Teaching Module & Competency: Primary Tooth TraumaPrepared by :Cynthia Christensen; DDS, MSKarin Weber-Gasparoni; DDS, MS, PhDUniversity of Iowa2008

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

Tooth causing occlusalinterference

Follow up in 2 weeks: Advise parents of possible injury / damage to permanent teeth

Extract or repositionand splint

Primary Dentition

No

No

Yes

Yes

LATERAL LUXATION / EXTRUSION INJURIES: RECOMMENDATIONS

**All treatment is ideal and assumes patient has manageable behavior.

Recommendations also assumeappropriate radiographic survey.

(Reference: AAPD Handbook of Dentistry)

Extract and advise parents of potential damage to permanent tooth

Tooth is aspirationrisk

Allow for spontaneousre-positioning or

re-position and splint orconsider extraction

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

Pulp Exposed

Dentin Exposed

Rough Edge Present

Smooth edge and if required

restore with composite

Clinical and radiographic follow up. Advise parents of

possible injury to permanent teeth and monitor forsigns of pathology

Composite or GIprovisional restoration

“band-aid” if symptomatic

Primary Dentition

No

No

No

Yes

Yes

Yes

Treatment Planning Crown Fracture Injuries

All treatment is ideal and assumes patient has manageable behavior.

Recommendations also assume appropriate pre-operative radiographs

Reference: AAPD Handbook of Pediatric Dentistry

Pulpectomy and full coveragecrown (SSC or strip crown)

No further treatmentrequired

Yes

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