Primary tooth trauma

Question 1

Aetiology of primary tooth trauma

Answer 1

• Falls
• Bumping into objects
• Non-accidental trauma

Question 2

Predisposing factors to trauma

Answer 2

• Protrusion of upper incisors with insufficient lip cover
• AOB
• Medical issues - epilepsy, cerebral palsy
• Hyperactivity

Question 3

List the types of injuries to teeth

Answer 3

• E #, ED # or EDP #
• Crown-root #
• Subluxation
• Lateral luxation
• Intrusion
• Extrusion
• Avulsion

Question 4

What is the most common type of trauma to primary teeth? What % ?

Answer 4

Luxation

62-69%

Question 5

History taking for traumatised primary teeth

Answer 5

When,  where, how? 
Any treatment provided already 
Any loss of consciousness 
Any previous trauma 
Do you have all the teeth/fragments

Question 6

When should non-accidental injury be suspected?

Answer 6

Delay on presentation
Discrepancy between trauma history and the presenting injuries
Other signs of neglect?

Question 7

EO examination following trauma

Answer 7

• Symmetry
• Any soft tissue lesions - assess for tooth fragments
• Palpate bony borders of mandible and maxilla
• Assess TMJ for deviations

Question 8

Special IX for primary tooth trauma

Answer 8

• Radiographs

- colour, tpp, pathological mobility and sinus

Question 9

Define: concussion/subluxation injuries

Answer 9

Trauma to perio tissue without displacement out of the socket
Subluxation = loosening of tooth in socket
Concussion is ttp without loosening

Question 10

Define: Luxation injury

What are the types?

Answer 10

Dislodgement from normal position

Lateral, intrusion and extrusion

Question 11

Define: Lateral luxation

Answer 11

Displacement of tooth in socket in any direction other than apically

Question 12

Define: Intrusion

Answer 12

Apical displacement of tooth into alveolar bone

Question 13

Define: Extrusion

Answer 13

Partial displacement of tooth out of the socket

Question 14

Define: Avulsion

Answer 14

Tooth completely extruded from the socket

Question 15

Define: Crown-root fracture

Answer 15

Fracture extending below the gingival margin

Question 16

Tx aims for traumatised primary tooth

Answer 16

• Pain relief
• Maintain vitality
• Prevent infection
• Prevent damage to permanent successor
• Maintain tooth in the arch (Function, aesthetics and space maintainer)

Question 17

Post op advice

Answer 17

• Pain relief with OTC analgesics
• Soft diet 2 weeks
• OHI - gentle and use of CHX
• Avoid sports

Question 18

Tx options for subluxation

Answer 18

Monitor if mild

Splint for 2 weeks to reduce discomfort

Question 19

Tx options for lateral luxation

Answer 19

If no occlusal interference = leave to spontaneously reposition, monitor
If occlusal interference = reposition with LA
If severe = extract

Question 20

Tx options for intrusion

Answer 20

• If intruded TOWARDS tooth germ = remove

- If AWAY from tooth germ = retain and monitor for 6 months, if it hasn’t spontaneously extruded then extract

Question 21

Radiographic signs the tooth is intruded towards tooth germ -
What direction is it?

Answer 21

The apical tip is indistinct and tooth appears elongated

Palatal/lingual

Question 22

What direction is away from the tooth germ

Answer 22

Labially

Question 23

Management of extrusion

Answer 23

• If minor (<3mm) or immature tooth primary tooth - reposition or allow spontaneous alignment
• If severe or mature primary tooth - extract

Question 24

Management of avulsed primary tooth

Answer 24

DO NOT REIMPLANT AS IT WILL DAMAGE PERMANENT TOOTH

Question 25

What should be discussed with the parent

Answer 25

Long term sequelae on both the primary and permanent teeth

Question 26

Long term effects of traumatised primary teeth

Answer 26

- Discolouration - Infection - Delayed exfoliation

Question 27

Long term effects to permanent teeth following trauma to primary tooth

Answer 27

- Enamel defects - white, yellow or brown lesions (44%) or hypoplasia - Abnormal tooth/root morphology - dilaceration - Delayed eruption

Question 28

Describe discolouration changes to traumatised primary teeth

Answer 28

- Immediate - red/brown - Weeks - brown/black - Months - yellow/opaque

Question 29

What ages are more susceptible to damage to the permanent successor? Why?

Answer 29

0-36 months as permanent teeth are still developing

Question 30

Most important long term sequelae for permanent teeth

Answer 30

Hypomineralisation +/- hypoplasia

Question 31

Management of subluxation

Answer 31

Monitor | If discolouration occurs, check for signs of infection and treat appropriately

Question 32

Management of root fracture

Answer 32

If no displacement of coronal fragment - leave and monitor but extract if signs of infection If coronal fragment displaced, extract coronal segment and allow apical segment to resorb

Question 33

Why shouldn't the apical fragment be removed

Answer 33

The permanent successor can be damaged in the process of removal

Question 34

Treatment of EDP fracture of a primary tooth

Answer 34

Restorable - Partial pulpotomy or pulpectomy | Extract if uncooperative or unrestorable

Question 35

Signs of crown-root fracture

Answer 35

Tooth loose but attached Minimal to moderate displacement RG may indicate the presence of a fracture line

Question 36

Signs of root fracture

Answer 36

Coronal fragment mobile and displaced | RG showing mid-root or apical third fracture

Question 37

Signs of concussion

Answer 37

Tender to touch | No mobility, sucular bleeding or RG abnormalities

Question 38

Signs of subluxation

Answer 38

Increased mobility but no displacement Sucular bleeding No RG abnormalities

Question 39

Signs of lateral luxation

Answer 39

Tooth displaced palatally or labially Immobile RG shows increased PDL space apically

Question 40

What view is important in lateral luxation

Answer 40

Occlusal to assess proximity of tooth to the successor

Question 41

Signs of extrusion

Answer 41

Elongated tooth Excess mobility RG showing incr PDL space apically

Question 42

Why should a radiograph be taken following avulsion of primary tooth

Answer 42

To ensure there has not been severe intrusion