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Injuries to the Deciduous Dentition |
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The most accident prone time in the primary dentition is between 2 and 4 years of age. This means that treatment must be simple and straightforward, with a decision between extraction and maintenance.
A traumatised primary tooth that is retained should be assessed clinically and radiographically regularly for signs of pulpal or periodontal complications. Soft tissue injuries in children should be assessed weekly until healed. Tooth injuries should be reviewed every 3—4 months for the first year and then annually until the primary tooth is exfoliated.
Uncomplicated crown fracture: ¨ Either smooth sharp edge or restore with an acid-etch restoration if co-operation is satisfactory
Complicated crown fracture: ¨ Extraction ¨ Pulp extirpation and canal obturation with zinc oxide cement, followed by an acid-etch restoration if co-operation allows
Crown—root fracture: ¨ Extraction
Root fracture: ¨ If only small mobility and no displacement—keep under observation. If the coronal fragment becomes non-vital and symptomatic then extract ¨ The apical portion normally remains vital and undergoes normal resorption ¨ If markedly displaced and mobile only the coronal portion should be removed
Concussion: ¨ Often not brought to the dentist until tooth discolours
Subluxation: ¨ If slightly mobile advise soft diet for 1—2 weeks and keep traumatised area as clean as possible ¨ If markedly mobile—extract
Extrusive luxation: ¨ Extraction
Lateral luxation: ¨ If crown displaced buccally—extract ¨ If crown displaced palatally—conservative treatment is possible if occlusion is not gagged. Await some spontaneous realignment
Intrusive luxation: ¨ Establish direction of displacement through radiographic investigation ¨ If root is displaced palatally towards the permanent successor—extract primary tooth ¨ If root is displaced buccally then periodic review to monitor spontaneous re-eruption should be allowed ¨ Review weekly for a month, then monthly for 6 months ¨ Most re-eruption occurs between 1 and 6 months and if this doesn’t occur then ankylosis is likely and extraction is necessary to prevent ectopic eruption of the permanent successor
Avulsion: ¨ Leave, do not re-implant! ¨ Eruption of the permanent successor may be delayed for about 1 year, due to abnormal thickening of connective tissue overlying the tooth germ |
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With any injury to a primary tooth there is a risk of damage to the underlying permanent successor |
