28: The displaced primary incisor

28 The displaced primary incisor

Summary

James, who is 3 years old, tripped over while playing outside. He hit his front teeth on the ground. How do you manage the immediate problem and what do you advise his parents about potential damage to the permanent teeth?

History

Complaint

James has been brought to your surgery straight from home by his mother. She says his upper front tooth has been pushed back (Fig. 28.1).

image

Fig. 28.1 Palatal luxation of image.

History of complaint

James tripped and fell forward hitting his teeth on the ground. One tooth is ‘pushed backwards’.

Medical history

James is a healthy boy who has had no significant childhood illnesses and who is up-to-date with all his vaccinations.

Dental history

James has been a regular attender at his dentist since the age of 2 years. He has had his teeth polished and has no caries.

image What specific questions would you ask and why?

Was there any loss of consciousness? If there was, then this signifies intracranial trauma and the child should be referred to an accident and emergency department.
When did the accident occur? Delay in seeking help might arouse suspicions of a non-accidental injury.
Where did the accident occur? An accident outside raises the additional problem of potential wound contamination. Any child brought up in the UK should be immunized against tetanus. If a child has not been immunized seek the advice of a local GP or accident and emergency department.
What was the surface on which the accident occurred? Newly constructed playgrounds have to conform to British Standards and should be either of an energy-absorbing polymer or bark chippings. Older playgrounds and normal pathways will have non-yielding surfaces and are likely to produce greater damage and potentially greater risk of more underlying injuries.
How did the accident occur? This gives an indication of the force that produced the injury. The clinician needs to be highly suspicious of the high impact injury that looks simple. Always suspect a deeper underlying injury until proven otherwise.

Examination

Extraoral

James is distressed but there is no obvious extraoral swelling or facial asymmetry.

Intraoral

image The appearance of the upper anterior teeth is shown in Figure 28.1. What can you see?

Palatal displacement of image and associated gingival trauma.

image What specific signs will you look for in your examination?

The mobility of the teeth. Are they a danger to the airway?
The occlusion. Do the injured teeth prevent normal occlusion?
Mobility of a segment of teeth. This indicates a dentoalveolar fracture.

image What question should dentists keep at the back of their minds when examining children?

Are the injuries consistent with the history, and if you feel they are, is this normal behaviour?
Child physical abuse presents with orofacial signs of bruising, abrasions and lacerations, burns, bites and fractures in approximately 65% of cases.
Dentists should have a copy of their local area Child Protection Committee guidelines. This will tell them who they shou/>

Related posts:

  1. 27: Facial swelling and dental abscess
  2. 33: Tooth discoloration, hypomineralization and hypoplasia
  3. 22: Nursing and early childhood caries
  4. 12: Increased overbite
  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 28: The displaced primary incisor

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