Traumatic Dental Injuries to the Primary Dentition

Dr M K Muasya

Paediatric dentist

University of Nairobi

IntroductionTrauma refers to injury; damage; impairment;

external violence producing injury or degeneration to the tooth.

Injuries to the primary dentition have been reported at a prevalence of 4 to 36%

Age group with highest incidence 2-3 year olds when motor coordination is developing

Teeth most affected are the maxillary incisors

Why manage theseA close relationship exists between the apex of the root

of the primary tooth and the developing permanent toothThese are therefore managed to prevent sequelae such

as:Failure of eruption of permanent teethWhite of yellow-brown discoloration Hypoplasia or hypomineralisation of secondary teethDelayed eruptionOverretention of primary teeth

Factors to considerChild’s mental age and ability to cope with dental

treatmentParents’ willingness to comply with treatmentTime of shedding of the primary toothClinician factors: training, experience and acquired

skills in managing children and dental traumaAnatomical factorsFinancial implications

Overview of managementHistory: where, when, how?Examination: both extra oral and intraoral are crucial

in arriving at a diagnosis. Intraoral: soft and hard tissue examination

Investigations:Radiographs: IOPA, Occlusal views, Extraoral views,

CT scan

Types of injuries and

management

Enamel and enamel dentin fracturesInvolves enamel and

enamel and dentin respectively

Management is by composite restoration

Crown fracture with exposed pulpIf root formation is

incomplete a calcium hydroxide pulpotomy followed by Glass Ionomer base and Composite permanent filling

Pulpectomy where root formation is complete

When the child is unable to cope with the above extraction may be done.

Root fractureUsually extraction of the

toothIf an apical segment of

the root is in situ it may be left and extracted at a later date to avoid injury to the permanent tooth

Alveolar fractureThe fracture involves

the alveolar bone Reposition any

displaced segment and splinting of teeth.

GASegment stabilisation

for 4 weeks

Concussion injuryA tooth is tender to

palpation or percusion, not mobile or displaced

Observation and re-evaluation after 1 year

SubluxationMobility of the tooth

without displacementObservation and re-

evaluation after 1 year

ExtrusionDisplacement of the tooth

coronally hence it appears longer than adjacent teeth and is mobile

Extrusion less than 3mm for an immature tooth:Repositioning and use of

a splint Repositioning and

observeExtrusion more than 3mm

usually extract

Lateral luxationMobility and displacement

labially or palatallyIf there is occlusal

interference the tooth is repositioned under local anaesthesia using digital pressure

If there is severe displacement with crown displaced labially the tooth is indicated for extraction

Intrusion injuriesIf the apex is displaced

toward the labial bone the tooth is left for spontaneous repositioning

If the apex is displaced into the developing tooth germ it should be extracted

AvulsionComplete loss of the

tooth from the socketReplantation is not

recommendedThe parents and child

are reassured and await eruption of the permanent tooth

Prevention of traumaSafe home and class room layoutsUse of staircase gates Use of infant and toddler car seatsPrompt treatment by a dentist to minimise sequelae

of traumatic injuriesWe cannot totally prevent trauma because children

must fall as they learn to walk

Challenges encountered in the countryLack of skilled personnel to manage these injuries at

lower level health facilitiesPerception by health care workers that “are just

baby teeth they will fall out”Parental knowledge and attitudesLack of equipment and materials at peripheral health

facilities to render treatment hence the common treatment prescribed is extraction.

Thank you