Assessment of Acute Alveolar Injuries in Children - PDF

9/5/2023 Aims Assessment of acute dento-alveolar injuries in children To be able to:...

9/5/2023 Aims Assessment of acute dento-alveolar injuries in children To be able to: Understand the epidemiology of dental Plenary: Trauma 1 trauma BDS2/DTH2 Obtain a history and conduct a thorough examination of child presenting with oro-facial Peninsula Dental School trauma University of Plymouth Recognise tissues involved in the range of A/Prof Nicky Kilpatrick traumatic oro-dental injuries [email protected] 1 2 Epidemiology Epidemiology: primary dentition Upper incisors are most commonly affected Teeth: upper a’s Most common injury Age: 1 - 2 yrs old – Primary dentition: luxations (displacements) How: falls at home – Permanent dentition: crown fractures Prevalence: 17 - 34% Peak incidence – 2-4 years M:F: upto 4:1 – 8-10 years Injuries: – Fractures – 2-38% – Luxations – 21- 89% 3 4 Epidemiology: permanent dentition Aetiology Common aetiological factors change with age Age (yrs) Prevalence – Babies: – 8 – 9: 11% Unusual, may indicate NAI – 10 – 11: 18% – Infancy: Falls as child developing motor skills – 12 – 13: 25% Usually soft tissue and luxations – 14 – 15: 26% – Childhood: Falls/play accidents/sports Most common injuries – Adolescence – Crown fractures Sporting injuries Fights/assaults 5 6  9/5/2023 Predisposing factors First experiences Malocclusion Child – Class II Div 1 – Pain – > 6mm overjet  3x frequency – Scared Medical/physical impairments Parent – Cerebral palsy, epilepsy – Anxious The ‘Y’ chromosome !! – Pre-occupied – i.e being a boy – Guilty – M:F ~4:1! Staff – Busy – Worried 7 8 First experiences Why information? Reassurance ‘It nearly always looks worse than it is’ Outcomes Medico-legally – TLC – Are affected – Insurance – Child Prioritorisation – Court – Carer – now, today, next week? – Your own protection Information – referral? – Safeguarding children – Child Preparation Complaints – Carer – Equipment; LA/nitrous – Alittle TLC goes a long – Accident – Advice way – Tooth 9 10 History History Carer Medical – Who is with the child? – Bleeding disorders Trauma – Allergies – What? – Medications – When? – Immunisation status – How? Dental – Attendance – Where? – Behaviour – Other injuries? – Past treatment Loss of consciousness – Previous injuries 11 12  9/5/2023 Extra-Oral Examination Intra-Oral Examination Observe injuries elsewhere in body Soft tissues – Assess need for medical management – Lips, buccal mucosa, palate, tongue, floor of mouth Facial asymmetry – Look for lacerations, degloving, bleeding, bruising – Observe from above and behind the patient Palpation facial skeleton Facial injuries – Swelling – Abrasions – Lacerations – Contusions Have a REALLY good look! 13 14 Intra-Oral Examination Radiographic Examination Soft tissues Periapical – Degree of displacement Occlusion – Locating teeth Teeth – Extent of fractures – Loss of tooth tissue (fractures/loss of whole tooth) Occlusal – Position – Lateral luxations, root fractures – Mobility OPG – Where is the tooth? – General surveillance – Facial fractures 15 16 Additional Radiographs Special Investigations Maxillary true lateral Percussion – Tenderness – May be useful for primary intrusions – Tone Soft tissue views Mobility – Lip lacerations Pulp sensibility testing CBCT – Not useful in primary dentition – TMJ and complex jaw fractures Transillumination – Root fractures Photographs 17 18  9/5/2023 Classification of injuries Permanent dentition: crown fractures Hard dental tissues and pulp Uncomplicated # – Fractures, with or without involving the pulp – No pulpal involvement Periodontal tissues Pulpal protection ASAP – Concussion, luxations and avulsions – seal dentine/pulp complex Supporting bone – GIC temporary dressing – Socket walls, alveolar bone, facial bones – definitive composite restoration Gingivae or oral mucosa – Lacerations, deglovings As per Paediatric Dentistry. Welbury et al. 5th Ed. Pg 229 19 20 Permanent dentition: luxation injuries Permanent dentition: luxation injuries Displacement from the socket Tissues involved include any/all: Extrusive Luxation PDL – stretched, contused, torn Palatal Luxation Pulpal vessels/nerves Intrusion – stretched, torn, severed Avulsion Gingivae – lacerated Bone – fractured 21 22 Classification of injuries Summary The outcomes of an injury are dependant on – A comprehensive history and examination – Accurate diagnosis of the affected tissues Good clinical records are essential – Photographs +/- draw a diagram Always consider the possibility of – Non-accidental injury – Medico-legal follow up Paediatric Dentistry. Welbury et al. 5th Ed. Pg 229 23 24  9/5/2023 References Chapter 13 in Paediatric Dentistry. Welbury et al. 5th Edition. Dewhurst et al. Br J Oral Max Surg 1998 36: 165 – 175. Kullman and Sane. Dent Traumatol 2012 28: 193 – 199. 2020 International Association of Dental Traumatology (IADT) Guidelines (x 4 parts) https://www.iadt-dentaltrauma.org/for-professionals.html [email protected] 25