1. Traumatic Dental Injuries to the Primary Dentition
Dr M K Muasya
Paediatric dentist
University of Nairobi

2. Introduction
Trauma refers to injury; damage; impairment; external violence producing injury or degeneration to the tooth.
Injuries to the primary dentition have been reported at a prevalence of 4 to 36%
Age group with highest incidence 2-3 year olds when motor coordination is developing
Teeth most affected are the maxillary incisors

3. Why manage these
A close relationship exists between the apex of the root of the primary tooth and the developing permanent tooth
These are therefore managed to prevent sequelae such as:
Failure of eruption of permanent teeth
White of yellow-brown discoloration
Hypoplasia or hypomineralisation of secondary teeth
Delayed eruption
Overretention of primary teeth

4. Factors to consider
Child’s mental age and ability to cope with dental treatment
Parents’ willingness to comply with treatment
Time of shedding of the primary tooth
Clinician factors: training, experience and acquired skills in managing children and dental trauma
Anatomical factors
Financial implications

5. Overview of management
History: where, when, how?
Examination: both extra oral and intraoral are crucial in arriving at a diagnosis. Intraoral: soft and hard tissue examination
Investigations:
Radiographs: IOPA, Occlusal views, Extraoral views, CT scan

6. Types of injuries and management

7. Enamel and enamel dentin fractures
Involves enamel and enamel and dentin respectively
Management is by composite restoration

8. Crown fracture with exposed pulp
If root formation is incomplete a calcium hydroxide pulpotomy followed by Glass Ionomer base and Composite permanent filling
Pulpectomy where root formation is complete
When the child is unable to cope with the above extraction may be done.

9. Root fracture Usually extraction of the tooth
If an apical segment of the root is in situ it may be left and extracted at a later date to avoid injury to the permanent tooth

10. Alveolar fracture The fracture involves the alveolar bone
Reposition any displaced segment and splinting of teeth. GA
Segment stabilisation for 4 weeks

11. Concussion injury
A tooth is tender to palpation or percusion, not mobile or displaced
Observation and re-evaluation after 1 year

12. Subluxation Mobility of the tooth without displacement
Observation and re-evaluation after 1 year

13. Extrusion
Displacement of the tooth coronally hence it appears longer than adjacent teeth and is mobile
Extrusion less than 3mm for an immature tooth:
Repositioning and use of a splint
Repositioning and observe
Extrusion more than 3mm usually extract

14. Lateral luxation Mobility and displacement labially or palatally
If there is occlusal interference the tooth is repositioned under local anaesthesia using digital pressure
If there is severe displacement with crown displaced labially the tooth is indicated for extraction

15. Intrusion injuries
If the apex is displaced toward the labial bone the tooth is left for spontaneous repositioning
If the apex is displaced into the developing tooth germ it should be extracted

16. Avulsion Complete loss of the tooth from the socket
Replantation is not recommended
The parents and child are reassured and await eruption of the permanent tooth

17. Prevention of trauma Safe home and class room layouts
Use of staircase gates
Use of infant and toddler car seats
Prompt treatment by a dentist to minimise sequelae of traumatic injuries
We cannot totally prevent trauma because children must fall as they learn to walk

18. Challenges encountered in the country
Lack of skilled personnel to manage these injuries at lower level health facilities
Perception by health care workers that “are just baby teeth they will fall out”
Parental knowledge and attitudes
Lack of equipment and materials at peripheral health facilities to render treatment hence the common treatment prescribed is extraction.

19. Thank you