Traumatic Injuries in the Primary Dentition

Resident: Swan

Article Title: Traumatic Injuries in the Primary Dentition

Journal: Dental Traumatology

Volume (Number): 18; 2002, pgs 287-98

Major Topic: Injuries to the primary dentition

Type of Article: Literature Review

Main Purpose: update the “state of the art” regarding epidemiology and treatment of traumatic dental injuries in the primary dentition

Overview of method of research: Medline search and review of 75 articles that met inclusion criteria: clinical cases with no abstracts available and published before 1984 were excluded. Articles were sorted as pertaining to “epidemiology” or “therapy.”

Findings:

Epidemiology—

Prevalence of traumatic injuries in the 0-6 year old population varies from 11 to 30%. When the child starts walking alone between 18 and 30 months, the risk of trauma doubles compared to the average incidence for all children. In children up to age 2, avulsion and intrusion are the most severe injuries that can affect the developing tooth germ. Traumatic displacement of the root may alter the secretory phase of the ameloblast, leaving a defect known as circular enamel hypoplasia. A study of 255 traumatized primary teeth showed 23% with damage to corresponding permanent teeth. Highest incidence found after intrusion.

Therapy—Fractures

a) Non complicated crown fractures (in enamel and dentin)

a. PA taken as baseline, polish sharp edges, possibly restore with composite if child cooperates

b) Complicated crown fractures (w/ pulp exposure)

a. PA taken 1) partial pulpotomy if apex is open and child’s behavior allows it, 2) pulpotomy with formo/ZOE in cases where root is fully formed and not resorbing, 3) root canal treatment filled with ZOE, and 4) extraction

c) Crown-Root fractures (fracture compromises both crown and root)

a. PA, extract mobile fragments, leave root fragments to avoid permanent tooth germ damage

d) Root fracture

a. PA, 1) if coronal fragment is in place, root is complete, and pt cooperates, splint teeth. Tooth will have some mobility until the permanent tooth erupts, may lose crown 2) if crown is displaced (more common), extract coronal fragment

e) Alveolar fracture

a. PA/Pano, look for discontinuity in surrounding oral mucosa, reposition segment, splint for up to 4 weeks

Therapy—Luxations/Avulsions

a) Concussion (no mobility or sulcular bleeding)

a. Monitor, don’t do endo on discolored teeth (most are necrotic and asymptomatic)

b) Subluxation (mobile w/o displacement. May bleed)

a. Monitor. Most teeth regain stability within 2 weeks

c) Lateral luxation

a. With no occlusal interference, nearly all re-position spontaneously within a year

b. With interference, reposition and splint 2-3 weeks (reposition increases risk of necrosis

d) Intrusion

a. Apex is usually labially displaced (80%) On PA, apical tip can ben seen and tooth appears shorter than contralateral. If displaced toward permanent germ, apical tip is hidden and tooth appears elongated.

b. Palatally displaced—Extract, Labially displaced—leave for re-eruption (~88% re-erupt to occlusal plane)

e) Extrusion

a. Repostion and splint, or extract

Therapy—Avulsion

a) PA, do not replant

Instructions to Parents:

1) Soft diet for two weeks, 2) brush teeth after each meal, 3) chlorhexidine 2x daily for a week, 4) inform of possible complications and appearance of fistulae 5) w/ intrustion, avoid pacifier/bottle use to allow re-eruption

Key Points/Summary: Conservative treatment is the way to go with this population

Assessment of Article: Good overview of tx for primary teeth, research method not very statistically-based, hard to know how much weight to assign to their reported averages.