teaching module & competency: primary tooth trauma prepared by : cynthia christensen; dds, ms...
TRANSCRIPT
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Teaching Module & Competency: Primary Tooth TraumaPrepared by :Cynthia Christensen; DDS, MSKarin Weber-Gasparoni; DDS, MS, PhDUniversity of Iowa2008
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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
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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.
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Clinical Examination
Intra/ extra oral soft tissues
Swelling Fractured, luxated, or
missing teeth Pulp exposures Occlusion Deviation on opening
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TRIAGE: Occlusion Indicates Fractured Alveolus or Mandible
Immediate referral to Oral Surgeon or ER Advise patient to be kept NPO
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Radiographic Exam
For young children, parent or dental staff must hold
Establish Baseline
Detect root or alveolar injuries or pathosis
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What about Sutures?
Extraoral: Plastic/ENT surgeon best for esthetic outcome
Introral: Small laceration = No
sutures. Larger lacerations =
General Dentist or Oral Surgeon
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Possibility: Foreign Body in Lip or Tongue
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Checking for Tooth Fragment
Palpate puncture/laceration
Soft tissue radiograph
¼ the exposure time of nearest teeth
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Common Injuries
Treatment Options
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Concussion / Subluxation
Concussion: injury to the tooth and ligament without displacement or mobility
Subluxation: tooth is mobile, but is not displaced
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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
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Concussion/Subluxation
Neurovascular bundle at apex may be crushed or severed
PDL may be torn
Prognosis for Recovery = Good
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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
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Pulpal Obliteration/Calcific Metamorphosis
History of Trauma Tooth darker-usually
yellowish Radiograph shows pulpal
space narrowing or obliterated
NO TX-observe for normal exfolitation
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All Teeth Do Not Recover: Abscess 6 Months Post Concussion
Note associated soft tissue swelling
Confirm Dx and check root structure with periapical radiograph
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Radiographic Abscess #F
Note: #E resorption post trauma. No Tx #F extraction indicated
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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
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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
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Extrusion and Luxation With Occlusal Interference
Primary Teeth Reposition
and Splinting RARE unless..
Excellent Patient Cooperation
Excellent Recall Compliance
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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
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Enamel Fx Dentin Fx Pulp Exposure
Ellis Class I Ellis Class II Ellis Class III
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Enamel Fracture in Primary Teeth: Ellis Class I
Radiograph Smooth Sharp Edges GI or Composite
Optional Periodic Follow Up
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Enamel and Dentin Fx:Ellis Class II
Radiograph Protect Dentin
Glass Ionomer Bonding Agents
Composite Ideal Periodic Follow Up
Dentin Exposed
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Pulp Exposure: Ellis Class III
Radiograph
Pulpectomy Extraction
Pulp Exposed
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Vertical Crown Fracture
RARE- more likely to luxate or intrude
Extraction