AAP: What to watch for in pediatric dental trauma

Martha Ann Keels, DDS, PhD, of Children’s Pediatric Dentistry at Duke University,provided a case-based overview of the management of pediatric dental trauma atthe 2008 American Academy of Pediatrics’ National Conference and Expositionin Boston.

The etiology of dental trauma falls into four categories, Dr. Keels explained:toddler falls, sports/play, automobile accidents, and child abuse. Primary toothtrauma can result in teeth that are pushed back (intrusion), bumped (subfluxation),moved (luxation), or lost (avulsion).

The majority of intruded primary teeth will re-erupt, Keels stated. Extractionsof this kind of primary tooth are rare. Primary teeth that undergo subfluxationmay be discolored temporarily in the first six weeks after an injury; after that,they may return to their normal color, or turn yellow or grayish-brown. All yellowtooth cases, and half of grayish-brown tooth cases, will require further treatment.Luxated primary teeth should be repositioned as soon as possible, and then assessedfor stability and correct occlusion. Lastly, Keels noted that very rarely willlost primary teeth be replaced, as there is not enough root to offer sufficientstability.

Although permanent teeth normally replace primary teeth between the ages of 5and 6, that timing cannot be relied upon. “We’re having some childrenchanging teeth at 4 years of age,” Keels said.

Keels also noted that while primary teeth tend to be knocked out of position,permanent teeth tend to have fractures. Permanent tooth trauma types include bothnon-complicated and complicated crown fractures, displaced teeth, intrusions,and avulsions.

Chipped teeth can be rebonded onto the damaged tooth, Dr. Keels explained. Ifthe fracture has exposed the nerve, immediate dental care should be sought toprotect the nerve and potentially avoid future root canal therapy. For luxatedpermanent incisors, the tooth should be repositioned with digital pressure assoon as possible. An avulsed permanent incisor will require an immediate replant.After a luxated or avulsed permanent incisor is in the correct position, it shouldthen be assessed for whether the tooth is stable (no splint needed) or unstable(needs dentist referral for splint).

Keels also pointed out to watch for child abuse. More than 50% of physical childabuse occurs to the oral-facial region, she noted.