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Traumatic Injuries to the Primary Dentition I
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
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:
Complicated crown fracture:
Immediate Evaluation for Triage
Immediacy of dental treatment
Quick Neurologic Assessment
Evaluation by Dentist
Indicators for Additional Medications
Loss of Consciousness
Other injuries such as bone fractures or excessive bleeding
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
Headache, vomiting, seizures
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
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
History of the Injury
Previous Dental Injury
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
•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
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
•Bony structures – palpate for fractures, ridges in cortical plate