Developmental disturbances of permanent teeth following trauma to the primary dentition 8/14/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date:8/14/09 Region: Prov.
Article title: Developmental disturbances of permanent teeth following trauma to the primary dentition
Author(s): Von Arx, Thomas
Journal: Australian Dental Journal
Volume #; Number; Page #s): 38(1), 1-10
Year: 1993
Major topic: disturbances of permanent teeth following trauma to the primary dentition
Minor topic(s): n/a
Type of Article: Multiple Case review, retrospective
Main Purpose: To investigate developmental disturbances of permanent teeth following trauma to the corresponding primary dentition
Overview of method of research: Re-examination of 114 children with primary tooth trauma

Findings. Up to 45% of all children sustain injuries to their primary teeth. Injuries include crown/root fracture w/ pulpal exposure, w/o pulpal exposure, intrusion, subluxation, partial luxation, avulsion, medications, fever during tooth development, and developmental disturbances. These injuries can present as enamel hypoplasia(the most common), crown dilcaeration, root malformation, odontoma like teeth, and cessation of maturation. Any trauma to primary teeth may disturb the odontogenesis of the permanent teeth. The primary teeth most susceptible to trauma are the maxillary incisors, and consequently, the most affected permanent teeth after primary tooth trauma are the central incisors, with their labial surface being the most affected. The perm. Centrals lie palatally in very close proximity to the roots of the prim. Centrals. The perm. Laterals are behind the perm centrals, thus protecting them from labial traumatic forces. When there is intrusive luxation, there is a 69% chance of tooth malformation on the permanent teeth. In this study, 114 children, with 255 traumatized teeth were reassessed an average of five years after their initial visit. Only 56% of the permanent teeth could be examined clinically and radio graphically , with the remained being checked only by radiographs. A total of 41 teeth showed both clinical and radiographic malformation. Of this 41, 28 teeth had enamel hypoplasia, 4 had root malformation, 7 had crown dilacerations, and 2 had odontome like teeth.

Key points in the article discussion: The basic results of the study illustrate the correlations between the frequencies of developmental disturbances of perm. Teeth and the intensity of the trauma to the primary teeth i.e., intrusion bears the highest risk of damaging a developing tooth bud, while crown/root fracture w/ or w/o pulp exposure show no effect on the perm. tooth. The frequency of permanent tooth malformation following primary tooth trauma can range from 25-69%. Of the 255 traumatized teeth reviewed, only 23% showed developmental disturbances. The most common defect is enamel hypoplasia, which is usually located in the incisal half of the affected teeth. In addition, the effects of breakdown products from areas of hemorrhaging can lead to tooth discoloration. This can also affect adjacent teeth. Odontome like teeth most commonly developed when the permanent tooth was traumatized very early in development, usually when the child is around 1 year of age. Crown dilacerations occurred in cases where the child was between 1.5-3.5 years old, and root malformation between 4-5.

Summary of conclusions: Essentially, perm. Tooth trauma occurs 23% of the time following primary tooth trauma, with intrusion being the most common culprit. ANY type of trauma may lead to tooth malformation, except for fractures of the primary tooth. The extent of how malformed the perm. Teeth are is directly related to the type of trauma, the intensity of the trauma, and the stage of development that at the tooth is currently in. At the time of trauma, the parents of the child should be informed about possible effects on the developing perm. Teeth. All possible outcomes should be discussed as to ensure that the parent will not be “surprised” when you see an odontome like tooth and you need to extract it. Regular recall visits and careful following of the child following trauma is paramount.

Assessment of article: A great review of primary tooth trauma and it’s effects on perm. Teeth. Good table, easy to read.

Pictures

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http://images.google.com/imgres?imgurl=http://cudental.creighton.edu/images/tdfect.jpg&imgrefurl=http://cudental.creighton.edu/htm/p_trma.htm&usg=__ykzVPmvvHvZ2ZU4unypPOKc6HtA=&h=329&w=456&sz=20&hl=en&start=13&um=1&tbnid=l2pIbHxPTKHu6M:&tbnh=92&tbnw=128&prev=/images%3Fq%3Dtooth%2Bintrusion%26hl%3Den%26rlz%3D1T4DMUS_enUS317US253%26um%3D1