Transcript Primary Dentition
Teaching Module & Competency:
Primary
Tooth Trauma
Prepared by : Cynthia Christensen; DDS, MS Karin Weber-Gasparoni; DDS, MS, PhD University of Iowa 2008
Objectives
Understand the incidence of primary tooth trauma Understand how to triage primary tooth trauma Understand clinical presentation of the most common types of primary tooth trauma and treatment options
Epidemiology of Tooth Trauma
30% of children suffer trauma to primary dentition.
Most injuries to primary teeth occur at 18-30 mo of age:
“…more traumatic dental injuries occur to younger children, probably because the children are gaining mobility and independence, yet lack full coordination and judgment.”
Garcia-Godoy
et al.
Clinical Examination
Intra/ extra oral soft tissues Swelling Fractured, luxated, or missing teeth Pulp exposures Occlusion Deviation on opening
TRIAGE
: Occlusion Indicates Fractured Alveolus or Mandible Immediate referral to Oral Surgeon or ER Advise patient to be kept NPO
Radiographic Exam
For young children, parent or dental staff must hold Establish Baseline Detect root or alveolar injuries or pathosis
What about Sutures?
Extraoral: Plastic/ENT surgeon best for esthetic outcome Introral: Small laceration = No sutures. Larger lacerations = General Dentist or Oral Surgeon
Possibility: Foreign Body in Lip or Tongue
Checking for Tooth Fragment
Palpate puncture/laceration Soft tissue radiograph ¼ the exposure time of nearest teeth
Common Injuries
Treatment Options
Concussion / Subluxation
Concussion
: injury to the tooth and ligament without displacement or mobility
Subluxation
: tooth is mobile, but is not displaced
Concussion and Subluxation Management
Periapical radiograph OTC pain meds prn Soft diet for 1 week Advise parent of possible sequelae Follow-up, 2-4 weeks
Concussion/Subluxation
Neurovascular bundle at apex may be crushed or severed PDL may be torn Prognosis for Recovery = Good
Discoloration of Primary Tooth Post Trauma Color may change 2-4 weeks after trauma May retain/regain vitality and return to near normal color within 6 months Monitor. Esthetics may be a concern if color does not resolve Color may be pink, purple, grey or brown
Pulpal Obliteration/Calcific Metamorphosis History of Trauma Tooth darker-usually yellowish Radiograph shows pulpal space narrowing or obliterated NO TX-observe for normal exfolitation
All Teeth Do Not Recover: Abscess 6 Months Post Concussion Note associated soft tissue swelling Confirm Dx and check root structure with periapical radiograph
Radiographic Abscess #F
Note
: #E resorption post trauma. No Tx #F extraction indicated
LATERAL LUXATION / EXTRUSION INJURIES: RECOMMENDATIONS
Primary Dentition
Tooth is aspiration risk
Yes
Extract and advise parents of potential damage to permanent tooth
No
Tooth causing occlusal interference **All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume appropriate radiographic survey.
(
Reference: AAPD Handbook of Dentistry)
Yes No
Allow for spontaneous re-positioning or re-position and splint or consider extraction Extract or reposition and splint Follow up in 2 weeks: Advise parents of possible injury / damage to permanent teeth
Extrusion and Luxation With Occlusal Interference
Extraction is recommended most of the time due to risk of aspiration of mobile teeth and damage to permanent tooth bud
**Key = Degree of Severity and cooperation
Extrusion and Luxation With Occlusal Interference
Primary Teeth Reposition and Splinting RARE unless..
Excellent Patient Cooperation Excellent Recall Compliance
No
Pulp Exposed
No
Dentin Exposed
No
Rough Edge Present No further treatment required
Yes Yes
Treatment Planning Crown Fracture Injuries
Primary Dentition
Pulpectomy and full coverage crown (SSC or strip crown) All treatment is ideal and assumes patient has manageable behavior.
Recommendations also assume appropriate pre-operative radiographs
Reference: AAPD Handbook of Pediatric Dentistry
Composite or GI provisional restoration “band-aid” if symptomatic
Yes Yes
Smooth edge and if required restore with composite Clinical and radiographic follow up.
Advise parents of possible injury to permanent teeth and monitor for signs of pathology
Enamel Fx Dentin Fx Pulp Exposure Ellis Class I Ellis Class II Ellis Class III
Enamel Fracture in Primary Teeth: Ellis Class I
Radiograph Smooth Sharp Edges GI or Composite Optional Periodic Follow Up
Enamel and Dentin Fx: Ellis Class II Radiograph Protect Dentin Glass Ionomer Bonding Agents Composite Ideal Periodic Follow Up Dentin Exposed
Pulp Exposure: Ellis Class III Radiograph Pulpectomy Extraction Pulp Exposed
Vertical Crown Fracture RARE- more likely to luxate or intrude Extraction