Pedodontics II Al Azhar University Palestine Gaza Upload By: Lama El Banna Faculty of oral and dental medicine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
1

2. College of Dentistry
Pedodontic II
Management of Traumatic Injuries in
Children - 2 -
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic
2

3. Descriptive classification:
• Injuries to the tooth.
• Trauma to the supporting bone:
Involves alveolar bone fractures.
3

4. Diagnosis:
I. History.
II. Clinical Examination.
III. Sensitivity or Vitality test.
IV. Radiographic Examination.
4

5. I. History:
1. Personal History:
It should include the patient's
name, age, sex, address, source of referral
if any, and reason for attendance.
5

6. 2. Medical History:
Routine data on the patient's general health
should be obtained particularly those relevant
to dental injuries.
 Cardiac disease which would necessitate
prophylaxis against subacute bacterial
endocarditis.
 Bleeding disorders.
 Allergies to medication.
6

7. Seizure disorders.
Current medications.
The child's current immunization status which
is particularly important if the child suffers
from a dirty wound.
7

8. • Children acquire active immunity through a
series of injections of heat-denatured tetanus
toxoid in their first 18 months of life. They
should then receive a booster dose at 4-6 years
of age. Boosters are recommended every 10
years or in cases of an accident in a dirty
environment.
8

9. 3. Dental History:
 Previous dental history:
Information can be obtained on the
frequency of dental visits, type of treatment
performed such as extraction or
conservative procedures. The type of
anesthesia used for the procedures and the
cooperation of the child can be determined.
9

10. History of the injury:
Histories should be short and to the point.
Only three questions need to be asked to obtain
maximum information: When, Where, and
How?
10

11. When did the accident occur?
In cases of oral trauma with damage to the
teeth, time elapsed since trauma is very
important. If there is avulsion of the tooth the
need to reposition, or treat a fractured crown
with pulp involvement, the shorter the time
between accident and treatment the better the
prognosis.
11

12. Where did the accident occur?
If the accident occurred in a particularly dirty
environment, prophylactic tetanus treatment is
indicated.
How did the injury happen?
A direct blow under the chin may cause a
fracture in the condyle and fracture of crowns
of molars and premolars.
For young children, when there is a marked
discrepancy in clinical findings and the history
given, the child abuse should be suspected.
12

13. II. Clinical Examination:
1. Extra-oral Examination:
The extra-oral examination begins
immediately when the patient enters the
office.
 Lacerations, abrasions, and contusions on
the face, head, neck and exposed limbs can
be noted visually.
 Any asymmetries including any deviation
in mandibular path during mouth opening.
Extra-oral wounds should be inspected for
foreign bodies.13

14. 2. Intraoral Examination:
It includes: (A) the soft tissues, (B) the
hard tissues.
A. Soft-tissue Examination:
Note any laceration of the tongue, gingiva,
labial and buccal mucosa or penetrating
wounds. The presence of embedded tooth
fragments should always be suspected in this
case. A hematoma in the floor of the mouth
indicates mandibular fracture.
14

15. B. Hard-tissue Examination:
1) Displacement:
Teeth may suffer labial, lingual,
palatal, or lateral displacement as well as
intrusion, extrusion or avulsion. Visually
determine and note any displacement.
2) Mobility:
If two or more teeth are seen to
move, an alveolar fracture should be
suspected.
15

16. 3) Tooth fracture:
A modification of Ellis and Davey
classification of crown fracture is useful in
recording the extent of damage involving
young permanent incisors.
 Class I: Traumatized teeth with fracture
involving enamel only or enamel and little
dentine.
 Class II: Traumatized teeth with fracture of
enamel and considerable amount of dentine.
16

17. Class III: Traumatized teeth with fracture of
enamel and dentine with pulp exposure.
Class IV: Traumatized teeth where amputation
of the crown en-mass occurs.
Class V: Traumatized teeth where there is root
fracture accompanied with or without crown
fracture.
17

18. 18

19. 4) Color change:
Non-vital teeth often appear discolored.
This is due to an interruption in the blood
supply of the tooth. The blood already
present in the pulp chamber undergoes a
normal breakdown process, but the products
are unable to dissipate. This results in tooth
discoloration varying from gray-brown to
black.
19

20. III. Sensitivity or Vitality test:
In order to obtain a full evaluation of
injury, vitality testing of the teeth must be
performed. Vitality testing just following
traumatic injury is of little value because
false responses often occur. Further testing
should be performed at subsequent visits.
20

21. • There are many types of vitality tests:
Thermal pulp testing.
Electrical pulp testing.
Laser Doppler flow-meter.
Test cavity.
21

22. IV. Radiographic Examination:
All traumatized teeth should be
radiographed to investigate the following:
1. The stage of root formation.
2. The presence of any root fracture.
3. The presence of periapical radiolucencies.
22

23. 4. Injuries to the supporting periodontal
membrane, such as the degree of intrusion or
extrusion of the tooth.
5. The size of the pulp chamber.
6. Presence of tooth fragments or foreign bodies
in the soft tissue.
23

24. • If teeth are missing and no accurate history of
their whereabouts, it is advisable to refer the
patient to a hospital for chest radiographs.
• If a jaw fracture is suspected, extra-oral
radiographs are indicated (panoramic and
lateral oblique views).
24

25. Thank You
25