crown-Root (Uncomplicated or complicated)
- Root
- Alveolar
Concussion
Subluxation
Luxation
Lateral / Intrusive / Extrusive
Avulsion
What to do during an emergency situation?
- Observation is often most appropriate option in emergency situation
- Provision of dental treatment depends on child’s maturity and ability to cope - don’t want to make child more anxious
When to interfene/ treat in emergency situation?
when there’s risk of
- aspiration
- ingestion
- occlusal interference
What important info do you need to tell parent/carer ?
- Analgesia - pain relief
- Soft diet for 10-14days (can be normal diet but cut everything small, chew with molars)
- Ensure good oral hygiene
- Brush teeth with soft toothbrush after every meal
- Topical chlorhexidine gluconate 0.12% mouthrinse applied topically twice daily for one week
- Warn about signs of infection
How to manage an enamel fracture (primary tooth)?
- Smooth sharp edges using Sof Lex disc
