Part 8: Dental Trauma in Children

Statistics
-trauma more common in males in max. anterior teeth
-pts w/ increased overjet more likely to have trauma
-no reliable method to determine vitality of recently traumatized tooth
Reactions of Teeth to Trauma
1) Pulpal hyperemia: can lead to necrosis from increased intrapulpal pressure
2) Internal hemorrhage: capillaries rupture from increased pressure
-can cause discoloration
3) Calcific metamorphosis: pulp canal obliteration
-teeth remain vital but can become yellow in color
4) Internal resorption: osteoclast action on root
-Pink spot perforation can occur
5) External root resorption: due to damage of periodontal structures occurring in severe injuries causing
displacement
a) Surface resorption: normal PDL w/ resorption only in small areas
b) Replacement resorption: ankylosis
c) Inflammatory resorption: granulation tissue forms; radiolucency seen
6) Pulpal necrosis: due to severing of apical vessels or prolonged hyperemia causing strangulation of vessels
7) Ankylosis: occurs w/ PDL injury leading to inflammation and osteoclast activity causing fusion of bone and
cementum
-clinically, ankylosed tooth has incisal/occlusal surface gingival to adjacent teeth
-do not erupt but continue to sink into gingival tissue
Consequences of Permanent Teeth w/ Injury to Primary Predecessor
-primary anterior teeth are positioned labial to permt successor, so an injury that forces root of primary tooth into
developing permt tooth can cause injury
1) Hypocalcification/hypoplasia
2) Reparative dentin formation
3) Dilaceration (or bending of permanent tooth)
Tetanus Coverage
1) Uncovered children: give antitoxin (tetanus immune human globulin)
2) Children w/ previous coverage but outdated: toxoid booster
3) Active immunization: no need for booster
-active immunization includes:
a) 3 injxns of diphtheria, pertussis, and tetanus (DPT) vaccine during first year
b) booster at 1.5 and 3 yrs
c) booster at 6 yrs and then every 4-5 yrs
Traumatic Injury Follow-up
-performed at 1, 2, and 6 month intervals post-injury
-electrical pulp tests and thermal tests may be unreliable in primary teeth, but teeth may be normal
Concussion and Subluxation
1) Concussion: injury to tooth w/o displacement or mobility (no injury of supporting structures)
-PDL inflamed and tender to pressure
2) Subluxation: injury to tooth w/o displacement but has mobility (injury to supporting structures)
3) Txt: usually no txt needed, but tell pt to use soft diet, good oral hygiene, and chlorhexidine or peroxide rinse