Dental trauma in children

งานนำเสนอเรื่อง: "Dental trauma in children"— ใบสำเนางานนำเสนอ:

1 Dental trauma in children
อ.ทญ.ดร. ศิริพร ส่งสิริประดับบุญ ภาวิชาทันตกรรมสำหรับเด็ก คณะทันตแพทยศาสตร์จุฬาลงกรณ์มหาวิทยาลัย

2 Introduction Peak incidences are found at 2-3 years of age, motor coordination is developing. อุบัติเหตุที่เกิดในเด็ก 0-6 ปี พบมี oral injuries ได้ถึง 18 % ของอุติเหตุที่เกิดขึ้นบริเวณร่างกานภายนอก โดยช่วงอายุที่พบอุยัติการณ์การเกิดได้บ่อนที่สุด คือช่วง 2-3 ขวบ เป็นวัยกำลังเดินได้ ชอบวิ่ง แต่กล้ามเนื้อยังพัฒนาไม่สมบูรณ์ การทำงานร่วมกันของกล้ามนื้อกับระบบสั่งการยังไม่สมบูรณ์

3 Pathogenesis Surrounding bone is less dense and less mineralised.
A tooth can easily displaced instead of fractured. Frontal trauma is quite frequent —> lateral luxation ลักษณะเฉพาะของการเกิดอุบัติเหตุในเด็กเล็ก การสะสมแร่ธาตุ การสร้างกระดูกรอบๆฟันยังไม่หนาแน่นเหมือนเด็กโตหรือผู้ใหญ่ทำให้เมื่อเกิดอุบัติเหตุ ฟันจะมีการเคลื่อนตำแหน่ง มากกว่าการเกิดการหักของตัวฟันหรือรากฟัน แรงที่เกิดขึ้น

4 Etiology Falls Accidents Child abuse Self-inflicted ora-dental
ทำร้ายตัวเอง

5 Goals The ways which may damage permanent dentition
Prevent the occurrence of sequelae in the permanent dentition. The ways which may damage permanent dentition 1. Direct displacement toward the permanent tooth bud 2. Infection caused by bacteria invasion to the injury site 3. Extraction, Repositioning, or Pulp treatment

6 History taking Loss of consciousness ? Tetanus innoculation
How injury occurred ?… normal or abnormal Who reported?

7 Clinical examination Extra-oral Intra-oral
Tooth mobility and alignment

8 Extra-oral examination
facial asymmetry swelling of the lips skin laceration scars (previous injuries) bleeding from nostrils mouth opening

9 Intra-oral examination
Surrounding soft tissue • lips, oral mucosa, gingiva, and frenum Submucosal haemorrhage • upper lip / under tongue Bleeding from sulcus

10 Radiographic examination
AAPD guideline recommends size 2 film for 1. 90° horizontal view 2. Occlusal view 3. Extra-oral lateral view

11 Radiographic examination
Apex is displaced toward labial bone Apex is displaced toward permanent tooth germ Foreshortening Elongation

12 Radiographic examination
Extra-oral lateral radiograph the relationship between the apex of the displaced tooth and permanent tooth bud Rarely adds extra information

13 Radiographic examination
Radiographic examination for soft tissue lesion Indication: a penetrating lip lesion Marking with lead foil or clip

14 Treatment principle To minimise the risk to the permanent teeth
Implies a conservative approach Child: Behaviour management Parents: Empathy and support their minds

15 Treatment principle Traumatic injuries to primary teeth - Lack of scientific data Factors related to treatment selection 1. Shedding time 2. A child’ maturity and compliance 3. The close proximity of the root of primary tooth to permanent tooth bud

16 Crown fracture Enamel Enamel-dentin Enamel-dentin-pulp
Smooth sharp edges Seal with GIC Restoration Partial pulpotomy with calcium hydroxide Extraction

17 with or without pulp involvement
Crown-root fracture with or without pulp involvement Fragment removal and restoration +/- pulp treatment Extraction

18 Root fracture Repositioning and splinting Extraction

19 Repositioning and splinting for under G.A.
Alveolar fracture Repositioning and splinting for under G.A.

20 Luxation injuries Injuries Clinical findings Treatments Concussion
tender to touch No treatment Subluxation increased mobility bleeding from gingival crevice

21 Extrusion Treatment based on degree of displacement and root formation
Minor extrusion (< 3 mm.) in an immature tooth • Repositioning • Leaving for spontaneous reposition Severe extrusion in mature tooth • Extraction

22 Lateral luxation Palatal/lingual luxation Labial luxation Extraction
no occlusal interference Observe minor interference Grinding severe interference Repositioning Extraction

23 Intrusion Apex is displaced toward Apex is displaced toward
labial bone Apex is displaced toward permanent tooth germ Spontaneous reposition Extraction

24 Intrusion • Spontaneous eruption normally take place within 3 months • However some cases (25%) were not fully erupted after 1 year of trauma

25 Immediate extraction and antibiotic therapy
Intrusion • complications during the re-eruption phase • acute inflammation around the displaced tooth • gingiva : swelling • pus from gingival crevice Immediate extraction and antibiotic therapy

26 Avulsion • Alternative trauma scenarios should be explored
deeply intrusion ? • Avulsed primary tooth should not be replanted may displace a coagulum into the follicle of permanent incisor pulp necrosis may cause mineralization disturbance

27 Avulsion • Tooth must be found to ensure that it has not been aspirated. Leith et al., Aspiration of an avulsed primary incisor: a case report Dental Traumatology 2008; 24: e24–e26. Coughing or breathing problems are the most common symptoms

28 Chin trauma • Crown and crown-root fractures may occur in molar regions • Treatment depend on the severity of fracture • If extraction is the treatment of choice, space maintainer should be considered

29 Complications in the primary dentition
How to evaluate ? Color changes Radiographic findings Clinical findings : abscess

30 Color changes • After luxation injuries • Pink / Yellow / Gray

31 Color changes Gray discoloration
Transient —> Permanent yellow discoloration Permanent —> frequently associated with pulp necrosis

32 Color changes More than 50% of the primary incisors with dark
coronal discoloration remain clinically asymptomatic.

33 Pulp necrosis Related factors age degree of displacement
presence of crown fracture

34 + Pulp necrosis Diagnosis Conclusive clinical symptoms • fistula
• swelling and abscess formation + Crown discolouration Radiographic evidence • a periapical rarefaction • lack of root formation

35 Instructions to parents
Keep an affected area clean Soft toothbrush Swab with chlorhexidine • No pacifiers and nursing bottle • โอกาสเกิด trauma ซ้ำ

36 Trauma ครั้งนี้จะมีผลอะไรต่อฟันแท้ได้บ้าง ?
• Crown discolouration with or without enamel hypoplasia • Malformation or dilaceration of the crown • Cessation of root development • Odontoma-like formation • Disturbance in eruption

37 Conclusion