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Case Study on Trauma to Primary Teeth

Learn from an example of a young child presenting with dental trauma.
Trauma To Primary Teeth Case Example

It’s always easier to understand something with an actual example. So we’ve added that here. In this worked example, we’ve tried to bring together some of the teachings for trauma to primary teeth into a real-life case.

Look at the image and consider the attached bio of this patient.

The patient BA is a 3-year-old girl who has attended your practice following an accident at home.

History of the Presenting Complaint

BA suffered trauma three weeks ago whilst playing in the garden. She was taken to A&E at the time as her Mum was concerned about bleeding from her mouth. No treatment was provided at the hospital and the mother was advised to see her dentist. This is why she is at your practice today. BA has not visited the dentist before.

Medical History

Nil relevant

Social History

Came with mother No sibling, no reported dental problems

Diet History

Drinks water and milk. Likes fruit

Toothbrushing

Two x daily with child fluoride paste

Now we need to think about formulating a plan. We will walk through this step by step, outlining what factors we consider.

What other factors from the history might be important

Our priority is to establish the urgency of the situation. Given that it’s taken three weeks to get to the dentist following the accident, it’s probably safe to assume that it probably isn’t that urgent. But — this needs to be confirmed. In a child of this age, detailed questions around pain won’t work. So focus on the obvious indicators — is BA eating, drinking and sleeping as usual? If they are then it means you have some time to plan your next move.

Next up is a complete trauma history — how, where and when. This will help you with your diagnosis, assessment of prognosis and management. It also is important to explore any safeguarding aspects of this case. Arguably the presentation is quite delayed which can raise concerns. Even though the family attended A&E immediately, it’s been a bit of a delay getting to see you. So you want to be sure the history of the injury makes sense and matches the clinical appearance in front of you.

What is the Likely Diagnosis?

Before we can get to that, we need to examine the patient thoroughly. Standard sensibility tests we use for trauma (eg hot, cold or electric pulp test) won’t really work in someone this young. But you can gently palpate the gum around the intruded tooth to see if it’s sore at all or if there are any mobile bone or tooth fragments. Examination generally can be challenging, it’s important to have a proper look even if this means some tears. Try the Knee to Knee technique (discussed in the last week of this course). A radiograph is going to be important, if you can then an upper standard occlusal view should let you see the tooth and surrounding structures. Remember you can use a large periapical film rather than the larger standard occlusal film for young children, as they will tolerate this better. And as for the diagnosis? Well, it looks to be a pretty clear case of intrusion.

What is the Plan?

So it’s happened now. The tooth is where it is and any damage to the permanent successors has already occurred. Probably the first part of any plan for this child is reassurance for the family. But also an explanation that there may be some longer-term consequences for the permanent incisors. From that point on this is a waiting game. Most intruded primary incisors end up re-erupting. It’s tempting to think they should be extracted or extruded but that only carries the risk of damage to the permanent incisor. Usually, these teeth will move into a better position over the next two-three months. If they don’t, and you think they might be impeding the eruption of the permanent tooth, then extraction should be considered at this point.

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Paediatric Dentistry for Non-Specialists

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