Dental Specialties: Pediatric Dentistry 2

Dental trauma to paediatric patients can be categorised into four different types: coronal fractures, concussion, fractured roots,  and avulsed teeth.


There is perhaps no single dental disturbance that has greater physiological impact on both the parent and the child than the loss of fracture of a child's anterior teeth.


It is extremely important for the dentist to preserve the vitality of injured teeth whenever possible and to restore them to their original appearance without producing additional trauma or endangering the integrity of the teeth.


The time is the most important consideration in the treatment of fractures or displacements and every effort should be made to see the patient in the office immediately.


1. Coronal Fracture

• Comes in 5 different classes
• Class 1: involves only the enamel - may only need smoothing
• Class 2: involves enamel and dentin - usually requires restoration
• Class 3: exposed the pulp - requires pulp capping, pulpotomy or endodontic treatment
• Class 4: involves the crown being fractured at the CEJ - requires extensive treatment or an extraction
• Class 5: is on the root below the epithelial attachment - extraction is required

class 1

class3

 class 2

2. Concussion

• A direct blow received by a tooth usually results in the compression of the root against the wall of the socket. It can also effect the blood supply to the tooth. The force of the blow may completely sever the apical blood vessels or may produce an apical edema and or hematoma.
• Treatment involves relieving the bite of the affected tooth and instructing the patient to avoid biting, chewing, or exposing the tooth to extremes of temperature. The tooth will then be evaluated at each recall appointment to determine if any permanent damaged was sustained.
• The tooth can become necrotic (non-vital)
• If someone in a contact sport gets a brain concussion it can affect the teeth as well.
• Concussion of the teeth occurs when the jaws close quickly and severely, not always in proper occlusion.
• Concussions with Displacement
• Traumatic Intrusion
• the tooth is forcefully pushed up into the gums
• Traumatic Extrusion
• the tooth is forcefully pull out of the gums but still present in the mouth.
• Lateral Luxation
• tooth is displaced either facially of lingually - early treatment would be t move the tooth back into place with pressure then create a splint to hold it secure until the bone and PDL repair.

3. Fractured Roots

• Is a small crack in the root of the tooth, kind of like a hair line fracture on a bone.
• An x-ray needs to be taken at different agulations to dected that fracture.
• A root fracture may simply require splinting of the tooth or it may be severe enough to require endodontic therapy.

4. Avulsed Teeth

•  Permanent teeth that have been knocked out can be re-implanted with varying degrees of success.
• The biggest factor that determines success or failure of re-implanting a tooth is time.
• Studies have shown that 90% success rate in teeth that are re-implanted within 20mins of the accident. The success rate dropped to 43% when the procedure was attempted after 90 mins.
• the patrient should be instructed to recover the tooth immediately, wrap the tooth in moistened gauze or keep the tooth mosit in saliva, water or milk and come to the office as soon as possible.

There are different kinds of discrepancies that can occur while the teeth are growing.
Supernumerary Teeth (Hyperdontia)

• Means extra teeth
• very rare
• mostly found in the reigion of the upper front teeth.
• if they are found in the midline they are called mesiodens
• these teeth frequently cause delay in erruption of permantent teeth or anomalies of position such as a diastema (space between the teeth) or rotations.
• they may cause the development of cysts that can damage or resorb roots of adjacent teeth.
• these teeth are usually removed to prevent crowding and shifting in the dentition

Unerupted (impacted) Upper K9 Teeth

• an impaction means that a tooth cannot fuly eurpt into the mouth
• the tooth most often associated with impaction is the wisdom teeth
• the second most affect is the cuspids, a.k.a K9
• the dentist may choose to surgically remove the tooth, or to expose the crown of the tootb and atempt to move it into position orthodontically.

Frenum Induced Diastema

• a frenum is a flap of skin that hold our lips or tounge to our gums
• when the frenum is very thick and fibrous it can cause a space between the upper and lower central inscisors.
• a frenectomy may be preformed to remove that thick tissue that otherwise would not allow those teeth to come into contact.

 this is an example of a very thick frenum that is causing the front teeth to separate.

 this is a normal frenum that is located at the bottom of our mouth underneath the tounge. If this is very thick a person can have a speech impediment also known as tounge-tied.

Ankylosis

•  when the roots of primary teeth lose their noraml attachment to the bone (small ligamnets) and become fused directly to the bone
• the tooth will eventually need to be extracted and a space maintainer is place in order to allow for proper eruption of the permantent tooth

 you can see that one tooth and farther down then the others, meaning it is more fused to the bone beacuse of the shorter ligaments.