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