6- fractures in primary and permanent

Fractures are…

2nd cause of paediatric dental care

Several etiology

Doesn’t follow predictable pattern of intensity and extent

Needs multidisciplinary approach

How do you classify dental trauma into 4 categories?

Hard tissue and pulp injuries

Luxation injuries

Soft tissues injuries

Facial and bone injuries

Name 6 hard tissue and pulp injuries

Infraction

Crown-fracture uncomplicated or complicated

Crown/root fracture uncomplicated or complicated

Root fracture

What is an enamel infraction? How to treat if severe?

An incomplete fracture (crack/crazing) of enamel without loss of tooth structure

If severe- etch and seal with bonding resin- this prevents discolouration and bacterial contamination

What is an uncomplicated crown fracture (enamel only)? Treat, it depends on…

A coronal fracture involving enamel only, with loss of tooth structure

If tooth fragment available if can be bonded back to tooth

Depending on extent and location- tooth edges can be smooth or composite can be placed

What is an uncomplicated crown fracture (enamel- dentin fracture)?

Fracture confined to enamel and dentin without pulp exposure

If fragment intact- bond back- should be rehydrated by soaking in water or saline for 20mins before

Cover exposed dentin with GIC or using bond + composite

If exposed dentin within 0.5mm of pulp (pink no bleeding)place CaOH

What is a complicated crown fracture (enamel-dentin fracture with pulp exposure)?

Fracture confined to enamel and dentin with pulp exposure

Immature root and open apex- PRESERVE PULP- partial pulpotomy or pulp capping

If completed root- be conservative, but if need post for crown retention- just do RCT

Place CaOH or calcium silicate cements in pulp wound

Rebond fragment or if absent- cover with GIC

What is an uncomplicated crown root fracture (without pulp exposure)?

A fracture involving enamel, dentin and cementum

These typically extend below the gingival margin

What is a complicated crown root fracture (with pulp exposure)?

A fracture involving enamel, dentin, cementum and pulp

These typically extend below the gingival margin

What is a root fracture?

Fracture of root involving dentin, pulp, cementum

May be horizontal, oblique or combo of both

What are 6 types of luxation injuries? (Read ppt but covered in ppt 5)

Concussion

Subluxation

Lateral luxation

Intrusion

Extrusion

Avulsion

What are 3 types of soft tissue injuries?

Laceration- cut/tear in skin by being struck by a blunt or penetrating object

Contusion- Injury with submucosal haemorrhage that occurs without tearing- usually blunt object

Abrasion- superficial wound caused by tearing of mucosa- bleeding and rough surface

What are 4 types of facial bone injuries

Fracture of alveolar process of mandible/maxilla- involves alveolar bone and may extend to adjacent bones

Fracture of body of mandible/maxilla

Prevalence of traumatic dental injuries in children

25% of all school children

33% of adults

More freq in anteriores

Why can traumatic dental injuries occur? (Possible etiologies)

Primary dentition- 1-3yrs, crawl, stand up, walk

Permanent- more freq in boys, 6-12 yrs, violent sports/games

Abused child syndrome- intentional injuries

Traffic accidents

How do you approach the initial presentation and minimising anxiety?

Structured approach- history taking, clinical exam, collect test results, extra/intra oral photos

Be alert for concomitant injuries- head injury, facial fracture, missing tooth fragments or lacerations

Discolouration common complication of luxation injury so record colour of teeth at each visit

Antibiotics and tetanus

Why must you check the impact of orofacial primary teeth trauma on permanent dentition?

Close relationship between apex of primary tooth root and underlying perm tooth germ

May cause complications in development of perm teeth esp after intrusion, avulsion and alveolar fractures

Why may the patient need ATB or tetanus facing a TDI?

Booster if environmental contamination or injury has occurred- refer to medical practitioner within 48hrs

After a TDI, what are some parental instructions for home care?

Clean affected area with soft brush or cotton swab

Alcohol free chlorhexidine gluconate 0.12% mouth rinse applied topically 2x daily for 1 week

This prevents plaque accumulation and debris to reduce bacterial load

What prognostic factors need to be collected at initial and follow up visits?

Pulp inflammation

Necrosis

Pulpar revascularization

Change colour /discolouration

Conduct obliteration

Radicular development alteration

Radicular resorption: external or internal

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