Trauma to Primary Teeth
Frequency and Aetiology
Trauma in young children is extremely common with up to 30% of children suffering injuries to their primary teeth. It is obviously upsetting for parents. The peak incidence is at 2–4 years of age when children are toddlers and still learning gross motor skills. Falls and play accidents are the most common cause of injuries. While child abuse contributes only a small percentage of injuries, those treating children should be aware of children presenting with injuries that are inconsistent with the history and be prepared to inform their appropriate child protection authorities about such incidents. It is important to remember that the responsibility of the clinician is to the child first and not the alleged perpetrator. Dog bites account for a significant number of injuries, and, commonly, the animal is known to the child.
There must be a thorough history and examination of the child to exclude any other injures or medical conditions that might affect your management. The treating dentist also needs to be cognisant of the concerns of the child and those of the parents about the immediate treatment needs and possible long-term sequelae for the permanent dentition. At this time it is essential to consider what behaviour management techniques might be required and it is appropriate that sedation or general anaesthesia might be needed for many young children requiring invasive treatment.
Luxations in the Primary Dentition
In most cases, there are only two options in management; either to extract the traumatised tooth or leave it alone and observe. Repositioning of displaced primary teeth runs the risk of further damage to the permanent successor. While it is possible to splint luxated primary teeth, there are always difficulties in placing the splint in a traumatised young child, and then having to remove it later! Warn parents about the risk of tooth discolouration and possible pulp necrosis. Always check the immunisation status, begin a soft diet and give advice to parents regarding possible sequelae.
Concussion and Subluxation
In these cases there is no displacement of the primary tooth but increased mobility and possible gingival damage (Fig. 28.1). The tooth will be tender to bite on and a soft diet and follow-up are all that is required. A periapical radiograph will confirm the presence of any root fracture.