Key Trauma Principles

Considerations upon Presentation: 

• Is there a more severe injury/consideration? 
  • Any signs of head injury? - refer to A&E 
  • Where's the tooth? - refer to A&E for chest X-ray 
  • Is the area dirty/muddy - do they need a tetanus booster? 
• History – how did the trauma occur and in what environment? 
  • Safeguarding – does the trauma match the story?  
• Check the soft tissues 
  • Are there any tooth fragments/lacerations? 
  • Clean them up with water/saline on some guaze to have a good look.  
• Take a medical and dental history (1)
  • Any relevant medical history before starting treatment? 
  • What is their dental age- is this tooth going to exfoliate soon or do we need to try and keep it for longer? 
    • Is it in the primary or permanent dentition?
    • If permanent, has it got an open/closed apex? - this will affect treatment options.
• Check 
  • TMJ- to ensure there are no jaw fractures (1)
  • Symmetry In the mouth 
  • Any numbness 
  • Type of tooth involved – is it primary or permanent dentition? This will affect treatment- eg. Open/closed apex? RCT or XLA? 
  • Is there any sudden mobility/tenderness - ask the patient and parent whether this is a new onset or not (tooth could be exoliating and hence already mobile). 
  • Evaluate what type of trauma has occurred- this will determine the treatment.  
  • Use X-rays to aid with diagnosis and see the guidelines for radiographic recalls.   

Remember: The main aims of treating traumatised teeth are to relieve pain and maintain vitality so that the tooth remains in the mouth in a sound condition for as long as possible. If primary dentition, we want to minimise the damage caused to the permanent successor.  

• Critical ages for Paediatric Dental Trauma: 
  • Birth - 5 years old: primary dentition (2)
    • Toddles learn to walk, lots of tumbles 
  • 6 -12 years old: secondary dentition (2)
    • Sports, bikes etc.  
  • Increased risk with increasing overjet  

Advice to give to parents: 

• If it is a primary tooth involved- make sure to warn the parents of the risks of damage to the permanent tooth. 
• Calm and reassure the patient and parents, whilst also giving realistic prospects of the potential courses of treatment for the tooth (eg, try all methods of saving the tooth but if these fail could lead to XLA).  
• Inform the patients of common signs to look out for which may indicate sequelae of trauma: eg. Colour change, spot on the gums, swelling etc.  

Trauma sequelae  

• Avulsion – DO NOT REIMPLANT: risk to permanent tooth germ by forcing blood clot or apex into it.  
• Discolourations  
  • Pink spot immediately after - transient, behaves like a bruise- should dissipate but keep an eye on it 
  • Pink spot remaining – could indicate root resoprtion, requires investigation.  
  • Yellow – pulp canal obliteration- monitor for necrosis and treat accordingly.  
  • Grey/black - pulp necrosis – will require treatment 
    • Can present as abscess/sinus/swelling/pain 
• Damage to permanent successor 
  • Localised enamel defect 
  • Dilaceration  
• Ankylosis 
• Cyst formation  

Follow the IADT guidelines and Dental Trauma Guide for up to date information on how to manage each type of trauma.