Trauma IV Flashcards
(42 cards)
aetiology of primary tooth trauma
Falls
Bumping into objects
Non-accidental
epidemiology of primary tooth trauma
Maxillary centrals most commonly affected
Prevalence 17-54%
Male = Female
Luxation commonest
2-4 years peak incidence
prevalence of types of injury
Enamel crack ED# 7-13% EDP# CR# 2% Root# 2-4% Luxation 62-69% Avulsion 7-13%
pt management of primary tooth morphology
Reassure History Examination Diagnosis Emergency treatment Advise parent of sequelae to permanent teeth Further treatment and review
trauma history
This injury
- When
- Where
- How
- Any other symptoms
- Lost teeth/fragments
Medical history
- R.Fever
- Congenital heart defects
- Immunosuppression
Dental history
- previous trauma
- Treatment experience
- Parent and child attitude
trauma examination
extraoral
Laceration
Haematomas
Haemorrhage/CSF
Subconjunctival haemorrhage
Bony step deformities
Mouth opening
trauma examination
intraoral
soft tissue
alveolar bone
occlusion
teeth
detailed intraoral examination for primary tooth trauma
Soft tissue damage
- penetrating wounds, foreign bodies.
Tooth mobility
- may indicate: displacement; root#; bone#.
Transillumination
- may show: fracture lines in teeth, pulpal degeneration, caries
Tactile test with probe
- look for: horizontal #’s; vertical #’s; pulpal involvement
Percussion
- duller note may indicate root#
Occlusion
- traumatic occlusion demands urgent treatment
Radiographs
- intra-oral or ant occlusal, lateral pre-maxilla, OPT, soft tissue.
Classify the trauma
- trauma stamp
issue with sensibility tests in children
common to be incorrect in children as they want to please you
classifications for primary tooth trauma
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
Crown Fractures
- Enamel only
- Enamel + dentine
- Enamel, dentine + pulp
immediate home manage of all primary tooth trauma injuries
Soft diet for 10-14 days (normal diet just cut everything small and chew with molars)
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 more frequent review (see guidelines).
treatment of primary tooth trauma injuries
enamel only
smooth sharp edges
treatment of primary tooth trauma injuries
enamel only or enamel-dentine fractures
restore/bandage with composite or compomer (do not use GI)
treatment of primary tooth trauma injuries
enamel-dentine-pulp fractures
endodontic therapy or extraction
be careful not to encroach on dental follicle - 2mm away - do not take EWL X-rays in children
treatment of primary tooth trauma injuries
crown and root fractures
exact coronal fragment
don’t be overzealous to remove any root fragments that aren’t obvious
- these should be left to resorb physiologically
treatment of primary tooth trauma injuries
alveolar bone fractures
reposition segment
- splint to adjacent teeth 3-4 weeks
teeth may need to be extracted after alveolar stability has been achieved
treatment of primary tooth trauma injuries
concussion and subluxation
observation
treatment of primary tooth trauma injuries
lateral luxation
radiograph - increased pl space apically
no occlusal interference - allow to position spontaneously
occlusion interference - extract
treatment of primary tooth trauma injuries
localisation of intrusion injury with one film
not parallax as only using one radiograph
there are 2 types of film you can use to help localise - PA or lateral premaxilla (extra oral film)
being able to assess the danger to the permanent tooth allows better counselling re prognosis
treatment of primary tooth trauma injuries
localisation in intrusion injury with one PA
take a periapical radiograph
- if the apical tip appears shorter than that of the contralateral tooth then it has been displaced towards or through the buccal plate - preferable direction (away from developing tooth germ)
- if the apical tip is indistinct and the tooth appears elongated in comparison to the contralateral tooth then the apex is displaced towards the permanent tooth germ
treatment of primary tooth trauma injuries
localisation premaxilla
identifies direction of displacement as providing a lateral view
treatment of primary tooth trauma injuries
intrusion
monitor re-eruption of tooth
if no re-eruption after 6 months consider extraction to avoid problems in eruption of permanent tooth
treatment of primary tooth trauma injuries
extrusion
extract
guidelines consider reposition but change of damage to permanent tooth is high
treatment of primary tooth trauma injuries
avulsion
radiograph to confirm avulsion
do not replant - damage to permanent
