Guideline on Management of Acute Dental Trauma

Resident’s Name: Joanne Lewis Date: August 14, 2009
Article title: Guideline on Management of Acute Dental Trauma (focused on primary dentition for this lit review)
Originating Council: AAPD Council on Clinical Affairs
Journal: AAPD Reference Manual 29
Adopted: 2001 (revised 2004, 2007)
Major topic: dental trauma
Main Purpose: to define, describe appearances, and set forth objectives for general management of acute traumatic dental injuries.
Overview of method of research: The guideline is based on a review of current dental and medical literature related to dental trauma.
Findings: Greatest incidence of trauma to the primary dentition occurs at 2-3 years of age, when motor coordination is developing. Rapid and thorough assessment of the nature and extent of the patient’s injuries is essential to delivering appropriate treatment. After a primary tooth has been injured, the treatment strategy is dictated by the concern for the safety of the permanent dentition. It is important to inform parents about possible pulpal complications, such as the development of an abscess or sinus tract or color change of the crown, as well as potential sequelae to permanent teeth, such as enamel hypoplasia, hypocalcification, crown/root dilacerations, or disruptions in eruption. Specific recommendations are as follows:
- Infraction – no treatment indicated
- Uncomplicated crown fracture – for small fractures, rough margins and edges can be smoothed; for larger fractures, lost tooth structure can be restored.
- Complicated crown fracture – decisions are based on life expectancy of the primary tooth and vitality of the pulpal tissue. Treatment alternatives are pulpotomy, pulpectomy, and extraction.
- Crown/root fracture – extract the entire tooth, unless the retrieval of apical fragments may result in damage to the succedaneous tooth.
- Root fracture – extract the coronal segment with or without the removal of the apical fragment.
- Concussion – unless an associated infection exists, no pulpal therapy is indicated.
- Subluxation – no immediate treatment needed, tooth should be followed for pathology – should return to normal within 2 weeks.
- Lateral luxation – allow passive repositioning or actively reposition and splint for 1-2 weeks as indicated, except when the injury is severe or the tooth is near exfoliation.
- Intrusion – allow spontaneous reeruption except when displaced into the developing successor. If the apex is displaced toward the permanent tooth germ, extraction is indicated. 90% will reerupt spontaneously within 2-6 months. Ankylosis may occur.
- Extrusion – reposition and stabilize with a splint for 1-2 weeks or extract.
- Avulsion – do not reimplant primary teeth.
Assessment of article: Concise reference – recommendations are very general.