In the name of GOD

Prevention and Management of Traumatic Injuries in the Primary and Permanent Dentition

Etiology and Epidemiology Peak age in primary : 2-4 y Falls Contact sports: mouthgaurds Automobile accidents Seizure disorders Permanent teeth more crown fx / primary more luxation Maxillary central incisor Protruding incisor Child abuse in primary :50 % head and neck Injuries in various stages of healing, labial frena

History Medical and dental History of dental injury : When,where,how First or not Tetanus prophylaxis Central nervous system : consciousness,disoriented,nauseated 24 h : every 2-3 h waking the child

Non-complicated Crown Fracture Enamel fracture Enamel-dentin fracture

Complicated Crown Fracture Enamel,dentin,pulp exposure

Crown-root Fracture Multiple( pulp may or not be involved) Coronal fragment : attached to the gingiva,mobile  Treatment Extraction of mobile fragments Do not insist on removing root fragments(damage to the tooth germ )

Root Fracture Mobile tooth,displacing of coronal fragment

Alveolar Fracture Mobile,displaced (tooth in the affected segment) Discotinuity in the surrounding area

Concussion Tender to touch No mobility,no sulcus bleeding No abnormal changes in the X-ray  Treatment Observation

Subluxation Mobile,without displacement Sucus bleeding may or not  Treatment Observation Careful bacterial control: Good oral hygiene

Lateral Luxation Displaced laterally Crown usually in palatal direction

Intrusion Apex labially (80%) PA X-ray  Shorter,apical tip is seen: toward labial bone plate  Elongated,apex tip isn’t seen : toward permanent tooth germ Hypoplasia in permanet tooth

Extrusion Mobile,displacing out of the socket  Treatment Left or Extarct

Primary teeth Tooth out of the socket PA X-ray :ensure that the lost tooth is not intruded Treatment Must not be replant :damage to the developing tooth germ Replant : aspiration,retention,inflamatory resorption,abscess formation Hypoplasia,white or yellow brown opacity Esthetics,function loss Phonation disorder or tongue interposition: removable appliance

Permanent Teeth Time out of socket Immediately reimplant by the first capable person

Transport medium :Viaspan,Hanks Balanced salt solution (HBSS): EMT tooth saver Cool Milk > salin,water Saliva/patient’s mouth

As soon as possible to dentist Office : HBSS/ moth rinse Doxycycline /penicillin V Splint

Uncomplicated crown fracture Immediate treatment : none Refer to dentist: within 48 h

Complicated crown fracture Immediate treatment : none,don’t place any medication on the bleeding pulp,stop bleeding with sterile cotton gauge Refer to dentist: as soon as possible,could wait 48 h if patient can tolerate cold and eat

Root fracture Immediate treatment : none Refer to dentist: as soon as possible

Concussion /Subluxation Immediate treatment : none Refer to dentist: within 48 h for evaluation

Luxation Immediate treatment : move the tooth back Refer to dentist: as soon as possible

Avulsion Immediate treatment : replace the tooth in its hole,restor in milk or saline Refer to dentist: immediately

Education How to avoid injuries How to manage at the site of the injury Who are at the high risk? Severe maxillary overjet : orthodontic treatment before 11 Another injuries Young children Looking for all fragments

Facegaurd Prefabricated/custom Not applicable to all activities Hit under the chin : no False security

Mouthgaurd 100 y Amateur: Boxing, football, ice hocky,lacrosse Baseball.basketbal,soccer,school physical classes Promote the rules requiering the use of mouthgaurds

Best fitted by dentist Cover all teeth in max arch except in mandibular prognatism Fix orthodontic appliances/congenital abnormalities: cleft Adequet thickness : min 3 mm over occlusal Retentive fit Speech consideration Material

Custom-fabricated Mouth formed Thermoplastic Shell line stock