primary trauma

Question 1

aetiology of primary trauma

Answer 1

falls
bumps
NA trauma

Question 2

patient management -primary trauma

Answer 2

Reassure
* History
* Examination
* Diagnosis
* Emergency treatment
* Advise parent of sequelae to permanent teeth
* Further treatment and review

Question 3

classifications of injury - primary trauma

Answer 3

• Enamel - E# - uncomplicated
• Enamel-dentine - ED# - uncomplicated
• Enamel-dentine-pulp - EDP# - complicated
• Crown-root (pulp involved)
• Root #
• Alveolar #
• Concussion / Subluxation
• Luxation - lateral, intrusive, extrusive
• Avulsion

Question 4

home management of a primary trauma injury
-instructions to parents
-Radiographic managment for PDL injuries

Answer 4

Soft diet for 10-14 days
* Brush teeth with soft toothbrush after every
meal
* Topical chlorhexidine by parent twice daily
for one week (cotton wool rolls for swabbing)
* After initial treatment review 1, 3 ,6 monthly
taking radiographs if possible 6 monthly
* Intrusion requires monthly review for 6
months then 6 monthly. Radiograph initially
then 6 monthly.

Question 5

PRIMARY trauma - management of E#
-?radiographs
-Treatment
-Follow up

management of ED#

Answer 5

No radiographs recommended

Treatment:
Smooth any sharp edges

Parent/patient education:
-Exercise care when eating not to further traumatize the injured tooth while encouraging a return to normal function as soon as possible
-Encourage gingival healing and prevent plaque accumulation by parents cleaning the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1 to 0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 wk

No follow up recommended

Question 6

PRIMARY trauma - management of CR#

Answer 6

Extract coronal fragment
• Don’t be overzealous to remove any root
fragments that aren’t obvious. These should
be left to resorb physiologically

Question 7

PRIMARY trauma - alveolar bone #

Answer 7

Reposition segment. Splint to adjacent teeth
3-4 weeks.
• Teeth may need to be extracted after
alveolar stability has been achieved.
• This is the only case where a splint will be
used in the management of primary trauma

Question 8

PRIMARY trauma - concussion/subluxation

Answer 8

observe

Question 9

PRIMARY TRAUMA - lateral luxation

Answer 9

Radiograph - increased PDL space apically.

• No occlusal interference - allow to reposition spontaneously
• Occlusal interference - extract

Question 10

how to localise an intrusion injury

Answer 10

take a PA radiograph
-if the apical tip appears shorter than that of the
contralateral tooth then it has been displaced toward
or through the buccal plate (this is the preferable
direction- away from the developing tooth germ)

• if apical tip is indistinct and the tooth appears
  elongated in comparison to the contralateral tooth
  then the apex is displaced toward permanent tooth
  germ

Question 11

PRIMARY trauma - management of intrusion

Answer 11

If root has been displaced labially away from tooth
germ- leave to re-erupt. If no progress after 6 months
then extract.
• If palatally, toward permanent tooth germ - extract
Intrusion

Question 12

PRIMARY trauma - management of extrusion

Answer 12

XLA

Question 13

PRIMARY trauma - management of avulsion

Answer 13

Rg to confirm all out

-DON’T REPLANT

Question 14

long term effect of trauma on primary teeth

Answer 14

discolouration
delayed exfoliation
discolouration and inf

Question 15

PRIMARY trauma - management of discolouration of primary tooth

• vital
• non vital

Answer 15

Vital: no treatment
• Non-vital:
-sinus or PAP on radiograph: RCT or
extraction.
-no sinus or PAP then leave and review.
• Opaque: no treatment

Question 16

long term effect on permanent teeth if primary trauma occured

Answer 16

enamel defect
delayed eruption
failure to form
abnormal tooth/root formation
odontome formation
ectopic tooth position
arrest in tooth formation

Question 17

delayed eruption - when to investigate

Answer 17

-if greater than 6 month delay compared to contralateral tooth

• if >1yr from opposing arch tooth
• if abnormal sequence

Question 18

treatment of complications

• crown dilaceration
• root dilaceration
• arrested development
• odontome
• underdeveloped tooth germ

Answer 18

Crown dilaceration - surgical exposure, ortho
realignment, improve appearance
• Root dilaceration/angulation/duplication -
combined surgical and ortho
• Arrest of root development - RCT / extraction
• Odontome - surgical removal
• Undeveloped tooth germ - may sequestrate
spontaneously or require removal

Question 19

PRIMARY trauma - management of ED#
-?radiographs
-Treatment
-Follow up

Answer 19

Baseline radiograph optional
-Take a radiograph of the soft tissues if the fractured fragment is suspected to be embedded in the lips, cheeks, or tongue

Treatment
-Cover all exposed dentin with glass ionomer or composite
-Lost tooth structure can be restored using composite immediately or at a later appointment

Parent/patient education:
-Exercise care when eating not to further traumatize the injured tooth while encouraging a return to normal function as soon as possible
-Encourage gingival healing and prevent plaque accumulation by parents cleaning the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1 to 0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 wk

Follow up
-Clinical examination after 6-8 wk
-Radiographic follow up indicated only when clinical findings are suggestive of pathosis (eg, signs of pulp necrosis and infection)

Question 20

PRIMARY trauma - management of EDP#
-?radiographs
-Treatment
-Follow up

Answer 20

Baseline Raiograph: Periapical and Max occlusal

Treatment
Preserve the pulp by partial pulpotomy. Cervical pulpotomy is indicated for teeth with large pulp exposures.
Treatment depends on the child´s maturity and ability to tolerate procedures. Therefore, discuss different treatment options (including pulpotomy) with the parents. Each option is invasive and has the potential to cause long-term dental anxiety. Treatment is best performed by a child-oriented team with experience and expertise in the management of pediatric dental injuries. Often no treatment may be the most appropriate option in the emergency situation, but only when there is the potential for rapid referral (within several days) to the child-oriented team

Parent/patient education:
-Exercise care when eating not to further traumatize the injured tooth while encouraging a return to normal function as soon as possible
-To encourage gingival healing and prevent plaque accumulation, parents should clean the affected area with a soft brush or cotton swab combined with an alcohol-free 0.1 to 0.2% chlorhexidine gluconate mouth rinse applied topically twice a day for 1 wk

Follow up: 1 week, 6-8 weeks and 1yr