1 Assessment

• % of boys suffering trauma at age 5

  31-40
• % of boys suffering trauma at age 12

  12-33%
• % of girls suffering trauma at age 5

  16-30
• % of girls suffering trauma at age 12

  4-19%
• most accidents with primary dentition occur from the ages of 2-4 why?


  becoming more ambient
• Accidents involving permanent dentition mostly occur when, and why?

  7-10 as they begin to take up sports
• what is the most common injury in primary teeth?

  luxations due to short roots
• what are the most common injuries in permanent teeth

  crown fractures
• when is there a worse prognosis

  when there is more than 1 injury
• injuries in permanent dentition are most commonly associated with?

  • collisions at play
  • horse riding accidents 
  • cycling accidents
  • sports injuries
  • trampolining 
  • RTA 
• what occlusion puts pt at higher risk?

  • increased overjet
  • protrusion of upper incisors
  • 2x more likely
• an increased overjet leads to an increased number of?

  affected teeth
• what needs to be taken for a full assessment ?

  1. history of accident
  2. MH
  3. SH
  4. examination
  5. additional investigations
• Taking history of the accident

  how is happened?

  • accident or NAI
  • other injuries as well as dental
  • loss of consciousness, drowsiness, vomiting, headache, amnesia = A&E

  When?

  • time between injury and Tx = affects prognosis
  • delayed presentation = safeguarding

  where?

  • tetanus jab needed?
  • Medico legal implications (prevented, records may be used legally)
• Who is it more important to listen to

  the child
• Medical history?

  • bleeding disorders
  • Cardiac disease (risk introducing bacteria and infective endocarditis)
  • Epilepsy (will it be knocked out after fall again)
  • Allergies (important if need antibiotics)
  • Tetanus status and are they up to date with immunisations (eg. MMR)
• SH?

  • who has PR
  • any involvement with social services
  • hobbies - do they need mouthguard
  • smoking or alcohol involved
• Why is it important to know if there is involvement with social services?

  • previous incidents
  • if NAI and pt is known to SS, it must be reported
• Examination Extra orally

  • take pictures
  • signs of shock
  • swelling
  • bruising
  • lacerations
  • asymmetry
• Intra oral exam?

  • soft tissues
  • hard tissues
  • occlusion
  • mobility
• Types of injury are based on

  a WHO classification system
• Types of injury?

  1. soft tissues (EO)
  2. Bony
  3. associated (gingiva, OM and periodontium)
  4. Dental (crown or root - either complicated or uncomplicated)
• EO injuries ?

  1. contusion = no Tx
  2. Abrasion = clean
  3. Laceration = suturing

  GDP can suture but best to refer to A and E
• Bony injuries ?

  • fracture to any bone in the face
  • refer to maxillofacial unit
• Associated tissue injuries

  1. Contusion
  2. Abrasion
  3. Laceration 

  nb. also degloving
• Degloving 


  top layers torn away from bottom layers leaving hole
• Periodontal injuries ?

  1. concussion
  2. subluxation
  3. luxation - extrusive, intrusive or lateral
  4. Avulsion

  Tooth has moved instead of breaking
• Concussion ?

  impact which causes PDL to well leaving tooth tender but not mobile
• Subluxation?

  impact which causes some PDL fibres to rupture giving slight mobility but the tooth is still where it should be 
• Luxation ?

  where impact causes tooth to not be in the correct place 
• Avulsion?

  whole tooth has come out
• Dental injuries ?

  1. crown (complicated or uncomplicated)
  2. Root (complicated or uncomplicated)
• uncomplicated fracture

  enamel with or without dentine ONLY
• Complicated fracture

  pulpal involvment
• if a complicated fracture of an immature tooth with an open apex what Tx should be done

  aim to get continued root closure and development, why length of injury has effect of prognosis
• if a mature tooth with a closed apex

  different Tx
• Why should you always ask where the broken tooth is ?

  could have swallowed it, inhaled it, embedded it in the lip or lost it.
• Home care advice ?

  • analgesia as required (what you give a child for a headache, follow instructions on box, no aspirin for under 12)
  • soft diet
  • meticulous OH and soft TB
  • rinse and swab 2x daily with CHX
  • avoid contact sports
• Referral letter ?

  • Practice contact details 
  • Letter date 
  • Name and address of dentist/consultant referred to 
  • Patient’s name, DoB, contact details 
  • Reason for referral - outline event, Tx provided and give rads
  • Degree of urgency of referral 
  • General medical history 
  • Relevant dental and social history 
  • Clinical/unusual features 
  • Provisional diagnosis 
  • Legible signature of referring practitioner and printed name