Traumatic Dental Injuries to the Primary Dentition Dr M K Muasya Paediatric dentist University of Nairobi

Introduction Trauma refers to injury; damage; impairment; external violence producing injury or degeneration to the tooth. Injuries to the primary dentition have been reported at a prevalence of 4 to 36% Age group with highest incidence 2-3 year olds when motor coordination is developing Teeth most affected are the maxillary incisors

Why manage these A close relationship exists between the apex of the root of the primary tooth and the developing permanent tooth These are therefore managed to prevent sequelae such as: Failure of eruption of permanent teeth White of yellow-brown discoloration Hypoplasia or hypomineralisation of secondary teeth Delayed eruption Overretention of primary teeth

Factors to consider Child’s mental age and ability to cope with dental treatment Parents’ willingness to comply with treatment Time of shedding of the primary tooth Clinician factors: training, experience and acquired skills in managing children and dental trauma Anatomical factors Financial implications

Overview of management History: where, when, how? Examination: both extra oral and intraoral are crucial in arriving at a diagnosis. Intraoral: soft and hard tissue examination Investigations: Radiographs: IOPA, Occlusal views, Extraoral views, CT scan

Types of injuries and management

Enamel and enamel dentin fractures Involves enamel and enamel and dentin respectively Management is by composite restoration

Crown fracture with exposed pulp If root formation is incomplete a calcium hydroxide pulpotomy followed by Glass Ionomer base and Composite permanent filling Pulpectomy where root formation is complete When the child is unable to cope with the above extraction may be done.

Root fracture Usually extraction of the tooth If an apical segment of the root is in situ it may be left and extracted at a later date to avoid injury to the permanent tooth

Alveolar fracture The fracture involves the alveolar bone Reposition any displaced segment and splinting of teeth. GA Segment stabilisation for 4 weeks

Concussion injury A tooth is tender to palpation or percusion, not mobile or displaced Observation and re-evaluation after 1 year

Subluxation Mobility of the tooth without displacement Observation and re-evaluation after 1 year

Extrusion Displacement of the tooth coronally hence it appears longer than adjacent teeth and is mobile Extrusion less than 3mm for an immature tooth: Repositioning and use of a splint Repositioning and observe Extrusion more than 3mm usually extract

Lateral luxation Mobility and displacement labially or palatally If there is occlusal interference the tooth is repositioned under local anaesthesia using digital pressure If there is severe displacement with crown displaced labially the tooth is indicated for extraction

Intrusion injuries If the apex is displaced toward the labial bone the tooth is left for spontaneous repositioning If the apex is displaced into the developing tooth germ it should be extracted

Avulsion Complete loss of the tooth from the socket Replantation is not recommended The parents and child are reassured and await eruption of the permanent tooth

Prevention of trauma Safe home and class room layouts Use of staircase gates Use of infant and toddler car seats Prompt treatment by a dentist to minimise sequelae of traumatic injuries We cannot totally prevent trauma because children must fall as they learn to walk

Challenges encountered in the country Lack of skilled personnel to manage these injuries at lower level health facilities Perception by health care workers that “are just baby teeth they will fall out” Parental knowledge and attitudes Lack of equipment and materials at peripheral health facilities to render treatment hence the common treatment prescribed is extraction.

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