IADT Primary Dentition

What age does dental trauma most commonly occur?

2 - 6 years old

What is the treatment for an enamel fracture in a primary tooth?

- Smooth any sharp edges

What advice should be given to parents for the after care of any dental trauma?

- soft food diet

- good OH

- no contact sport

- analgesics

- 0.2% CHX mouthrinse/topical twice a day for 1 week

What are the unfavourable outcomes for trauma to primary dentition?

- Symptomatic

- Crown discolouration

- Signs of pulpal necrosis

- No further root development

What are the signs of pulpal necrosis?

- Sinus tract

- Swelling

- Increased mobility

- Persistent dark grey discolouration

- Radiolucencies

What is the risk of not knowing where a fragment of tooth is?

- embedded in soft tissue

- ingested

- aspirated

What is the treatment for an enamel dentin fracture on primary tooth?

- Cover exposed dentine with GIC

- Lost structure restored with composite (doesn't need to be done at same appt)

When is the follow up for an enamel dentin fracture on primary tooth?

6-8 weeks

What is the treatment for complicated crown fracture in a primary tooth?

- LA

- Partial Pulpotomy

- non setting CaOH applied over pulp

- cover with GIC

- finish with composite restoration

Cervical pulpotomy is indicated in large pulp exposures

When is the follow up for a complicated crown fracture in primary teeth?

1 week

6-8 weeks

1 year

What is the treatment for a crown root fracture in a primary tooth?

- Often no treatment is most appropriate in emergency apt - needs to be quick referral to paeds specialist team

If pulp exposed - perform pulpotomy

If unrestorable - extract

What is the follow upon for a crown root fracture in a primary tooth?

1 week

6-8 weeks

1 year

What is the treatment of root fracture if coronal fragment is not displaced?

- no treatment required

- leave even if some occlusal interference

What is the treatment in a root fracture if the coronal segment is displaced and excessively mobile?

1) XLA coronal fragment, leave apical fragment to resorb

or

2) reposition coronal fragment and splint for 4 weeks

What is the follow up for root fracture in primary tooth?

1 week

4 week (splint removal if necessary)

6-8 weeks

1 year

What is the treatment for alveolar fracture in primary dentition?

- Reposition under LA

- splint for 4 weeks

- should be done by paeds specialist

What is the follow up for an alveolar fracture?

1 week

4 week

8 week

1 year

Are pulp sensibility tests recommended in children?

No,

unreliable

What important factors influence the management of children?

- maturity

- ability to cope

- time of shedding injured tooth

- occlusion

Do you replant an avulsed primary tooth?

no

- causes damage to permanent tooth

- high aspiration risk

What is the treatment of an extrusive luxation on primary tooth?

- let spontaneously reposition

- if excessively mobile then XLA

What is the treatment of a lateral luxation on primary tooth?

- minimal occlusal interfere then allow to spontaneously reposition

severe displacement:

- XLA

or reposition and splint for 4 weeks

How long does it take for spontaneous reposition to occur?

usually within 6 months

can take up to a year

What is the follow up for a lateral luxation of a primary tooth?

1 week

4 weeks

8 weeks

6 months

1 year

What is the treatment for intrusive luxation on a primary tooth?

- spontaneously reposition

- refer to paeds specialist

What should happen if an avulsed primary tooth is not found?

child should be referred for medical evaluation to an emergency room, especially where there are respiratory symptoms

What are the gold standard radiographs for primary tooth trauma?

- IOPA

- Upper standard Occlusal