Management of Paediatric dental trauma for General Dental Practitioners In Primary Care 

Written By: Navneet Bhamra

Primary dental care practitioners play  a pivotal role in timely diagnosis and management of traumatic dental injuries, however a retrospective study showed that only half the number of patients who presented in primary care, also received emergency treatment in primary care. This may be due to complexity of injuries, but also due to the clinicians own confidence to carry out the required treatment.  Managing dental trauma can be daunting, especially if it is not something that you have previously done.  

This two part article aims to improve your confidence and knowledge regarding traumatic dental injuries. 

History Taking 

With paediatric patients it is important to go through a very thorough history, below are some pointers on things to consider. Take your time with going through your initial discussion with your patient and their guardian.

Check the following:

  1. Who the patient attended with (and if they have parental responsibility)
  2. Any Safeguarding concerns?
    1. Follow your practices safeguarding policy 
    2. If you are concerned about non-accidental injury; contact social services (local MASH team for your borough) and ask to speak to the duty officer 
  3. Medical History
    1. As well as the usual, ask if the patient received a childhood tetanus vaccine 
  4. Trauma History
    1. When, where (outside/inside) and how the injury occurred
    2. Did the patient lose consciousness (assess whether the patient needs a medical review first)

Examination

Start with an extra-oral examination, things to look out for include:

  1. Swellings and lacerations (check for fragments of teeth or debris in lacerations)
  2. Facial bone fractures (by palpating the facial bones)
  3. Changes in eye movements

Begin your intra-oral examination by assessing mouth opening and checking for an unusual bite (you should also ask the patient if they have noticed a change in the bite and if they are having trouble eating because of this).

Special Investigations

As well as your usual intra-oral examination, also carry out sensitivity/sensibility tests on top and bottom teeth. Results may be varied slightly due to the recent trauma, however it is important to have a baseline recording.

Radiographs – Periapical radiographs, upper/lower standard occlusal

Management of Trauma of Primary Teeth

Things to consider include

  1. If the child is able to eat or drink as normal
    1. If the tooth is affecting the patient’s bite, it would be better to extract the tooth
  2. If the patient is in pain
    1. Advice patient to take regular sugar free pain relief
  3. Mobility of tooth
    1. If the tooth is very mobile, it may pose as an inhalation risk, again extraction in this case would be better
  4. Infection
    1. Grey discolouration of the tooth is a common occurrence following traumatic dental injury, and may not require treatment unless it is accompanied by pain, swellings or PA radiolucency on a radiograph.
Type of Injury (Primary Teeth)Management
AvulsionDo not re-implant
LuxationOnly extract if it is causing a traumatic occlusion
Uncomplicated Crown FracturePlace Composite or GIC bandage based on cooperation
Complicated Crown FractureExtraction
IntrusionAllow spontaneous eruption

Treatment on a paediatric patient is all based on compliance, if you are unsure whether you can gain compliance, or if the patient would benefit from secondary or tertiary care providers, please refer the patient to a paediatric dental specialist

In any case, reassure the patient and their guardian and give the following advice:

  1. Oral Hygiene Instructions, using a soft toothbrush, chlorhexidine gel or mouthwash, or salt water rinses. If patient is unable to use mouthwash, advise placing some salt water on gauze to keep the teeth and gums healthy to promote healing.
  2. Trauma such as an intrusion injury, buccal luxation or infection may cause damage to the erupting adult tooth, if left untreated (such as enamel discolouration)

Part two of the article goes through trauma of permanent teeth.

Refer to the trauma guidelines for in depth management and recall periods

https://dentaltraumaguide.org/free-dental-guides/
× What'sApp