Paediatric Trauma II - Injury to the Primary Dentition

Question 1

Peak incidence of trauma to the primary dentition?

Answer 1

2-4 yrs old

More common in males

Question 2

What is the most common injury?

Answer 2

Luxation - upper incisors

Question 3

Risk factors of non-accidental injury?

Answer 3

Poverty
Parents abused
Parents of low intelligence, alcohol, drug use, single mother
Children under 2 yrs old most at risk
1 per 1000 under 4 yrs old in UK

Question 4

What to think of when considering a non-accidental injury?

Answer 4

 Delay in seeking treatment
 Inconsistent history
 Abnormal child reaction and interaction
with parent
 Withdrawn child
 50% of injuries involve the orofacial region
 Multiple injuries
 Burns account for 10% of injuries
 Bizarre lesions in odd sites
 Fraenum tears
 Bite marks

Question 5

How to manage dental trauma?

Answer 5

• full history
• intra- and extra-oral examination
• special investigations
• diagnosis &primary treatment
• review

Question 6

Clinical management - why is it difficult on children?

Answer 6

Young age - limited cooperation
Large pulp:tooth tissue ratio
Concerns regarding developing permanent dentition
Fear of unknown
Dental anxiety - 1 in 5 children (mostly females)

Question 7

How to manage different types of crown fractures?

Answer 7

• infractions - monitor
• enamel fractures - grinding if
necessary
• enamel/dentine fractures - grinding or
adhesive restoration
• complicated enamel/dentine fractures
- pulp-cap, pulpotomy, pulpectomy,
extraction (most likely!)

Question 8

Clinical management of crown/root fractures?

Answer 8

May or may not be complicated (pulp involved)

Extraction tx

Question 9

Clinical management of root fractures?

Answer 9

Unlikely before physiological root resorption started (3-4 yrs)
Tooth slightly extruded - mobility dependent on fracture site
Radiographs required
Supportive advice - extraction of coronal fragment only (if necessary)

Question 10

Clinical management of concussion, subluxation and intrusion injuries?

Answer 10

Concussion - tooth tender, not mobile supportive advice and review

Subluxation - tooth tender and mobile, not displaced, may be gingival haemorrhage, supportive advice and review

Intrusion - take radiograph to confirm presence of severely intruded tooth and relation to permanent successor.
- Leave to re-erupt (2-4 months), supportive advice and regular clinical and radiographic review or extraction if tooth displaced into follicle of permanent successor

Question 11

Clinical management of luxation injuries?

Answer 11

Depends on direction of root displacement
If crown displaced palatally (root will be labially positioned) can leave if not in traumatic occlusion
If crown displaced labially (root will be palatal) - reposition or extract.
Splinting not necessary for 1yr teeth

Question 12

How to manage lateral luxation?

Answer 12

If tooth mobile in danger of inhaling - extract

Question 13

How to manage avulsion?

Answer 13

Do NOT reimplant (primary tooth)

Question 14

Why have a trauma follow up?

Answer 14

Sequelae to the injured primary tooth

Sequelae involving the developing permanent successors

Question 15

Primary tooth sequelae?

Answer 15

Change in colour - pink/grey not an indication for interventive tx in absence of other signs/symptoms

Loss of vitality: Pain, extraoral swelling, sinus formation, pathological mobility
Internal/external inflammatory root resorption
Canal obliteration/sclerosis
Failure to exfoliate normally

Question 16

Permanent tooth sequelae?

Answer 16

Occurs in 12=69% of cases of injury to the primary dentition
Type and severity depends on type of injury to primary tooth and age at which it occurred
Occurs due to a disturbance in mineralisation or morphology of developing tooth germ

Question 17

What injury to primary teeth has the highest prevalence of damage to the permanent tooth?

Answer 17

Increase prevalence of damage to permanent tooth with younger age of primary tooth trauma
Luxation of primary tooth = higher prevalence of damage to permanent tooth

Question 18

Permanent tooth sequelae?

Answer 18

Enamel opacities (white, yellow, brown)
Enamel hypoplasia
Crown dilaceration

Odontoma-like malformation
Root duplication or dilaceration
Partial/complete arrest of root formation
Sequestration of permanent tooth germ
Disturbance in eruption