IADT guidelines - primary teeth

Question 1

what may a dull percussion note indicate

Answer 1

root fracture

Question 2

why are sensibility tests not used as part of a trauma stamp for primary teeth

Answer 2

sensibility tests are unreliable on primary teeth

Question 3

general parental instructions for homecare after trauma to primary dentition

Answer 3

successful healing relies on good OH
cleaning area with soft brush and use of chlorhexidine 0.2% mouth rinse topically in the area twice a day for 1 week
Take care when eating not to further traumatise area

Question 4

enamel fracture in primary teeth
- x ray recommendations and treatment

Answer 4

no x ray recommended
Tx - smooth sharp edges
+ general homecare instructions

Question 5

enamel fracture in primary teeth
- follow up and potential outcome

Answer 5

no follow up recommended
may become symptomatic, discoloured, necrotic, infected and further root development may be halted

Question 6

name 3 possible signs of pulp necrosis and infection

Answer 6

• sinus tract
• gingival swelling or abscess
• radiographic signs
• dark grey discolouration

Question 7

enamel dentine fracture in primary teeth
- radiographic recommendations and treatment

Answer 7

baseline radiograph is optional.
Tx - cover all exposed dentine with GI or composite. Restore lost structure with composite now or at a later date
general homecare instructions

Question 8

enamel dentine fracture in primary teeth
- follow up and potential outcomes

Answer 8

clinical exam after 8 weeks and encourage parents to look out for unfavourable outcomes. Radiographic follow up only recommended if signs of pathology
may become symptomatic, discoloured, necrotic, infected and further root development may be halted

Question 9

enamel dentine pulp fracture in primary teeth
- radiographic recommendation and treatment

Answer 9

• PA or occlusal radiograph
• aim to preserve pulp via partial pulpotomy (then seal canals with non setting CAOH, cover with GIC then composite)

Question 10

enamel dentine pulp fracture in primary teeth
(follow up and possible outcomes)

Answer 10

• clinical follow up at 1 week, 8 weeks and 1 year
  radiographic follow up 1 year
  may become symptomatic, discoloured, necrotic, infected and further root development may be halted

Question 11

crown root fractures in primary teeth
- radiograph recommendations

Answer 11

PA or occlusal

Question 12

crown root fractures in primary teeth
- treatment options

Answer 12

1st need to extract loose fragment anr establish if remaining tooth is restorable
A - tooth is restorable and no pulp exposure - cover dentine with GI
B - restorable with pulp exposure - pulpotomy or RCT
C - unrestorable - extract all loose fragments and leave firm root fragment in situ
D - unrestorable - extract whole tooth

Question 13

if tooth retained after crown root fracture in primary teeth when should follow up be done

Answer 13

clinical - 1 week, 8 weeks and 1 year
radiographs after 1 year if pulpotomy or RCT done

Question 14

what may be seen clinically in a primary tooth which has experienced root fracture

Answer 14

findings dependent on location of fracture
- coronal fragment may be mobile and may be displaced
occlusal interference may be present

Question 15

treatment options for a primary tooth with root fracture

Answer 15

If coronal fragment not displaced, or displaced with very little mobility - no treatment required , leave to spontaneously reposition
If coronal fragment is displaced, mobile and interfering with occlusion:
A - extract only loose coronal fragment (apical fragment should be left in place to be resorbed)
B - Gently reposition loose fragment and splint in place with flexible splint for 4 weeks

Question 16

follow up for a primary tooth that has experienced root fracture

Answer 16

if no displacement of coronal fragment - 1 week, 8 weeks and 1 year, then annually until permanent tooth eruption
if displaced coronal fragment repositioned - 1 week , 4 weeks (splint removal), 8 weeks , 1 year
if displaced fragment extracted - 1 year
(radiographs only indicated if signs of pathology)

Question 17

clinical findings of an alveolar fracture

Answer 17

mobility and dislocation of segment with several teeth moving together
occlusal interference normally present

Question 18

treatment for an alveolar fracture in primary dentition

Answer 18

should be done by paediatric specialist
stabilise with flexible splint to uninjured teeth for 4 weeks

Question 19

treatment for extrusive luxation in a primary tooth

Answer 19

tx based on degree of displacement and mobility, interference with occlusion and root formation
A - no interference with occlusion - leave to spontaneously reposition
B - if mobile or extruded >3mm, extract under LA

Question 20

treatment of lateral luxation in primary tooth

Answer 20

A - no or minimal occlusal interference - leave to spontaneously reposition
B - (severe displacement and risk of aspiration or ingestion) - extraction
C - (severe displacement) - reposition and flexible splint for 4 weeks

Question 21

normal clinical findings of a lateral luxation

Answer 21

possible occlusal interference
tooth will be immobile
normally displaced palatal/lingual or labial direction

Question 22

what are the potential unfavourable outcomes after extrusion of a primary tooth

Answer 22

• symptomatic , discolouration, necrosis and infection, halted root development
• no improvement in position of extruded tooth (if left to reposition)
• negative impact on development and/or eruption of permanent successor

Question 23

what are the potential unfavourable outcomes of a primary tooth that has experienced lateral luxation

Answer 23

• symptomatic , discolouration, necrosis and infection, halted root development
• no improvement in position of laterally luxated tooth (if left to reposition)
• negative impact on development and/or eruption of permanent successor
• ankylosis

Question 24

in what timescale would an intruded tooth usually spontaneously reposition

Answer 24

usually within 6 months, may be up to one year

Question 25

clinical findings of an intruded tooth (primary)

Answer 25

usually displaced through labial bone plate or can impinge on permanent tooth bud
May be almost or completely dissappeared into socket and can be palpated labially

Question 26

what are the potential unfavourable outcomes for a primary tooth that has experienced intrusive luxation

Answer 26

• symptomatic , discolouration, necrosis and infection, halted root development
• no improvement in position of extruded tooth (if left to reposition)
• negative impact on development and/or eruption of permanent successor
• ankylosis

Question 27

when should a radiograph be taken in avulsion cases

Answer 27

if tooth cannot be located
ensure it has not been intruded

Question 28

treatment for an avulsed primary tooth

Answer 28

avulsed primary tooth should NOT be replanted
give parent/ patient general advice of not aggravating area and cleaning topically with CHX and soft brush

Question 29

concussion injury to primary tooth
- x ray
- treatment
- follow up
- potential outcome s

Answer 29

• no x rays
• no treatment, just observation and general homecare
• 1 week and 8 week follow up
• symptomatic, infection, necrosis, discolouration, no further root development, negative impact on developing permanent tooth

Question 30

what may be seen radiographically on an x ray of a subluxated tooth

Answer 30

slightly widened PDL space

Question 31

treatment for a primary tooth that has experienced intrusion

Answer 31

allow to spontaneously reposition
urgent referral to a paeds specialist (within a couple days)