Primary Traumatic Injuries

What should be included in a child's medical history following dental trauma?

Epilepsy, seizures and immunisation history

What should be included in the dental history?

Regular attendance and existing radiographs

What should be considered in the social history?

Contact sports, Gillick competence and parental responsibility

What is the purpose of taking an accident history?

To establish how the injury occurred and identify other injuries

What questions should be asked about the accident?

When, where and how it happened

What other injuries or symptoms should be investigated?

Head injuries, concussion and other symptoms

Why ask who was present during the accident?

To establish who witnessed the injury and who was involved

Why check whether teeth and fragments have been accounted for?

To identify missing teeth or fragments and assess possible aspiration or ingestion

Why ask about management already provided?

To establish what treatment has already been given

What investigations may be used following dental trauma?

Clinical photographs, clinical tests and radiographs

What should be assessed during the clinical examination?

Mobility, tooth colour, occlusion and sensibility where appropriate

Which radiographic view may be used for dental trauma in children?

An upper standard occlusal view, where appropriate

Why might an occlusal radiograph be difficult for a child?

Biting on the film may be difficult or uncomfortable

Why may a child's cooperation be reduced after dental trauma?

The injured area may be tender or painful

What should be considered when assessing possible non-accidental injury?

History consistency, injury pattern, caregiver responses, presentation delay and previous trauma

Why should the reported history be compared with the injury?

To check whether the explanation matches the clinical findings

Why compare the child's and caregiver's accounts?

To identify inconsistencies that may require further assessment

Why is delayed presentation important when assessing possible non-accidental injury?

An unexplained delay may raise safeguarding concerns

Why ask who was with the child at the time of injury?

To establish the circumstances surrounding the injury

How can previous trauma history be checked?

Through records such as the London Care Record on Epic, where available and authorised

What are the main classifications of dental trauma?

Soft tissue injuries, hard tissue and pulp injuries, and periodontal tissue injuries

What are injuries to dental hard tissues and pulp commonly called?

Fractures

What are injuries to periodontal tissues commonly called?

Luxation injuries

What are the main aims of managing dental trauma in children?

Comfort the child and parent, prevent dental fear and protect the permanent successor

What dietary advice should be given after dental trauma?

Follow a soft diet

What oral hygiene advice should be given after dental trauma?

Maintain optimal oral hygiene

How can the injured area be cleaned if brushing is difficult?

Gently swab the area with an appropriate mouthrinse as advised

What analgesia may be recommended for dental trauma in children?

Age-appropriate paracetamol (Calpol) or ibuprofen (Nurofen), if suitable

Which guidelines should inform follow-up after dental trauma?

 IADT (International Association of Dental Traumatology) guidelines

How should an avulsed primary tooth be managed?

Do not replant it

Why are radiographs important when managing suspected avulsion?

To rule out intrusion and help locate the missing tooth

Why must missing teeth be accounted for after trauma?

To assess whether they are missing, intruded, swallowed or aspirated

What follow-up is required after dental trauma?

Follow-up according to the injury and IADT guidelines

What changes can occur in traumatised primary teeth?

Discolouration, pulpal obliteration, pulp necrosis, resorption, ankylosis, cyst formation and damage to the permanent successor

What is pulpal obliteration?

Calcification within the pulp space

What causes plural obliteration?

When hard tissue deposits rapidly along the internal walls of a tooth, narrowing or completely filling the pulp chamber and root canal due to trauma

What is pulp necrosis?

Death of the dental pulp

What is resorption?

Loss of tooth structure due to breakdown of its tissues

What is ankylosis?

Fusion of the tooth to the alveolar bone

How can trauma to a primary tooth affect its permanent successor?

It may disturb the development or eruption of the permanent tooth

What developmental defects can occur in permanent successors after trauma?

Hypo-mineralisation, hypoplasia, crown dilaceration, arrested root development and eruption disturbances

What is hypomineralisation?

Reduced mineral content in the tooth structure

What is hypoplasia?

Incomplete development or reduced thickness of enamel

What is crown dilaceration?

An abnormal bend in the developing tooth crown

What is arrested root development?

Premature cessation of root formation

What is an eruption disturbance?

Delayed, altered or failed eruption of a tooth