Dental Trauma in Children: A Clinical Guide

Orofacial trauma is a common emergency in pediatric dentistry. The International Association of Dental Traumatology (IADT) guidelines form the basis of trauma management — and are heavily tested in the Prometric exam.

Epidemiology

• Dental injuries occur in 30–40% of children affecting primary teeth
• Peak age for primary dentition trauma: 1.5 – 2.5 years (learning to walk)
• Peak age for permanent dentition trauma: 8 – 10 years (sports, falls)
• Most common teeth involved: Maxillary central incisors

Classification of Dental Injuries (IADT/Andreasen)

Hard Tissue Injuries

| Type | Description | |------|-------------| | Enamel Infraction | Incomplete fracture (crack) without loss of tooth structure | | Enamel Fracture | Loss of enamel only | | Enamel-Dentin Fracture | Loss of enamel and dentin, pulp not exposed | | Crown Fracture with Pulp Exposure | Complicated — dentin + pulp exposed | | Crown-Root Fracture | Extends into root, with or without pulp exposure | | Root Fracture | Fracture of root only |

Periodontal Injuries

| Type | Description | |------|-------------| | Concussion | No displacement, tender to percussion | | Subluxation | Abnormal mobility but no displacement | | Lateral Luxation | Displacement in lateral direction (not axial) | | Extrusive Luxation | Partial displacement out of socket | | Intrusive Luxation | Displacement into alveolar bone | | Avulsion | Complete displacement out of socket |

Management of Key Injuries

Avulsion — Most Critical

Golden Hour Concept: The prognosis depends heavily on extra-oral time.

Primary teeth: DO NOT replant — risk of damaging permanent successor

Permanent teeth:

1. Handle tooth by crown, NOT root
2. If dirty: rinse with saline for 10 seconds
3. Ideal storage media (in order):
   • Back in socket (immediate replantation)
   • HBSS (Hanks Balanced Salt Solution)
   • Milk
   • Saliva (inside cheek)
   • Saline
   • Water = WORST (hypotonic, kills PDL cells)
4. Replant ASAP and splint for 2 weeks
5. Start root canal within 7–10 days

Intrusion

• Primary teeth: Allow spontaneous re-eruption (6 months monitoring) or extract if risk to permanent tooth
• Permanent teeth < 7mm: Allow re-eruption with monitoring
• Permanent teeth > 7mm or mature apex: Orthodontic or surgical repositioning

Splinting Duration (IADT Guidelines)

| Injury | Splint Duration | |--------|----------------| | Subluxation | 2 weeks (flexible splint) | | Lateral luxation | 4 weeks | | Extrusive luxation | 2 weeks | | Avulsion | 2 weeks | | Root fracture (cervical third) | 4 months |

Trauma in Primary Dentition — Special Considerations

• Intrusion in primary teeth: Radiographic assessment to determine direction of displacement relative to permanent bud
• If root displaced toward permanent bud: Extract immediately
• If labially displaced away from bud: Monitor for spontaneous re-eruption

Long-Term Complications to Monitor

• Pulp necrosis — most common complication after trauma
• Root resorption — internal or external
• Ankylosis — loss of PDL, tooth fused to bone
• Discoloration — pink (internal resorption) or yellow-gray (necrosis)
• Disturbance to permanent successors — white/yellow opacities, crown/root dilaceration

Key Exam Points

• Avulsion of primary tooth = DO NOT replant
• Best storage medium = HBSS, then milk
• Water = contraindicated for storage
• Splint for avulsion = 2 weeks
• Concussion = no displacement, no mobility, only tenderness

Conclusion

Trauma management is a high-yield topic in the Prometric exam. Memorize the IADT classification, avulsion management protocol, and splinting durations — these appear repeatedly in exam questions.