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Traumatic Dental Injuries in Primary Dentition

Introduction 

For children, aged 0-6 years, oral injuries account for 18% of all physical injuries and the mouth is the second most common area of the body to be injured. Traumatic dental injuries have a world prevalence of 22.7% affecting the primary teeth. Unintentional falls, collisions, and leisure activities are the most common reasons for TDIs, especially as children learn to crawl, walk, run, and embrace their physical environment. They most commonly occur between 2 and 6 years of age.

Classification of traumatic dental injuries in primary dentition

Treatment options

  • Initial clinical examination

  • Radiographic examination

  • Pulp status evaluation

  • Stabilisation

  • Treatment 

  • Follow up

The management of traumatic dental injuries to the primary dentition aims to prevent damage to the developing permanent tooth germ, alleviate pain, and minimize possible complications, such as infection.


Fractures

Features

Treatment 

Concussion 

Tooth is tender to touch but no displacement 

Observation 

Subluxation 

Tender

Increased mobility 

Not displaced

Observation 

Extrusive luxation

Appears elongated

Excessively mobile

Occlusal interference 

If not interfering with occlusion, let the tooth for spontaneous repositioning

If excessively mobile oe extruded >3mm, extract under LA

Lateral luxation

Displaced usually in labial or lingual direction

Immobile

Occlusal interference 

If no occlusal interference, spontaneous repositioning of tooth by itself (it takes about 6 months)

If severely display, extract under LA to avoid aspiration or ingestion of tooth

Under LA, reposition the tooth and splint for 4 weeks with flexible splint.

Intrusive luxation 

Displaced through the labial cortical plate or impinged permanent tooth bud.

Tooth almost or completely disappeared into socket and can be palpated labially

Allow spontaneous repositioning by itself.

Avulsion

Completely out of socket

Should not be replanted.

Enamel fracture

Fracture of enamel only

Smoothen any rough edges

Enamel dentin fracture

Pulp not exposed, enamel and dentin fracture

Sensitivity 

Cover all exposed dentin by GIC.

Lost tooth structure can be restored with composite.

Complicated crown fracture

Fracture involving enamel, dentin and pulp 

Preserve pulp by partial pulpotomy

Crown root fracture 

Fracture involving enamel, dentin and root structure with or without pulp exposure.

Loose but still attached fragment can be present 

Remove the loose fragment

If restorable and there is no pulp involvement, cover the exposed dentin with GIC.

If restorable and pulp is exposed, perform pulpotomy or pulpectomy

If unrestorable, extract the entire tooth without disturbing the permanent tooth bud

Root fracture

Rare in primary dentition

Depending on the location of fracture, the coronal segment may be mobile or displaced and have occlusal interference 

If no displacement, no treatment 

If displaced but not mobile, allow for spontaneous repositioning by itself 

If displaced, mobile with occlusal interference, extract the loose fragment or reposition it with flexible splint for 4 weeks.

Alveolar fracture 

Fracture of alveolar bone involving labial and palatal/ lingual plate 

Mobility 

Dislocation 

Occlusal interference 

Repositioning under LA and stabilizing with a flexible splint for 4 weeks.



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