follow up in 4 weeks: advise parents of possible injury / damage to permanent teeth allow 6 months...
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Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth
Allow 6 months forspontaneous
re-eruption. Advise parents of potential
damage to adult tooth
Primary Dentition
Yes
No
INTRUSION INJURIES: RECOMMENDATIONS
All treatment is ideal and assumes patient has manageable behavior.
Recommendations also assumeradiographs ( periapical
and lateral anterior taken where appropriate).
(REFERENCE: AAPD Handbook of Pediatric Dentistry)
Extract if root tip isdisplaced into permanent tooth bud
Root tip is displaced towards buccal cortical plate or vertical
Intrusive Luxation
Most common in upper primary incisors
Management: allow to re-erupt or extract
Tooth Not Retrieved Post Trauma
Confirm Intrusion with Periapical Monitor up to 6 months for re-eruption
Intrusive LuxationPrimary Teeth
Consider antibiotic therapy - monitor for infection
Tetanus immunization current?
Extract if there are signs of swelling, spontaneous
bleeding, abscess and fever
Day of the Trauma 2 weeks Post Trauma
Intrusive LuxationPrimary Teeth
One of the most dangerous injuries to the developing tooth bud
Management: Minimize damage by assessing displacement of permanent bud
Ideally, a lateral film should be taken to confirm that intruded tooth has not displaced permanent tooth bud. If so, extraction recommended
Lateral Anterior Radiograph for Intruded Primary Tooth Angulation of intruded tooth Occlusal or size 4 extraoral film next to child’s
cheek and perpendicular to radiographic beam Exposure time is doubled
2 months after injury 3 months after injury 1 year after injury
Intrusion Luxation: Re-eruption of Primary Tooth
Clinical and radiographic follow up in 4 weeks: Advise parents of possible injury / damage to
permanent teeth.NO SPLINT IS INDICATED
Extract coronal segment. Leave
apical segment if notvisible/easily removed
Primary Dentition
No
Yes
ROOT FRACTURES : RECOMMENDATIONS
All treatment is ideal and assumes patient has manageable behavior.
Recommendations also assume appropriate pre-operative radiographs.
(Source: AAPD Handbook of Pediatric Dentistry)
Fracturelocated in coronal 1/3 of root or segment is aspiration risk
Root FracturesPrimary Teeth
Radiograph
Apical 1/3 - Most teeth maintain vitality and are
minimally mobile
- Apical fragment should
resorb normally
- Monitor with radiographs
Root FracturesPrimary Teeth
Radiograph Middle or Cervical 1/3
- Most teeth mobile. Extraction indicated
- Gently attempt to retrieve apical fragment
If not successful, monitor
- Don’t disrupt permanent tooth bud
Avulsion: Primary Teeth
Radiograph
Do not re-implant!
Space loss may not occur if
primary canines are present
Permanent tooth eruption
may be delayed due to scar
tissue/bone
Parents Question: Will the permanent teeth be damaged?
May not be able to be determined until the teeth erupt and can be evaluated clinically
The accident has happened - we can’t reverse it
Monitor clinically and radiographically
Complications of Trauma
Permanent teeth malformation:hypomineralizationhypoplasiadilacerationarrested development
History of Intrusive LuxationPrimary Teeth
Hypomaturation/Hypomineralization #8
History of Intrusion Luxation of Primary Tooth
Severe dilaceration of Root
History of Avulsion #E :Prior to Eruption of Primary Canines
Space maintainer not possible for pre-coop tot with incisors only
Ortho/space regaining will be needed
Acknowledgements
Photos and Diagrams taken from: Textbook and Color Atlas of Traumatic Injuries to the
Teeth, 4th edition: J.O. Andreasen (2007) Pediatric Dentistry, 4th edition; Pinkham (2005) Odontologia Para o Bebe’: Walter L.R.F. (1996) University of Iowa, Department of Pediatric Dentistry
Competency Exam
Answer the following questions on your worksheets
Case #1 “Anna”
Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago
Her mother has given her children’s Tylenol and is at your office for evaluation
The upper incisors are tender, but non-mobile. Her mother raises her lip to show you a 2 mm
tear in the labial frenum area Anna is cooperative
Case #1: “Anna”
What other clinical procedures do you need to perform? List at least 3.
“Anna’s” Pedo Occlusal
Is this radiograph within normal limits, or do you see any abnormalities or pathology?
Case #1 “Anna”
What is your plan for treatment and followup care for Anna?
What are your care instructions for mother?
Case #2: “Bart”
Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago
Mother felt his tooth “completely broke off at the gumline”, but could not find the piece
Clinically there are no additional findings
“Bart”
What radiographs are indicated for Bart?
Pedo Occlusal for “Bart”
Bart was not cooperative for further radiographs. What is your diagnosis based on this film?
Case #2 “Bart”
What is your plan for treatment and followup care?
Case #3: “Charlie”
Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning
His father is with him Clinical exam reveals enamel fracture #E and
dentin fracture #F No excessive mobility, no luxation Occlusion is normal Charlie is cooperative , but impatient and wiggly
Charlie’s Clinical Appearance (photo is a representation of the injury, not an actual photo of this patient)
What radiographs would you order for Charlie?
Pedo Occlusal for “Charlie”
Case #3 “Charlie”
What is your plan for treatment and followup care for Charlie?
Case #4 “Davonne”
Davonne is a 12 year old boy with a non-contributory Health History
He and his parents are at your office for comprehensive care.
The chief complaint is “discolored lower front teeth.”
Davonne Clinical Photo
Davonne
What most likely caused this discoloration?
What are treatment options?
Competency Exam
Answer Discussion
Case #1 “Anna”
Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago
Her mother has given her children’s Tylenol and is at your office for evaluation
The upper incisors are tender, but non-mobile. Her mother raises her lip to show you a 2 mm
tear in the labial frenum area Anna is cooperative
Case #1: “Anna”
What other clinical procedures do you need to perform? List at least 3. Periapical radiograph (pedo occlusal) Mobility check Percussion check Occlusion check Complete hard and soft tissue assessment
“Anna’s” Pedo Occlusal
Is this radiograph within normal limits, or do you see any abnormalities or pathology?
Answer: Within Normal Limits
Case #1 “Anna”
What is your plan for treatment and followup care for Anna? Do not suture Observe clinically and radiographically
What are your care instructions for mother? OTC pain meds prn Soft diet for about 1 week Tooth may discolor, but this may reverse Periodic reassessment needed
Case #2: “Bart”
Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago
Mother felt his tooth “completely broke off at the gumline”, but could not find the piece
Clinically there are no additional findings
“Bart”
What radiographs are indicated for Bart?
Periapical (pedo occlusal) Lateral
Pedo Occlusal for “Bart”
Bart was not cooperative for further radiographs. What is your diagnosis based on this film?
Intrusion. No fracture detected.
Case #2 “Bart”
What is your plan for treatment and followup care? Monitor for re-eruption Consider antibiotic therapy and assess tetanus
immunization Explain signs and symptoms of infection. Re-assess in 2 weeks
Case #3: “Charlie”
Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning
His father is with him Clinical exam reveals enamel fracture #E and
dentin fracture #F No excessive mobility, no luxation Occlusion is normal Charlie is cooperative , but impatient and wiggly
Charlie’s Clinical Appearance
What radiographs would you order for Charlie?
Periapical (pedo occlusal)
Pedo Occlusal for “Charlie”
Case #3 “Charlie”
What is your plan for treatment and followup care for Charlie? Smooth #E GI “Bandaid “ #F or composite if cooperation allows Periodic clinical and radiographic followup
Case #4 “Davonne”
Davonne is a 12 year old boy with a non-contributory Health History
He and his parents are at your office for comprehensive care.
The chief complaint is “discolored lower front teeth.”
Davonne Clinical Photo
Davonne
What most likely caused this discoloration? History of primary
tooth trauma/intrusion
What are treatment options? No treatment Cosmetic bonding