Department of Pediatric Dentistry

Lutheran Medical Center

Date: 08/14/2009

Article title: Traumatic injuries in the primary dentition

Author(s): Flores MT

Journal: Dental Traumatology

Volume (number): Vol 18

Month, Year: 2002

Major topic: Trauma to primary teeth

Minor topics: epidemiology, preschool, primary dentition

Type of Article: Review of Literature

Main Purpose: Review types of injuries to the primary dentition and present evidence based treatments

Overview of method of research: Review of Literature from 1984 to 2001, including 75 articles.

Findings:

Most luxation injuries heal spontaneously and conservative treatment for preschool aged kids is suggested. Good pain control, ability to cope with the child's anxiety and good hygiene can help save many injured teeth.

Key points/Summary :

• Epidemiology: Many children will experience trauma to their teeth, especially between 18 and 30 months. Some studies show incidences as high as 30%.
• Classification: The WHO has classified traumas based on work from Andreasen & Andreasen which can be seen in the article.
• Treatment: Luxation is the most common injury and there are few long-term studies to base treatment protocols on. The best decisions are going to be guided by evidence, biological and conservative, damage limiting principles.
• Emergency Management: Soft tissue injuries can often obscure tooth damage. Clean the soft tissue first and suture starting with the skin first moving towards mucosa lastly.
• Non-complicated crown fracture: Simple to fix with composite or ionomer. Take a PA to rule out any other pathology and to have as a baseline.
• Complicated crown fracture: Take a baseline PA and then treatment is partial pulpotomy if the apex is not closed. If the primary tooth has not yet started the root resorption process pulpotomy is an option, root canal treatment with ZOE fill, or finally extraction.
• Crown-root fracture: PA xray as a baseline, extract mobile portions and if it is not easily removed, leave root tip to avoid damage to tooth germ.
• Root fracture: PA xray, wire splint if coronal portion is still in place. The crown may be lost in the future. Also, if the crown is very mobile it is acceptable to remove it and leave the remaining root.
• Alveolar fracture: Xray, splint to adjacent teeth for up to 4 weeks. If it is not stable, splint for 2-3 more weeks or extract.
• Concussion: (tooth is tender to the touch only) Keep under observation and do not perform root treatment even if discoloration exists unless infection develops.
• Subluxation: (tooth is mobile without displacement, sulcar bleeding may be present) Good hygiene and infection control will usually lead to normal healing.
• Lateral luxation: (displaced tooth, usually with the crown palatal) Take 2 PAs. If there is no occlusal interference, leave the tooth to heal spontaneously. If occlusal interference was present you can reposition and splint for 2-3 weeks, but that has a higher incidence of pulpal necrosis.
• Intrusion: Take a PA, no need for extra-oral radiographs. If the tooth is displaced with the apex toward the labial bone plate, leave it. If the tooth is displaced with the apex toward the succedaneous tooth germ, extract with the forcep mesio-distally.
• Extrusion: No clinical studies of conservative treatment, reposition and splint or extract.
• Avulsion: Take a PA to rule out intrusion. Do not re-implant.
• Instructions for parents: Excellent hygiene is a must for proper healing. Soft diet for 2 weeks, chlorhexidine rinse, etc.
• Follow-up: the type of follow-up and frequency depends on the type of injury. For crown fractures it is 6-8 weeks; alveolar fracture 3-4 weeks, 6-8 weeks, 6 months, 1 year; Root fracture 2-3 weeks, 6-8 weeks, 1 year (assumes incomplete or no extraction); Lateral Luxation 2-3 weeks, 6-8 weeks, 6 months, 1 year; Intrusion once a week for the first 3 weeks, 6-8 weeks, then as needed.

Assessment of article: A good review that is essential to being able to treat the emergencies that we see. I found this one very useful when I started covering call and also very helpful in our clinic. The follow-up schedule is good to know and follow, especially in cases of litigation I would imagine.