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Traumatic Injuries to the Primary Dentition I

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Maryam Meschi

on 26 September 2013

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Transcript of 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

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
Peak occurrences
1.5-2.5 years old
5-6 years old

What is the most commonly injured tooth in the mouth?

Etiology in the Primary Dentition
Usually due to falls or objects directly hitting tooth
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




5 Types
4 Types
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


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


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
Time between injury and treatment is critical to outcome in most cases. Also, delay can indicate abuse/neglect.
Location can indicate need for medications.
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

Stay Safe

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
(4)Pulp exposures
(5)Vitality tests
•Bony structures – palpate for fractures, ridges in cortical plate
Full transcript