Anterior tooth trauma primary dentition

Dan Boboia
8/14/09

Anterior tooth trauma in the primary dentition: Incidence, classification, treatment methods, and sequelae: a review of literature

Authors: Irwin Fried, DDS, MS: Pamela Erickson, DDS PhD
Volume: 62:256-61
Month, Year: 1995
Major topic: Pediatric Dental Trauma
Main Purpose:
Overview primary tooth trauma, including incidence, classifications, treatment methods, follow-up, and possible sequlae
Methods: Lit Review
Findings:
There are recognized protocols for different types of primary anterior dental trauma: subluxation, concussion, luxation, avulsion, and fracture.
Key points / Summary:
71% of all primary tooth trauma involves the maxillary central. Most dental injuries occur in younger patients due to level of coordination and judgement. Case documentation should include elapsed time since the accident, care given immediately after trauma, indications for meds, and determination to transfer the case to a specialist. Evaluate for jaw fracture and TMD if patient is symptomatic. Check for avulsions, fractures, displacement, alveolar fracture / displacement, and mobility. Radiographs should be taken for initial diagnosis, follow-up, and insurance/liability.
Concusions – no tx.
Subluxations – no tx unless teeth very mobile
Intrusive luxations – allow re-eruption unless there is contact with permanent tooth bud or apex pierces labial bone plate
Alveolar fractures – reduction and splinting (preferably rigid); healing time 7-10 wks
Elis fxs: 1 – nothing, 2 – resin / base, 3 pulpotomy / pulpectomy (artice does not recommend Sveck)
Ext root fx; leave root tip if high risk of damaging permanent tooth bud trying to remove it.
Follow-up trauma: 7-10 days, 3 weeks, 3 months, 6 months. Percussion palpation, temp tests, and electric pulp tests not reliable in most pediatric patients and should only be used as an adjunct. Color change should not be used as the sole diagnostic criteria in need for extraction-many studies show that discolored teeth (yellow and grey) do not develop any radiographic or clinical signs of infection.

Assessment: Very nice review: should be included in orientation to peds dental trauma for dental students and new residents