guidelines for managing primary teeth trauma IADT

1. Presented by : Rahahf Najjar
GUIDELINES FOR THE MANAGEMENT OF
TRAUMATIC DENTAL INJURIES:
3. INJURIES IN THE PRIMARY DENTITION

2.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

3.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

4.  Trauma to oral region comprise 5% of all injuries
witch people seek treatment for
 In age group 0-6 years, oral injuries are ranked as 2nd
most common injuries covering 18% of all somatic
injuries.

5.  Of oral injuries, dental injuries are the most
frequent, followed by oral soft tissues injury.
 In age group 1-3Years old luxation reported to be
the most common type of injuries due to falls.

6.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

7.  A young child is difficult to examine and treat because of lack
of cooperation and fear.

8.  It is important to keep in mind the close relation between the
apex of the root of injured primary tooth and the underplaying
permeant tooth germ

9. CONSEQUENCES AFTER PRIMARY TEETH/
ALVEOLAR BOON INJURY
Tooth
malformation
Impacted
teeth
Eruption
disturbance

10. THE MOST COMMON SEQUELA AFTER
INTRUSION / AVULSION OF PRIMARY TEETH
• White or yellow-brown discoloration of crown
• Enamel hypoplasia of permanent incisors
Age 1 -3 Y

11. FACTORS INFLUENCE TX SELECTION
Patient maturity and
cooperation
Time of shedding of
injured tooth
Occlusion
Trauma recurrence

12.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

13. 1. TREATMENT GUIDELINES
FOR FRACTURES OF TEETH
AND ALVEOLAR BONE

15. Follow upTreatmentRadiographic findingsClinical findingsCROWN FRACTURE
WITH EXPOSED PULP
1 week C
6-8 weeks C+R
1 year C+R
1) Preserve pulp vitality by
partial pulpotomy.(Calcium
hydroxide ). A well condensed
layer of pure calcium
hydroxide paste can be
applied over the pulp,
covered with a lining GIC.
Restore the tooth with
composite.
2) Extraction is usually the
alternative option.
The stage of root
development can be
determined from one
xray
Fracture involves enamel
and dentin and the pulp is
exposed.

16. Follow upTreatmentRadiographic findingsClinical findingsCROWN-ROOT
FRACTURE
In cases of
fragment
removal only:
1 week C
6-8 weeks C+R
1 year C(*)
Depending on the clinical
findings, two treatment
scenarios may be
considered:
● Fragment removal only. If
the fracture involves only a
small part of the root and
the stable fragment is large
enough to allow coronal
restoration.
● Extraction
● In laterally positioned
fractures, the extent in
relation to the gingival
margin can be seen.
● One exposure is necessary
to disclose multiple
fragments
●Fracture involves enamel,
dentin and root structure;
the pulp may or may not be
exposed.
● Additional findings may
include loose, but still
attached, fragments of the
tooth.
● There is minimal to
moderate tooth
displacement

17. Follow upTreatmentRadiographic findingsClinical findingsROOT FRACTURE
● No displacement:
1week C,
6-8 weeks C,
1 year C+R and C(*)
annually until
exfoliation.
● Extraction
1 year C+R and C(*)
annually until
exfoliation.
1) If the coronal fragment is
not displaced no treatment is
required.
2) If the coronal fragment is
displaced, extract only that
fragment. The apical
fragment should be left to be
resorbed
● The fracture is usually
located mid-root or in the
apical third.
● The coronal fragment
may be mobile and
may be displaced.

18. Follow upTreatmentRadiographic findingsClinical findingsALVEOLAR
FRACTURE
1 week C
3-4 weeks S+C+R
6-8 weeks C+R
1 year C+R and C(*)
each subsequent year
until exfoliation.
●Reposition any displaced
segment and then splint.
● General anesthesia is often
indicated.
● Stabilize the segment for 4
weeks.
● Monitor teeth in fracture
line resorbed
● The horizontal fracture
line to the apices of the
primary teeth and their
permanent successors
will be disclosed.
● A lateral radiograph
may give information if
the segment is displaced
in labial direction
● The fracture involves
the alveolar bone and
may extend to adjacent
bone.
● Segment mobility
and dislocation are
common findings.
● Occlusal interference
is often noted.

20. 2. TREATMENT GUIDELINES
FOR LUXATION INJURIES

21. Follow upTreatmentRadiographic findingsClinical findingsCONCUSSION
1 week C
6-8 weeks C
No treatment is needed.
Observation.
No radiographic
abnormalities.
The tooth is tender to
touch.
It has normal mobility
and no gingival
bleeding.
Follow upTreatmentRadiographic findingsClinical findingsSUBLAXATION
1 week C
6-8 weeks C
● Observation
No treatment is needed
unless a fistula develops.
● Crown discoloration might
occur.
●Dark discolored teeth
should be followed carefully
to detect sign of infection .
●No radiographic
abnormalities
●Normal periodontal
space.
● An occlusal radiograph
is recommended to
screen for possible signs
of displacement or the
presence of a root
fracture..
● The tooth has
increased mobility but
not displaced.
● Bleeding from
gingiva may be noted.

22. Follow upTreatmentRadiographic findingsClinical findingsEXTRUSIVE
LUXATION
1 week C
6-8 weeks C+R
6 months C+R
1 year C+R
●Treatment decisions are
based on the degree of
displacement, mobility, root
formation and the ability of
the child to cope .
● For minor extrusion (<
3mm) in an immature
developing tooth, careful
repositioning or leaving the
tooth for spontaneous
alignment .
● Extraction for severe
extrusion in a fully formed
primary Tooth
● Discoloration might occur.
Dark discolored teeth should
be followed carefully to
detect sign of infection
Increased periodontal
ligament space apically.
● Partial displacement
of the tooth out of its
socket.
● The tooth appears
elongated and can be
excessively mobile.

23. Follow upTreatmentRadiographic findingsClinical findingsLATERAL
LUXATION
1 week C
2-3 weeks C
6-8 weeks C+R
1 year C+R
● If there is no occlusal
interference, as is
often the case in anterior
open bite, the tooth is allowed
to reposition spontaneously.
● If minor occlusal
interference, slight grinding is
indicated.
● When there is more severe
occlusal interference, the
tooth can be gently
repositioned by combined
labial and palatal pressure
after the use of local
anesthesia.
● In severe displacement,
when the crown is
dislocated in a labial
direction, extraction is
the treatment of choice.
●Increased periodontal
ligament space apically is
best seen on the occlusal
exposure. And an
occlusal exposure can
sometimes also show the
position of the displaced
tooth and its relation to
the permanent successor
● The tooth is
displaced,
usually in a
palatal/lingual or
labial direction.
● It will be immobile.

24. Follow upTreatmentRadiographic findingsClinical findingsINTRUSIVE
LUXATION
1 week C
3-4 weeks C + R
6-8 weeks C
6 months C+R
1 year C+R and (C*)
● If the apex is displaced
toward or through the
labial bone plate, the tooth is
left for spontaneous
repositioning
●If the apex is displaced into
the developing
tooth germ, extract
● When the apex is
displaced toward or
through the labial
bone plate, the apical tip
can be visualized and
appears shorter than its
contra lateral.
● When the apex is
displaced towards the
permanent tooth
germ, the apical tip
cannot be visualized and
the tooth appears
elongated
● The tooth is usually
displaced through the
labial bone plate,
or can be impinging
upon the permeant
tooth bud

26. Follow upTreatmentRadiographic findingsClinical findingsAVULSION
•1 week C
• 6 months C + R
• 1 year C + R and (C*)
It is not recommended to
replant avulsed primary
teeth.
A radiographic
examination is
essential to ensure that
the missing tooth is not
intruded.
The tooth is completely
out of the socket

27.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

28. The possibility of child abuse should considered when assessing
child under 5 years who presented with intraoral trauma
affecting :
 Lips
 Tongue
 Palate
 Severe tooth injury

29.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

30. Depending on the child’s ability to cooperate and the type of
injury suspected.
 periapical view ( 90° Horizontal).
 Occlusal view.
 Extra-oral lateral view of the tooth in question, to reveal the
relationship between the apex of the displaced tooth and the
permanent tooth germ as well as the direction of dislocation.

31.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

32. Splinting
AntibioticCrown discoloration
Pulp canal
obliteration

33.  Used ONLY for
SPLINTING
Alveolar bone fracture
Intra alveolar root
fracture

34.  No evidence on the use of systematic antibiotics
 Depend on the child medical status >> contact the child
physician
 May used in soft tissue injuries and associated injuries
required surgical intervention.
USE OF ANTIBIOTIC

35.  It is one of the commonly asked question from the parents/
guardians, especially for esthetic.
 It is a common complication after luxation injury
 It may fad, and the tooth regain its normal color.
 There is an association between discoloration and pulpal
necrosis in traumatized primary teeth.
 Root canal Tx is NOT indicated unless
infection exist.
CROWN DISCOLORATION

36.  It is a common sequela in luxation injury
 It is occur in 35- 50% of cases
 It indicates ongoing pulp vitality
 A yellowish hue can be noted
PULP CANAL OBLITERATION

37.  Introduction
 Special considerations for trauma to primary teeth
 Guidelines for the clinician
 Clinical examination
 Radiographic examination
 Other considerations
 Parents instructions

38.  Maintaining good oral hygiene >>> good healing
 Brushing with soft tooth brush
 Use alcohol free .1% chlorohexidine gluconate topically on
cotton swap 2X/ daily on affected area for 1 week
 Soft diet for 10 days
 Restriction on the use of the pacifier
 Advice about further complications that may occur ( swelling,
increase mobility, sinus tract)