2 Primary Dentition

• mouth is the

  2nd most common area to injur
• world wide prevalence of oral injuries in kids

  22.7%
• Differences between primary and secondary dentition ?

  • root fractures rare in primary
  • bouncy bone allows some displacement without fracture
  • tooth discolouration common
  • underlying successors need to be considered
• Assessment ?

  • difficult = fear, lack of cooperation and distress from incident both parent and child
  • could be first dental visits so minimise anxiety + ability to cope ?
  • time to exfoliation
  • occlusion
  • EO and IO photos
  • sensibility tests unreliable
  • record
• What should be recorded?

  mobility , colour , tenderness , displacement
• PDL injuries ?

  • little evidence to support Tx
  • Monitoring often most appropriate
  • associated tissue damage = wound is kept clean with daily chlorhexidine swabs
• When is monitoring not appropriate ?

  • risk of aspiration
  • interferes with occlusion
• Monitoring reduces?

  • stress to child
  • risk of damage to permanent successor
• concussion clinically?

  • TTP
  • no mobility
  • no displacement
  • no bleeding
  • rads not recommended
• Tx of concussion?


  • rads not rec
  • no Tx
  • home care advice
  • warn of sequelae
  • monitor
  • XLA is devitalises
• subluxation clinically?

  • TTP
  • mobile
  • NOT displaced
  • some gingival bleeding
• Subluxation Tx?

  • baseline rad
  • No Tx
  • home care
  • warn of sequelae
  • refere dentist follow up
• luxation clinically

  partial displacement
• Luxation Tx

  • baseline rad
  • allow spontaneous realignment - usually occurs in 6 months
  • home care
  • warn sequelae
  • monitor
  • if extruded more than 3mm = XLA
• How does spontaneous realignment occur?

  • permanent successor will push back into place
  • usually in 6 months
  • refer if does not occur
  • rv 3 monthly
• Avulsion Tx


  DO NOT REPLANT

  
  

  • monitor eruption of permanent successor
  • rads to rule out complete intrusion
  • risk of inhalation = listen for altered chest sounds = refer to GP for xray
  • antibiotics / tetanus?
  • home care advice
• why should you not replant and avulsed primary tooth?

  could cause damage to permanent successor underneath
• Uncomplicated fracture Tx?

  Enamel only = smooth sharp edges, radiograph not recommended 

  Enamel and dentine = baseline rad optional, cover exposed dentine with GIC

  • restoration
  • home care
  • sequelae warning
  • dentist for follow up
• Complicated fracture?

  involves pulp

  • Tx depends on coop
  • baseline rad
  • aim to preserve vitality
  • non setting caoh over exposure
  • GIC bandage
  • composite restoration
  • may need partial pulpotomy or XLA
  • Home care
  • dentist follow up
• Success rate or RCT in primary teeth

  64% but caused 60% permanent successors to have enamel formation disturbance

  no RTC = 21% enamel disturbance
• Sequelaeprimary dentition

  Document that carers have been informed!

  • discolouration 
  • Devitalisation
  • Infection
  • Root resorption
  • Altered exfoliation
• discolouration?

  • yellow, grey, black, pink
  • most common w/ luxations
  • may fade
  • can be clinically symptomatic and radiographically normal
  • can dev apical periodontitis +/- symptoms
  • pulp Tx not needed unless signs of infection
• discolouration meanings?

  yellow = pulp chamber obliterated

  pink = internal haemorrhage

  grey/black = pulpal necrosis so +++ chance of infection
• sequelae permanent successor

  root apex of primary close to tooth germ of the dev permanent successor

  • most common in intrusion and avulsion injuries
  • document
  • Opacities
  • Malformations
  • Dilaceration
  • Failure of root formation
  • Impaction
  • Disturbed eruption
• Why does trauma cause dilaceration?

  trauma cause crown to be pushed in different direction to root - usually results in surgeries)