TRAUMATIC INJURIES IN PRIMARY DENTITION

Etiology of Traumatic Injuries??? (6)

Iatrogenic injuries

Falls

Physical abuse

Sports accidents

Hits and collisions (traffic accidents)

Systemic Problems (mental retardation/epilepsy)

Worldwide prevalance of trauma?

6-37%

___ of children under age 7 have one of the primary incisors injured as a result of trauma

1/3

By age ___ , half of the children will have experienced a dental traumatic injury

14

Frequency of TDIs:

Ages ___-___ > ___-___

Males ___ females - how much?

Risk doubles between what ages?

At home ____ at kindergarden

2-4 > 8-10

> 2x

18-30 mo

=

Physical abuse definition?

What % of all abuse cases? After what?

Prevalence?

Non accidental injury in a child

18%, 2nd -after neglect

.1-10%

What % of all physical injuries are head and neck?

50

What percent of injuries are ecchymosis, abrasion, burns and fractures in children?

Greater than 50%

Child abuse should be considered as a possible etiology in any child under __ with trauma affecting what? (5)

under 5

• Lips, gingiva, tongue, palate, severe tooth injury

Physical Exam Findings: Facial Lesions %

Contusions and Ecchymosis?

Abrasions, lacerations?

Burns?

Fractures?

Bites?

66%

28%

3%

2%

1%

Patient assessment includes what 4 things?

History (med and dental)

Extra oral exam

intraoral exam

radiographic exam

During a percussion test: Sensitivity to vertical percussion is a sign of what?

Perio injury

Percussion:

• With fingers in ________

• Sensitivity to vertical perussion sign of __________ injury

Toddlers

periodontal

A high pitch, metallic sound during percussion test in indicative of what three things?

Lateral luxation

Intrusion

Ankylosis (if during follow ups)

Mobility:

• The amount of ___________

• Single tooth in _______ direction

• Multiple teeth moves as a _________

luxation

axial

group

Why is a detailed radiologic exam important?? (3)

Extent of injury to supporting structures

Stage of root development

Relation to permanent successors

What is recommended for radiologic exams?

what views?

Several angles

90 degree Horizontal angle with central beam through the tooth in question (size 2)

occlusal view (size 2 film)

Extra oral- lateral (size 2 film, vertical view), sledom indicated

Laceration of lips usually accompanies what?

What X ray is needed?

Crown fracture

PA - halved exposure time

Enamel Fracture:

Radiographic Abnormalities?

Tx?

No

Smoothen sharp edges

Enamel Dentin Fracture:

Pulp exposure?

Radiographic Abnormalities?

Tx?

No

No, the relation between the fracture and pulp chamber may be disclosed.

Seal dentin to prevent microleakage with GI or resin

Tx for crown fracture with pulp exposure? (3)

Preserve pulp vitality - partial pulpotomy or pulpotomy

Pulpectomy if necrosis

EXT if no child cooperation

Crown Root Fracture:

Pulp exposed?

Loose but still attached _____

_____ to _____ tooth displacement

May or may not be

Root fragments

Minimal to moderate

Tx for Crown Root Fracture:

Fragment removal if

• the fracture involves a small part of the root

• or there are still enough stable fragments to allow for coronal restoration

EXT of root

Where are root fractures usually?

What part is usually mobile/displaced?

Mid or apical third

coronal fragment

Root fracture tx if:

Coronal fragment is not displaced?

Coronal fragment is displaced?

No tx

Reposition and splint, or ext coronal fragment and let apical fragment resorb

Alveolar Fractures may cause segment _____ and _______, _____ interference

Mobility and dislocation

Occlusal

Radiograph of alveolar fractures may disclose the horizontal fracture line to the ______ of the primary teeth and their permanent successors

apices

Tx for alveolar fractures?

How long to stabilize?

What is indicated?

What do we need to monitor

Reposition any displaced segments and splint

4 weeks

GA

Teeth in fracture line

Luxation injuries? (6)

1. Concussion

2. Suluxation

3. Extruxion

4. Lateral Luxation

5. Intrusion

6. Avulsion

The injury affects the periodontal tissues without displacement and mobility?

Concussion

Treatment for concussion?

Follow up w analgesics and antiinflammatories

The injury causes increased mobility without tooth displacement and major periodontal injury?

Subluxation

Tx for sublxation?

Follow up → Analgesics and antiinflammatories, splint?

The partial displacement of the tooth out of the alveolar socket along its long axis?

Extrusion

Treatment for Extrusion:

>3mm (mature root)?

<3mm (immature root)?

EXT

Repositioning/spontaneous alignment

Displacement of tooth in alveolar socket in a direction other than its long axis?

Lateral luxation

What direction did root tip move if tooth is shorter and root tip is visivle?

Bucally

What direction did root tip move if tooth is longer and root tip is not visible?

Palatally

Tx for Lateral Luxation:

No occlusal interference?

Minor occlusal interference?

Major occlusal interference?

Severe occlusal interferece?

Allow to reposition spontaneously

Slight grinding

Reposition gently after LA

EXT

The injury causes the tooth to be buried into the alveolar socket along its long axis?

Intrusion

Tx for intrusion moved buccally?

Monitory for 3-4 weeks wait for spontaneous re-eruption

Tx for intrusion moved palatally?

Ext

Total removal of tooth from its alveolar socket?

Avulsion

What is NOT recommended for avulsion in primary teeth?

Replantation

Prognosis of Primary Teeth with Ectopic Eruption?

Fully Intruded?

Partially Intruded?

37%

45%

30%

Prognosis of pulp canal obliterated primary teeth?

Fully intruded?

Partially intruded?

52%

64%

40%

Most common finding in primary?

Discoloration and premature

Development of Pulpal Necrosis determining factors??? (3)

Age

Amount of luxation

Additional crown (dentin/pulp) fracture

Development of pulpal canal obliteration determining factors?? (2)

Luxation injury

Existing physiological root resorption

Complications in the permanent dentition??? (3)

Intrusion

Avlusion

Alveolar fracture

Complications in permanent dentition <3 years old??? (3)

Enamel hypoplasia

Crown/root deformation

Eruption disturbances (ankylosis, retardation, ectopic)

Where does enamel hypoplasia occur on permanent teeth?

What phase?

Incisal and middle third

Secretory phase of ameloblasts

Conclusions:

• Periodontal tissue injuries ____________

• Accompanying systemic injury was _____

• Treatments were mostly limited to ________ or ________

predominated

rare

examination or extraction