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Traumatic Injuries to the Primary Dentition I

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by

Maryam Meschi

on 26 September 2013

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Transcript of Traumatic Injuries to the Primary Dentition I

TRAUMATIC INJURIES TO THE PRIMARY DENTITION I
4-60% of all children will suffer an injury to the primary dentition; 4-40% of children will suffer an injury to the primary dentition by age 5 years.
Injures to hard dental tissue, the pulp and the alveloar process
GENERAL INFORMATION



Reports vary due to large numbers of parents who do not take these injuries to the dentist unless really severe
parents are more likely to take children to the dentist in countries with national health care dental benefits.


Realistically, probably every child has some
injury even if it is simply a concussion of the
tooth.
Peak occurrences
1.5-2.5 years old
5-6 years old

What is the most commonly injured tooth in the mouth?
MAX CENTRAL INCISOR

Etiology in the Primary Dentition
Usually due to falls or objects directly hitting tooth
CLASSIFICATION OF TRAUMA
Injuries to the periodontal tissues

Uncomplicated crown fracture:

Enamel fracture




Complicated crown fracture:
Enamel-dentin-pulp fracture


Crown-root fracture:
Enamel-dentin-cementum-pulp fracture
Root fracture


Alveolar fracture



Concussion

Subluxation


Avulsion

5 Types
4 Types
EVALUATION
Immediate Evaluation for Triage
Immediacy of dental treatment
Quick Neurologic Assessment
Child Abuse
Evaluation by Dentist
Indicators for Additional Medications


Loss of Consciousness

Other injuries such as bone fractures or excessive bleeding

Dental/orofacial injuries:
Displacement of teeth
Fractures of the teeth and jaws
Disturbances in occlusion

Almost every dental injury is a true emergency
Delays in treatment can affect not only the outcome of the treatment but what the treatment options are
Possible exception – no bleeding or obvious injury, no pain, child able to bite in occlusion

Tetanus

Not current on immunization schedule
• Dirty injury, especially if soft tissues involved

Antibiotics

Heart disease, shunt, joint replacement
• Dirty injuries
• Avulsions- always

Gait and communicative skills
Cranial nerves
Headache, vomiting, seizures
Rhinorrhea, otorrhea

Over 50% abuse cases involve trauma to head and neck.
Injury doesn’t match story – check out story from child, if possible, as well as adult separately.
Delay in seeking treatment
Multiple other injuries or history of other injuries. Look for injuries on areas not usually hurt by falls.

Rule out any less apparent injuries
Radiographs for baseline data – always a must for documentation of baseline state of tooth immediately after injury with regard to fractures, dislocations, root formation/resorption, underlying conditions
Record history for future evaluation
Give appropriate instructions and sequelae of injuries


Enamel-dentin fracture





Etiology video : http://www.dentaltraumaguide.org/Primary_Alveolar_fracture_Etiology.aspx
Etiology Video: http://www.dentaltraumaguide.org/Primary_Subluxation_Etiology.aspx
Etiology Video: http://www.dentaltraumaguide.org/Primary_Concussion_Etiology.aspx
Lateral luxation

Intrusive luxation

Extrusive luxation


Luxation injuries:
History of the Injury
Radiographic Examination
Clinical Examination
Previous Dental Injury
Medical History
When?
Time between injury and treatment is critical to outcome in most cases. Also, delay can indicate abuse/neglect.
Where?
Location can indicate need for medications.
How?
Etiology can give clues to other injuries or abuse/neglect

Review and update medical history – hx of heart disease, seizures, psychiatric illness and associated drugs may alter treatment

Observe and record child’s condition upon examination, i.e. quick neurologic assessment

Previous injury may diminish prognosis or treatment

Previous restorations or caries may diminish prognosis or treatment

Patient management
•Medical immobilization is commonly needed in this age group. You may elicit the parent’s help to hold the child.
•Premedication/sedation – since time is of the essence and there is always the possibility of a closed head injury, this is neither practical nor advisable




Baseline state of the tooth immediately after injury

Aid in diagnosis with regard to fractures, displacements, root
formation/resorption, underlying conditions

Third party payer documentation

EXAMINATION AND DIAGNOSIS
Stay Safe


THE END
Soft tissue examination – Clean and debride area – warm water and gauze or cotton are least traumatic and painful
•Note and record all intraoral and extraoral injuries, take photos if appropriate
•Palpate soft tissues for fragments, take soft tissue x-rays



Hard tissue examination
•Teeth
(1)Displacements
(2)Fractures
(3)Mobility
(4)Pulp exposures
(5)Vitality tests
•Occlusion
•Bony structures – palpate for fractures, ridges in cortical plate
Full transcript