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Pedo > Trauma of Primary Teeth > Flashcards

Trauma of Primary Teeth Flashcards

1
Q

Which teeth are most commonly affected by trauma?

A

Upper central incisors

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2
Q

What are the types of trauma injuries?

A

Soft tissue:
- Loosening
- Displacement

Hard tissue: fractures
- Children have softer bones => less likely to fracture due to impact => hard tissue injury less common

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3
Q

What is the presentation of concussion?

A
  • Tender to touch
  • No displacement
  • Normal mobility
  • No sulcular bleeding
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4
Q

What is the management for concussion?

A
  • Soft diet
  • Monitor
  • No radiograph needed
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5
Q

What is the presentation of subluxation?

A
  • Tender to touch
  • No displacement
  • ↑ mobility
  • Sulcular bleeding
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6
Q

What is the management for subluxation?

A
  • Take baseline radiographs
  • Clean patient up
  • Soft diet
  • Analgesics
  • Monitor
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7
Q

What is the follow up management for teeth with concussion and subluxation?

A

Clinical examination after
- 1 week
- 6-8 weeks

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8
Q

What is the presentation of lateral luxation?

A
  • Tooth is displaced (labial or palatally displaced)
  • Tooth immobile
  • Occlusal interference may be present
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9
Q

What is the treatment for lateral luxation?

A

Take baseline radiograph

Leave alone if:
- No interference with bite
- Stable

Extract if:
- Tooth pushed into developing tooth bud (tooth bud usually palatal to primary tooth)
- Occlusal interference + reposition not possible
- Excess mobility, increased risk of aspiration

Immediate repositioning

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10
Q

Describe the procedure for immediate repositioning

A
  1. Clean area w water spray/saline/CHX
  2. Apply LA
  3. Suture gingival lacerations, if any
  4. Reposition tooth w gentle combined
    labial & palatial pressure
  5. If tooth unstable, stabilise w flexible
    splint for 4 weeks (take note: splint requires GA)
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11
Q

What is the follow-up management of teeth with lateral luxation injury?

A

Clinical examination after:
- 1 week
- 4 weeks (for splint removal, if splint placed)
- 6-8 weeks (8 weeks if had splint removed)
- 6 months
- 1 year

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12
Q

How do you determine the direction of the apex of a tooth radiographically?

A
  • Shortened tooth => closer to source
    => root apex buccal
  • Elongated tooth => further from source
    => root apex palatal
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13
Q

What is the presentation of an intrusion?

A
  • Tooth submerged into gum, can be palapted labially
  • Tooth may be displaced through labial bone plate or impinging or permanent tooth bud
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14
Q

What may intrusion be mistaken for?

A

Avulsion or crown fracture with root left behind – important to have good history taking

Tooth may also be aspirated – high chance of pneumonia

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15
Q

What is the treatment for intrusion?

A
  • History taking
  • Radiographs (PA/occlusal) to rule out avulsion and aspiration, to confirm that tooth is embedded in soft tissues

Leave alone to spontaneously reposition unless:
- Infection
- Failure to re-erupt

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16
Q

What is the follow up management for intrusion?

A

Clinical follow ups at
- 1 week
- 6-8 weeks
- 6 months
- 1 year

Further follow up at 6 years of age is indicated for severe intrusion to monitor eruption of permanent tooth

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17
Q

What is the presentation for extrusion?

A
  • Tooth is mobile
  • Displaced out of socket
  • Radiographically – increased PDL space
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18
Q

What is the treatment for extrusion?

A

If extrusion 1-2mm; no occlusal interference:
Monitor

If extrusion >3mm; occlusion affected: extract

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19
Q

What is the follow up management of teeth with extrusion?

A

Clinical follow up
- 1 week
- 6-8 weeks
- 1 year

20
Q

What are the general guidelines for follow up management for all trauma injuries?

A
  • If concerned that unfavourable outcome is likely, clinical follow-up every year until eruption of permanent teeth
  • Radiographic follow-up only indicated where clinical findings suggestive of pathosis
21
Q

What is the presentation of avulsion?

A

Tooth completely out of socket

22
Q

What is the treatment for avulsion?

A

History taking:
- Location of missing tooth should be explored: could have been aspirated, ingested, or embedded in soft tissues
- If location of missing tooth not found, child should be referred for medical evaluation, esp if have respi symptoms (high risk of pneumonia)

Baseline radiograph – to rule out intrusion + determine if permanent tooth bud was displaced

Do NOT replant

23
Q

What is the follow up management for avulsed primary teeth?

A

Clinical examination at 6-8 weeks.
Further follow up at 6 years of age to monitor eruption of permanent tooth

24
Q

What are the types of traumatic hard tissue injuries?

A
  1. Root fracture
  2. Crown fracture
  3. Crown-Root fracture
  4. Alveolar fracture
25
Q

How may a root fracture present?

A

Depending on location of fracture:
- Coronal fragment may be mobile and may be displaced
- Occlusal interference may be present

26
Q

What is the treatment for root fracture?

A
  • Baseline radiograph – fracture usually at mid-root or in apical 1/3

If stable – coronal fragment not displaced OR displaced but not excessively mobile: leave alone and monitor

If unstable – coronal fragment displaced, excessively mobile + interfering with occlusion:
1. Extract coronal segment and leave apical segment to be resorbed / pushed out when permanent tooth erupts OR
2. Reposition and splint for 4 weeks

27
Q

What is the follow up management for crown fracture?

A

Clinical examination after
- 1 week
- 4 weeks (if splint placed to remove splint)
- 6-8 weeks
- 1 year

28
Q

What are the types of crown fractures?

A
  • Enamel fracture
  • Enamel dentine fracture (with no pulp exposure)
  • Complicated crown fracture (with exposed pulp)
29
Q

What is the treatment for the different types of crown fractures?

A

Baseline radiograph (optional for enamel fracture) – PA or occlusal

If no pulp exposure (uncomplicated)
- Smoothen sharp edges
- CR restoration

If pulp exposure (complicated)
- Pulpotomy/pulpectomy
- Extraction (if non restorable)

30
Q

What are the recommended follow up managements for the various types of crown fractures?

A

Enamel fracture: no F/U recommended
Enamel-dentine fracture: 6-8 weeks later
Complicated fracture: 1 week, 6-8 weeks, 1 year

31
Q

How do crown-root fractures present?

A

Fracture involves enamel, dentin and root.
Pulp may or may not be exposed
Additional findings: loose but still attached fragments of tooth

32
Q

What are the treatment options for crown-root fractures?

A
  1. Remove loose fragment
  2. Assess if crown can be restored
    - If restorable + no pulp exposure: cover exposed dentine with GIC
    - If restorable + pulp exposure: pulpotomy/RCT
    - If unrestorable: extract
33
Q

How does alveolar fracture present?

A
  • Mobility and dislocation of the segment with several teeth moving together
  • Occlusal interference usually present
34
Q

What is the treatment for alveolar fracture?

A

Baseline radiographs (PA/occlusal) – other radiographs may be indicated

(done by pedodontist)
1. Reposition under GA
2. Stabilise segment with flexible splint for 4 weeks
3. Monitor teeth in fracture line

35
Q

What are the post treatment instructions to parents after traumatic injury treatment?

A
  1. Soft diet: prevent further trauma to injured tooth
  2. OH measures to encourage gingival healing
  3. Advise about possible complications that may occur and when to bring child in for tx
  4. Inform about possible effects on permanent tooth
36
Q

What are the OH measures for post-trauma instructions to parents?

A
  • Support tooth when brushing
  • Clean affected area w soft brush/cotton swab
  • Topical application of alcohol-free 0.1% CHX m/w, x2/day for a week
37
Q

What are 3 possible sequelae that parents should be informed of?

A
  1. Discoloration
  2. Loss of vitality (pulp necrosis & infection)
  3. Damage to permanent successor
38
Q

What does grey tooth discolouration mean?

A
  • Probably hemorrhage
  • Usually happens quickly w subsequent gradual resolution
  • In isolation => not sign of loss of vitality
  • *grey discolouration alone insufficient to dx pulp necrosis, could be due to
    haemosiderin by-products during healing => bruising within pulp chamber
39
Q

What are clinical signs of loss in vitality?

A
  • Pain
  • ↑ mobility
  • Sinus tract, gingival swelling, abscess
  • Persistent dark grey discolouration w ≥1 sign of root
    canal infection
40
Q

What does yellow discolouration mean?

A

Pulp canal obliteration

41
Q

What are radiographic signs of loss of vitality?

A
  • Periapical pathology
  • Infection-related resorption
42
Q

In what kind of injuries is damage to permanent successors more commonly seen?

A

Intrusion or avulsion
Younger age trauma occurs => ↑ risk

43
Q

What are possible effects that traumatic injuries can have on permanent successors?

A
  • White/brown discolouration
  • Dilaceration of crown/root (crown dilaceration requires exo)
  • Odontome-like malformation (aka Turner’s hypoplasia)
  • Failure of tooth dev: sequestration of permanent tooth germ => dissolves instead of calcifying
44
Q

What are the aims of treating traumatic injury?

A
  1. Prevent further damage to permanent successor
  2. Treat pain
  3. Restore function
  4. Restore aesthetics
45
Q

What are factors that influence the choice of treatment?

A
  1. Medical history
    e.g child w congenital heart disease requires RCT to save & keep tooth
    - BUT re-infection possible => risk of bacteraemia => infective endocarditis
    - Exo w 100% success => better option
  2. Severity of injury – restorable?
  3. Behaviour – affected by age (older children likely more cooperative)
  4. Parental choice

Pedo (15 decks)

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