In the name

of GOD

Dr.Nasim Seyfi(Assistant Professor of Pedodontics )

Prevention and Management of Traumatic Injuries in the Primary and Permanent Dentition

Traumatic Injuries in the Primary and Permanent

Dentition

Etiology and EpidemiologyPeak age in primary : 2-4 yFalls Contact sports: mouthgaurds Automobile accidentsSeizure disordersPermanent teeth more crown fx / primary more

luxationMaxillary central incisorProtruding incisorChild abuse in primary :50 % head and neckInjuries in various stages of healing, labial frena

History Medical and dental History of dental injury :When,where ,how First or notTetanus prophylaxisCentral nervous system :

consciousness,disoriented,nauseated24 h : every 2-3 h waking the child

Non-complicated Crown FractureEnamel fractureEnamel-dentin fracture

Complicated Crown FractureEnamel,dentin,pulp exposure

Crown-root FractureMultiple( pulp may or

not be involved)Coronal fragment :

attached to the gingiva,mobile

Treatment • Extraction of mobile

fragments• Do not insist on

removing root fragments(damage to the tooth germ )

Root FractureMobile tooth,displacing of coronal

fragment

Alveolar FractureMobile ,displaced (tooth in the affected

segment)Discotinuity in the surrounding area

Concussion Tender to touchNo mobility ,no

sulcus bleedingNo abnormal

changes in the X-rayTreatment

• Observation

Subluxation Mobile ,without

displacementSucus bleeding may

or notTreatment

• Observation• Careful bacterial

control: Good oral hygiene

Lateral Luxation Displaced laterally Crown usually in palatal

direction

Intrusion Apex labially (80%)PA X-ray

Shorter ,apical tip is seen: toward labial bone plate

Elongated,apex tip isn’t seen : toward permanent tooth germ

Hypoplasia in permanet tooth

Extrusion Mobile,displacing out of the socketTreatment

• Left or Extarct

AVULSION

Primary teethTooth out of the socketPA X-ray :ensure that the lost tooth is

not intrudedTreatment

Must not be replant :damage to the developing tooth germ

Replant : aspiration ,retention ,inflamatory resorption ,abscess formation

Hypoplasia,white or yellow brown opacity

Esthetics ,function lossPhonation disorder or tongue

interposition: removable appliance

Permanent TeethTime out of socketImmediately

reimplant by the first capable person

Transport medium :Viaspan,Hanks Balanced salt solution (HBSS): EMT tooth saver

Cool Milk > salin ,water

Saliva/patient’s mouth

As soon as possible to dentist

Office : HBSS/ moth rinse

Doxycycline /penicillin V

Splint

Uncomplicated crown fractureImmediate treatment : none Refer to dentist: within 48 h

Complicated crown fractureImmediate treatment : none ,don’t place any

medication on the bleeding pulp ,stop bleeding with sterile cotton gauge

Refer to dentist: as soon as possible,could wait 48 h if patient can tolerate cold and eat

Root fractureImmediate treatment : none Refer to dentist: as soon as possible

Concussion /SubluxationImmediate treatment : none Refer to dentist: within 48 h for evaluation

Luxation Immediate treatment : move the tooth back Refer to dentist: as soon as possible

Avulsion Immediate treatment : replace the tooth in its

hole,restor in milk or salineRefer to dentist: immediately

PREVENTION

EducationHow to avoid injuries How to manage at the site of the injuryWho are at the high risk?Severe maxillary overjet : orthodontic

treatment before 11Another injuriesYoung childrenLooking for all fragments

FacegaurdPrefabricated/

customNot applicable to all

activitiesHit under the chin :

no False security

Mouthgaurd 100 yAmateur: Boxing,

football, ice hocky,lacrosse

Baseball.basketbal,soccer,school physical classes

Promote the rules requiering the use of mouthgaurds

Best fitted by dentistCover all teeth in max arch except in

mandibular prognatismFix orthodontic appliances/congenital

abnormalities: cleftAdequet thickness : min 3 mm over occlusal Retentive fitSpeech considerationMaterial

Custom-fabricated Mouth formed

ThermoplasticShell line

stock