| Type of Trauma | Clinical Findings | Imaging/Radiographic | Treatment | Follow Up |
|---|---|---|---|---|
| 1-Concussion (primary teeth) | -Tender to touch (palpation) -No displacement -No bleeding -Normal mobility |
No baseline radiograph recommended | --No treatment is needed -Observation -Parent/patient education |
Clinical examination after: .1 wk .6–8 wk |
| 2-Concussion (permanent teeth) |
normal mobility -no displacement -tender to percussion and touch (palpation) -palp test: usually positive |
-no radiographic abnormality -recommended radiographs: .1 parallel P.A Additional radiographs: if signs or symptoms are present |
--no treatment is needed -monitor pulp condition for at least one yr |
-Clinical and radiographs examination after: .4wk .1yr |
| 3-Subluxation (primary teeth) |
-tender to percussion and touch (palpation) -increased mobility -no displacement -bleeding from gingival crevice may be noted |
-recommended radiographs: .A parallel P.A or occ radiograph -normal to slightly widened PDL |
--no treatment is needed -observation -Parent/patient education |
-Clinical examination after: .1wk .6-8wk |
| 4-Subluxation (permanent teeth) |
-tender to percussion and touch (palpation) -increased mobility -no displacement -bleeding from gingival crevice may be noted -the tooth may not respond to pulp test due to transient pulp damage |
-Radiographic appearance is usually Normal -recommended radiographs: .1 parallel P.A .2 additional radiographs with different angles -occ radiograph |
normally no treatment is needed --2wks flexible splint for excessive mobile teeth or tenderness when biting -monitor pulp condition for at least one yr |
-Clinical and radiographs examination after: .2wks .12wks .6mo .1yr |
| 5-Extrusive Luxation (primary teeth) | -Partial displacement -Long appearance -excessive mobile -occ interference maybe present |
recommended radiographs: .A parallel P.A or occ radiograph -slight increase to substantially widened PDL space apically |
Treatments are based on degree of displacement, mobility, occ interference, root formation, ability of child to tolerate the emergency situations. --no occ interference = spontaneously reposition -excessive mobility or extrusion more than 3mm: ext |
|
| 6-Extrusive Luxation (permanent teeth) | -long appearance -increased mobility -likely to have no response to pulp test | -PDL widening both apically and laterally -recommended radiographs: .1 parallel P.A .2 additional radiographs with different angles -occ radiograph |
gently reposition -flexible splint for 2wk (if fracture of marginal bone:4wk splint) -monitor the pulp conditions -if the pulp becomes necrotic: pulp therapy |
Clinical and radiographs examination after: .2wk .4wk .8wk .12wk .6mo .1yr .then yearly for at least 5 yr |
| 7-Lateral Luxation (primary teeth) |
no mobility -displacement (usually palatal or labial movement) |
-recommended radiographs: .A parallel P.A or occ radiograph -apically PDL widening (most clearly seen on an occ radiograph, especially if tooth displaced labially ) |
-minimal or no occ interference: allow to spontaneous reposition (usually occurs within 6mo) -in sever displacement: 1-if has a risk of ingestion or aspiration= ext 2--gently reposition the teeth (flexible splint for 4 wk :if unstable in new position) |
Clinical examinations after:
.1wk .6-8wk .6mo .1yr -if repositioned and splinted review after: .1wk .4wk for splint removal .8wk .6mo .1yr |
| 8-Lateral Luxation (permanent teeth) |
no mobility -displacement (any lateral direction) -associated with a fracture or compression of alveolar socket wall or facial cortical bone -metallic percussion. -Pulp test: usually negative |
PDL widening (best seen on horizontal angle shifts radiographs or occ radiograph) -recommended radiographs: .1 parallel P.A .2 additional radiographs with different angles -occ radiograph |
gently reposition -flexible splint for 4wk (fx of marginal bone or alveolar socket wall: maybe additional splinting -endodontic evaluation, about 2wk after injury: 1.teeth with incomplete root formation: .spontaneous revascularization may occur .in necrotic pulp: pulp therapy 2-tooth with complete root formation: .the pulp will likely become necrotic .use of corticosteroid or calcium hydroxide as an intra canal agent to prevent the inflammation or external resorption and then RCT ( monitor pulp condition) |
|
| 9-Intrusive Luxation (primary teeth) |
Displaced through the labial or palatal (it can impinge on the permanent bud) bone -almost or completely disappear -can be palpated labially |
recommended radiographs: .A parallel P.A or occ radiograph -labially displacement of apex: the apical tip can be seen and the image of teeth will appear shorter than contralateral tooth -palatally displacement of apex: the apical tip can’t be seen and the image of teeth will appear longer than contralateral tooth |
--allowed to spontaneously reposition itself (usually occurs in 6 mo and in some case until 1 yr) -rapid referral (within a couple of days) |
clinical examination after: .1wk .6-8wk .6mo .1yr -follow up at 6 yr of age to monitor of eruption (for sever intrusion) |
| 10-Intrusive Luxation (permanent teeth) |
apically displacement into the alveolar bone -no mobile -metallic percussion -Pulp test: usually negative |
PDL space may not be visible for all or part of root (especially apically) -the CEJ is more apically to compare with adjacent teeth -recommended radiographs: .1 parallel P.A .2 additional radiographs with different angles -occ radiograph |
1.immature teeth: .spontaneous reposition (independent of the degree of intrusion) .if no re-erupt with in 4 wk: orthodontic reposition .monitor the pulp condition .spontaneous revascularization may occur .in necrotic pulp: pulp therapy 2-mature teeth: A. less than 3 mm intrusion: allow re-eruption without intervention (if no re-erupt within 8 wk: surgical reposition and flexible splint fo 4wk or orthodontic reposition before ankyloses develops) B.3-7 mm intrusion: surgically (preferably) or orthodontically reposition c. more than 7 mm intrusion: surgically reposition --the pulp will likely become necrotic (RCT should be started at 2 wk or as soon as the position of teeth allows .use of corticosteroid or calcium hydroxide as an intra canal agent to prevent the inflammation or external resorption and then RCT |
Clinical and radiographic evaluations are necessary after: .2wk .4wk .8wk .12wk .6mo .1yr .then yearly for at least 5y |
| 11-Avulsion (primary teeth) |
-the tooth is completely out of the socket -the location of the missing teeth should be explored -avulsed teeth can be embedded in soft tissue ,into nose ,ingested or aspirated -if the avulsed teeth is not found: refer for medical evaluation, especially in patient with respiratory symptoms. |
recommended radiographs: .A parallel P.A or occ radiograph -use of radiograph(s) to determine the avulsed or intruded teeth |
avulsed primary teeth should not be replanted -patient/parent education |
Clinical examination after: .6-8wk .Further follow up at 6y of age is indicated to monitor eruption of the permanent teeth |