1. Primary Dentition: Trauma & Space Management
Dr. Ha T. Jacklynn Thai
Board Certified Pediatric Dentist
Associate Professor, University of California, San Francisco
Department of Pediatric Dentistry
HRSA Program: Pediatric Dentistry in Hygiene Dentistry
24700 Calaroga Ave. Suite 104 ~ Hayward, CA ~

2. Trauma

3. Explore the Problem Find out the story
Who
What
When
Where
Why
How
Prioritize medical status/condition(s)
Primary vs. permanent dentition

4. How to Address the Problem
Medical evaluation
Glascow Coma Scale
Behavior/mental status
Clinical exam
Radiographic exam

6. Types of traumas Common types of trauma Fracture
Tooth
Root
Alveolar bone
Concussion – tenderness
Movement of tooth position
Subluxation – increased mobility but not been displaced. Bleeding from gingival sulcus
Extrusion
Intrusion
Lateral luxation
Avulsion
Cut lip or other soft tissue

8. Avulsed Teeth How was it brought to you?
How long has it been out of the mouth?
Primary teeth
Do NOT reimplant
Permanent teeth
Patient age – is apex open or closed?
How long as it been out of the mouth?
Splint
Possible sequelae
Necrosis
Tooth discoloration
Pulpal obliteration
Ankylosis
Loss of tooth

9. Rule Out Child Abuse Does the story make sense?
Are there repeated occurrences?

10. Goals of Trauma Management in the Primary Dentition
Get patient out of pain
Preserve oral health/oral structures
Preserve adult dentition
Preserve/restore or maximize quality of life
Opportunity for patient education/anticipatory guidance

11. Space Management

12. They’re Just Baby Teeth
Know the exfoliation and eruption table – at least a rough estimate
Rule of 3

13. Types of Space Maintenance Appliances
Band and loop
Distal shoe
Bilateral – Permanent Teeth
Upper: Nance/TPA
Lower: Lingual Holding Arch

17. Goals of Space Management
Prevent loss of arch length, width, and perimeter by maintaining the relative position of the existing dentition
Space maintenance is NOT space gain
Space maintenance does not rule out future orthodontics

18. Few Thoughts to Walk Away With Regarding Pediatric Dental Care
Health Professional Service
Proper consent
Definition of a household
Co-parent – amicable or not?
MINOR MUST BE 15 YEARS OF AGE OR OLDER LAW CONFIDENTIALITY AND/OR INFORMING OBLIGATION OF THE HEALTH CARE PROVIDER GENERAL MEDICAL CARE “A minor may consent to the minor's medical care or dental care if all of the following conditions are satisfied: (1) The minor is 15 years of age or older. (2) The minor is living separate and apart from the minor's parents or guardian, whether with or without the consent of a parent or guardian and regardless of the duration of the separate residence. (3) The minor is managing the minor's own financial affairs, regardless of the source of the minor's income.” (Cal. Fam. Code § 6922(a)).