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Primary Tooth Trauma Flashcards

1
Q

Most common aetiologies for primary tooth trauma

A
  • Falls
  • 0-4 year old infants learning to walk
  • Bumping into objects
  • Non-accidental injury
  • Patients with disability eg epilepsy, CP
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2
Q

Predisposing factors to primary tooth trauma

A
  • Epilepsy
  • Hyperactivity
  • Protrusion of upper incisors
  • Increased overate and insufficient lip cover
  • Poor motor coordination
  • Anterior open bite
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3
Q

What teeth are most commonly affected during primary tooth trauma

A

-Maxillary centrals

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4
Q

What type of trauma is most common

A

Luxation most common

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5
Q

Name the different types of injuries in order of most common to least common

A
  • Luxation- 65%
  • Avulsion- 10%
  • ED#- 10%
  • EDP#- 10%
  • CR#- 10%
  • Root #- 4%
  • Enamel infraction- 2%
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6
Q

How to manage a patient as they walk into clinic with a primary tooth fracture

A
  • History
  • Examination
  • Diagnosis
  • Emergency treatment
  • Advise parent of sequelae to permanent teeth
  • Further treatment and review
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7
Q

What types of questions should be answered in the history of trauma

A
  • Presenting complaint
  • When,
  • How
  • Where
  • Who
  • Has tx been provided elsewhere
  • Has there been previous trauma
  • Are teeth/frsgments all accounted for
  • If avulsed how long in storage medium and what storage medium
  • Previous dental trauma
  • MH
  • Any systemic signs
  • Swallow?
  • MEchanism of injury (fall, bicycle, sport, assault)
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8
Q

What should you look for during the extra oral examination

A
  • General appearance
  • Facial asymmetry
  • Laceration
  • Contrusion (crowding)
  • Bruising
  • Abrasion
  • Swelling
  • TMJ Assymmetry
  • Fracture of facial skeleton
  • Foreign body/tooth fragment
  • Palpate bony borders of both maxillae and mandible
  • Soft tissue lesions
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9
Q

What should be looked for during intra oral examination

A
  • Gingival injury
  • OH
  • Tooth missing
  • Type of injury
  • Crown fracture (E/D/P)
  • Discolouration
  • Sinus/swelling
  • Percussion
  • Mobility
  • TTP
  • Response to EC
  • Response to EPT
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10
Q

What should be looked for during rx of primary trauma case

A
  • Root fracture
  • Root development
  • Permanent successor
  • Crown fracture proximity to pulp
  • Foreign body
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11
Q

What should you always be suspicious about and why

A
  • Orofacial signs such as bruises and abrasions from non accidental injuries
  • Discrepency between trauma history provided by parents and injuries found on examination or delay in presentation should arouse suspicions
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12
Q

What social history must you consider

A
  • Living with parents
  • Age
  • FrankL score
  • Type of school
  • Behaviour
  • Siblings
  • Habits eg. use of dummies
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13
Q

What medical history points are important

A

-Loss Of consciousness , cardiac conditions, bleeding disorders and allergies

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14
Q

What special investigations would you ideally like to do in children trauma cases?
But what realistically can you actually do

A

Ideally:

  • Colour
  • TTP
  • EPT
  • EC
  • Percussion
  • Sinus
  • Mobility

Realistically:

  • Colour
  • Sinus
  • Mobility
  • TTP
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15
Q

Classify types of dental trauma injuries

A
  • Avulsion
  • Alveolar fracture
  • Root fracture
  • Extrusion
  • Lateral luxation
  • Intrusion
  • Subluxation
  • Concussion
  • Crown-Root fracture
  • Crown fracture
  • None
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16
Q

Describe how you could diagnose a intrusion injury

A
  • Partial displacement of tooth from socket
  • No mobility
  • Tooth appears intruded rather than proclaimed/retroclined
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17
Q

Describe how you could diagnose a crown fracture

A
  • No displacement of the tooth
  • No loosening/mobility
  • Not TTP
  • Fracture does not go beyond the gingival margin
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18
Q

Describe how you could diagnose a extrusion injury

A
  • Partial displacement of tooth from socket
  • Mobility on a single tooth
  • No X ray signs of a root fracture
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19
Q

Describe how you could diagnose a lateral luxation injury

A
  • Partial displacement of tooth from socket
  • No mobility
  • Procliniation/retroclination of tooth
20
Q

Describe how you could diagnose an avulsion injury

A

-Complete displacement of tooth from socket

21
Q

Describe how you could diagnose a crown root fracture

A
  • No displacement of tooth from socket
  • No mobility or loosening
  • Not TTP
  • Fracture below gingival margin
22
Q

Describe how you could diagnose a concussion injury

A
  • No displacement of tooth from socket
  • No loosening of tooth
  • TTP
23
Q

Describe how you could diagnose a subluxation

A
  • No displacement of tooth

- Loosening of tooth

24
Q

Describe how you could diagnose an alveolar fracture

A
  • Displacement of tooth

- Mobility of multiple teeth as a unit on palpation

25
Describe how you could diagnose a root fracture
- Partial displacement of tooth from socket - Mobility of tooth - X ray evidence of root fracture
26
Aims of treatment planning
- Relieve pain - Maintain vitality - Prevent infection - Prevent damage to permanent successor - Maintain function, aesthetics, speech and mastication - Maintain arch space- prevent tilting/drifting/over-eruption - Maintain tooth in the arch
27
Common advice to all types of dental injuries
- Soft diet - Pain relief - OHI- tooth cleaning - Topical chlorhexidine by parent twice daily for one week - After initial treatment review 1,3 or 6 monthly taking rx if possible 6 monthly
28
Treatment for enamel or enamel dentine fractures
- Smooth sharp edges - Restore with composite - Cover exposed dentine - Consider GIC if compliance is poor for composite
29
What is a complicated crown fracture and how would you treat
- EDP fracture - Treatment dependent on behaviour - Pulp therapy (partial pulpotomy or RCT) is very difficult - Extract possible
30
Treatment for a crown root fracture and root fracture
- Monitor - If tooth is reasonably firm then leave it - If the tooth and there is risk of infection, extract it - Extract the coronal fragment potentially - Do not Dig for apical portion of root as can cause damage to successor - Should resorb physiologically
31
Treatment for an alveolar fracture
- Manual repositioning or repositioning using forceps of the displaced segment - General anaesthesia often indicated - Usually managed in a hospital setting - Stabilize segment with flexible splinting for 4 weeks - Monitor the teeth in the fracture line
32
Difference between subluxation and concussion and treatment for each
- Neither are displaced - Concussion is more of a shock. There is no mobility or discolouration. May be TTP. No Tx required - Subluxation may present with gingival bleeding at the sulcus. Discoloration may also be present. It may be tender and mobile -For both, just monitor
33
Rx evidence of lateral location and tx
- Increased PDL space apically - If no occlusal interference, allow to position spontaneously - If occlusal interference, reposition - Otherwise, extract the tooth
34
Rx and description for intrusion
- Tooth is usually displaced through the labial bone - Can impinge upon permanent tooth bud - USO or PA required - If apical tip appears shorter than its contralateral then it has been displaced towards or through the buccal plate - If apical tip is indistinct and the tooth appears elongated then apex is displaced towards permanent tooth germ
35
Tx guideline for intrusion
- If labial, away from the tooth germ. Leave to re-erupt. If no progress after 6 months then extract - If palatal towards the permanent tooth germ then extract
36
Tx plan for extrusion
-Extract
37
Tx plan for avulsion
- Rx to confirm complete avulsion | - Do not replant
38
What does prognosis of primary tooth fracture depend on
- Age of child - Mature or immature tooth - Type and severity of injury - Associated injuries - Time between injury and treatment - Presence of infection
39
Long term effects of primary dental trauma on primary and permanent successors
Primary Teeth: - Discolouration - Infection - Delayed exfoliation Permanent teeth - Enamel defects - Abnormal tooth/root morphology - Delayed eruption possible
40
How would discolouration progress from immediate to long term colour changes of the tooth
Immediate: -Reddish colour, may regress/remain and maintain vitality Intermediate (weeks) -Brown/black pulp breakdown products in tubules- non-vital ``` Long term (months) -yellow/opaque, pulp calcification ```
41
What does the time of discolouration tell you about vitality
- If immediate discolouration then it may still be vital | - If intermediate (weeks) then non vital
42
Problems in terms of exfoliation after primary tooth trauma
- May not resorb normally after trauma - XLA may be necessary or permanent successor will erupt ectopically - Premature loss of a primary tooth can result in delayed eruption of about 1 year due to thickened mucosa
43
When should you worry about a delay in tooth eruption
-if greater than 6 month delay compared with contralateral
44
Correlation between age of trauma and risk to permanent successor anomalies
-Higher percentage of anomalies on permanent teeth is observed when trauma occurred at an age less than 36 months
45
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Paediatrics (16 decks)

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