1 / 26

Teaching Module & Competency: Primary Tooth Trauma

Teaching Module & Competency: Primary Tooth Trauma. Prepared by : Cynthia Christensen; DDS, MS Karin Weber-Gasparoni; DDS, MS, PhD University of Iowa 2008. Objectives. Understand the incidence of primary tooth trauma Understand how to triage primary tooth trauma

happy
Download Presentation

Teaching Module & Competency: Primary Tooth Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Teaching Module & Competency: PrimaryTooth Trauma Prepared by : Cynthia Christensen; DDS, MS Karin Weber-Gasparoni; DDS, MS, PhD University of Iowa 2008

  2. 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

  3. 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.

  4. Clinical Examination • Intra/ extra oral soft tissues • Swelling • Fractured, luxated, or missing teeth • Pulp exposures • Occlusion • Deviation on opening

  5. TRIAGE: Occlusion Indicates Fractured Alveolus or Mandible • Immediate referral to Oral Surgeon or ER • Advise patient to be kept NPO

  6. Radiographic Exam For young children, parent or dental staff must hold Establish Baseline Detect root or alveolar injuries or pathosis

  7. What about Sutures? • Extraoral: Plastic/ENT surgeon best for esthetic outcome • Introral: • Small laceration = No sutures. • Larger lacerations = General Dentist or Oral Surgeon

  8. Possibility: Foreign Body in Lip or Tongue

  9. Checking for Tooth Fragment • Palpate puncture/laceration • Soft tissue radiograph • ¼ the exposure time of nearest teeth

  10. Common Injuries Treatment Options

  11. Concussion / Subluxation • Concussion: injury to the tooth and ligament without displacement or mobility • Subluxation: tooth is mobile, but is not displaced

  12. 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

  13. Neurovascular bundle at apex may be crushed or severed PDL may be torn Prognosis for Recovery = Good Concussion/Subluxation

  14. 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 Discoloration of Primary Tooth Post Trauma Color may be pink, purple, grey or brown

  15. Pulpal Obliteration/Calcific Metamorphosis • History of Trauma • Tooth darker-usually yellowish • Radiograph shows pulpal space narrowing or obliterated • NO TX-observe for normal exfolitation

  16. Note associated soft tissue swelling Confirm Dx and check root structure with periapical radiograph All Teeth Do Not Recover: Abscess 6 Months Post Concussion

  17. Radiographic Abscess #F • Note: #E resorption post trauma. No Tx • #F extraction indicated

  18. LATERAL LUXATION / EXTRUSION INJURIES: RECOMMENDATIONS Primary Dentition Tooth is aspiration risk Extract and advise parents of potential damage to permanent tooth Yes No Tooth causing occlusal interference **All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume appropriate radiographic survey. (Reference: AAPD Handbook of Dentistry) Yes No Allow for spontaneous re-positioning or re-position and splint or consider extraction Extract or reposition and splint Follow up in 2 weeks: Advise parents of possible injury / damage to permanent teeth

  19. 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

  20. Extrusion and Luxation With Occlusal Interference • Primary Teeth Reposition and Splinting RARE unless.. • Excellent Patient Cooperation • Excellent Recall Compliance

  21. Pulp Exposed Treatment Planning Crown Fracture Injuries Primary Dentition Yes Pulpectomy and full coverage crown (SSC or strip crown) All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume appropriate pre-operative radiographs Reference: AAPD Handbook of Pediatric Dentistry No Dentin Exposed Yes Composite or GI provisional restoration “band-aid” if symptomatic No Rough Edge Present Yes Yes Smooth edge and if required restore with composite No Clinical and radiographic follow up. Advise parents of possible injury to permanent teeth and monitor for signs of pathology No further treatment required

  22. Enamel Fx Dentin Fx Pulp Exposure Ellis Class I Ellis Class II Ellis Class III

  23. Radiograph Smooth Sharp Edges GI or Composite Optional Periodic Follow Up Enamel Fracture in Primary Teeth: Ellis Class I

  24. Radiograph Protect Dentin Glass Ionomer Bonding Agents Composite Ideal Periodic Follow Up Enamel and Dentin Fx:Ellis Class II Dentin Exposed

  25. Radiograph Pulpectomy Extraction Pulp Exposure: Ellis Class III Pulp Exposed

  26. Vertical Crown Fracture • RARE- more likely to luxate or intrude • Extraction

More Related