09/02/2010 Guidelines for the management of traumatic dental injuries. III. Primary Teeth

Resident: J. Hencler
Date: 09/02/2010

Article title: Guidelines for the management of traumatic dental injuries. III. Primary Teeth

Author(s): Flores et al.
Journal: Dental Traumatology 2007; 23: 196-202

Major topic: Trauma guidelines in primary teeth

Overview of method of research:
The IADT has developed guidelines that represent the current best evidence based on literature research and professional opinion.

Guidelines:

Uncomplicated Crown Fracture: Pulp not exposed. Tx: Smooth sharp edges-tooth restored w/ comp.

Complicated Crown Fracture: Pulp exposure. Tx: Preserve pulp vitality by pulp capping or partial pulpotomy. CaOH is a suitable material.

Crown-root fracture: Involved enamel, dentin, and root structure. May or may not involve pulp. Tx: EXT

Root fracture: coronal fragment is mobile. Tx: EXT coronal fragment, apical fragment left to resorb.

Alveolar Fracture: Tooth containing segment often mobile and usually displaced. Tx: reposition and splint.

Concussion: tooth is painful to touch, not mobile. Tx: observation.

Subluxation: Mobility noted but not displaced, bleeding from gingival sulcus may be noted. Tx: observation

Extrusive Luxation: Tooth appears elongated and is mobile. Tx: based on degree of displacement. For minor extrusion <3mm reposition or allow for spontaneous reposition. Severe extrusion=EXT.

Lateral luxation: Tooth is displaced and mobile. Tx: If no occlusal interference, allow tooth to spontaneously reposition. If occlusal interference observed, give LA and reposition. Severe displacement=EXT.

Intrusive luxation: displaced through labial bone or impinging on succedaneous tooth bud. Tx: If apex is displaced through labial bone plate, let tooth spontaneously reposition. If apex displaced into developing tooth bud=EXT.

Avulsion: Tooth out of socket. Tx: Do not replant tooth!

Discussion:
It is important to take a thorough med hx and hx of present illness. After clinical exam, radiographs should be considered depending on child’s ability to cope w/ procedure. Depending on child’s injury, typical radiograph may include a 90° horizontal-view, occlusal view, or extra-oral lateral view (useful to reveal relationship b/t apex and perm tooth bud). Post op patient instruction should include recommendations such as OHI and diet. Chlorhexideine (0.1%) applied topically to the affected area is often beneficial 2x/day for 2 wks. Inform parents of future complications such as defects in perm tooth structure or possible loss of traumatized primary tooth. Finally, give appropriate f/u appointment for post-op care and re-evaluation. (See last table)

Summary of conclusions:
An appropriate tx plan after an injury is important for a good prognosis. Guidelines are useful for dentists and other healthcare professionals in delivering the best care possible in an efficient manner. Management of trauma to primary teeth differs from that used in permanent teeth. Treatment selection should minimize any risk of further damage to permanent successor.

Assessment of article:
This is a great article that provides very useful clinical information that all pediatric dentists should know and/or can refer to when treating trauma cases. These guidelines combined with sound clinical judgment make treating traumatic injuries to primary teeth straightforward and more predictable.