Teaching Module &
Competency: Primary
Tooth Trauma
Prepared by :
Cynthia Christensen; DDS, MS
Karin Weber-Gasparoni; DDS, MS, PhD
University of Iowa
2008
Objectives
Understand the incidence of primary tooth
trauma
 Understand how to triage primary tooth
trauma
 Understand clinical presentation of the
most common types of primary tooth
trauma and treatment options
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Epidemiology of Tooth Trauma
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30% of children suffer trauma to primary dentition.
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Most injuries to primary teeth occur at 18-30 mo of age:
“…more traumatic dental injuries occur to
younger children, probably because the children
are gaining mobility and independence, yet lack
full coordination and judgment.”
Garcia-Godoy et al.
Clinical Examination
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Intra/ extra oral soft
tissues
Swelling
Fractured, luxated, or
missing teeth
Pulp exposures
Occlusion
Deviation on opening
TRIAGE: Occlusion Indicates Fractured
Alveolus or Mandible

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Immediate referral to Oral Surgeon or ER
Advise patient to be kept NPO
Radiographic Exam
For young children,
parent or dental staff
must hold
Establish Baseline
Detect root or alveolar
injuries or pathosis
What about Sutures?

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Extraoral: Plastic/ENT
surgeon best for
esthetic outcome
Introral:
 Small
laceration = No
sutures.
 Larger lacerations =
General Dentist or
Oral Surgeon
Possibility: Foreign Body in Lip or
Tongue
Checking for Tooth Fragment

Palpate
puncture/laceration

Soft tissue
radiograph
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¼ the exposure time
of nearest teeth
Common Injuries
Treatment Options
Concussion / Subluxation
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Concussion: injury
to the tooth and
ligament without
displacement or
mobility

Subluxation: tooth is
mobile, but is not
displaced
Concussion and
Subluxation Management
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Periapical radiograph
OTC pain meds prn
Soft diet for 1 week
Advise parent of
possible sequelae
Follow-up, 2-4 weeks
Concussion/Subluxation

Neurovascular bundle
at apex may be
crushed or severed

PDL may be torn

Prognosis for
Recovery = Good
Discoloration of Primary Tooth
Post Trauma

Color may change 2-4 weeks
after trauma

May retain/regain vitality and
return to near normal color
within 6 months
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Monitor. Esthetics may be a
concern if color does not
resolve
Color may be pink, purple,
grey or brown
Pulpal Obliteration/Calcific Metamorphosis
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History of Trauma
Tooth darker-usually
yellowish
Radiograph shows pulpal
space narrowing or
obliterated
NO TX-observe for
normal exfolitation
All Teeth Do Not Recover: Abscess
6 Months Post Concussion
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Note associated soft
tissue swelling
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Confirm Dx and check
root structure with
periapical radiograph
Radiographic Abscess #F
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Note: #E resorption post trauma. No Tx
#F extraction indicated
LATERAL LUXATION / EXTRUSION INJURIES: RECOMMENDATIONS
Primary Dentition
Tooth is aspiration
risk
Yes
Extract and advise
parents of potential
damage to
permanent tooth
No
Tooth causing occlusal
interference
No
Allow for spontaneous
re-positioning or
re-position and splint or
consider extraction
Yes
Extract or reposition
and splint
Follow up in 2 weeks: Advise parents of
possible injury / damage to permanent teeth
**All treatment is ideal and assumes
patient has manageable behavior.
Recommendations also assume
appropriate radiographic survey.
(Reference: AAPD Handbook of Dentistry)
Extrusion and Luxation
With Occlusal Interference
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Extraction is recommended
most of the time due to risk
of aspiration of mobile teeth
and damage to permanent
tooth bud

**Key = Degree of Severity
and cooperation
Extrusion and Luxation
With Occlusal Interference
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Primary Teeth Reposition
and Splinting RARE unless..

Excellent Patient Cooperation

Excellent Recall Compliance
Treatment Planning Crown Fracture Injuries
Pulp Exposed
Primary Dentition
Yes
Pulpectomy
and full coverage
crown (SSC or
strip crown)
No
Dentin Exposed
All treatment is ideal and
assumes patient has
manageable behavior.
Recommendations also assume
appropriate pre-operative radiographs
Reference: AAPD Handbook of
Pediatric Dentistry
Yes
Composite or GI
provisional
restoration
“band-aid” if
symptomatic
No
Rough Edge Present
Yes
Yes
No
No further treatment
required
Smooth edge
and if required
restore with
composite
Clinical and radiographic follow up.
Advise parents of
possible injury to permanent teeth and monitor for
signs of pathology
Enamel Fx
Dentin Fx
Ellis Class I
Ellis Class II
Pulp
Exposure
Ellis Class III
Enamel Fracture in Primary
Teeth: Ellis Class I
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Radiograph
Smooth Sharp Edges
GI or Composite
Optional
Periodic Follow Up
Enamel and Dentin Fx:
Ellis Class II
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Radiograph
Protect Dentin
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Glass Ionomer
Bonding Agents
Composite Ideal
Periodic Follow Up
Dentin Exposed
Pulp Exposure: Ellis Class III
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Radiograph
 Pulpectomy
 Extraction
Pulp Exposed
Vertical Crown Fracture
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RARE- more likely to
luxate or intrude
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Extraction