W2 Case 3_integrated

Case 3: Dental Trauma

Patient Profile¹

Age: 3 years old
Gender: Male
Chief Complaint: Oral bleeding

Clinical Overview

Initial discussion and history taking
Clinical and radiographic investigations
Diagnosis based on clinical presentation and imaging
Comprehensive management plan

Trauma History and Clinical Assessment

Injury History²

Mechanism of Injury: Fell forwards onto the edge of play equipment while playing at a park
Timing: 2 hours ago (acute presentation)
Location: At the park
Witnesses: Grandma and older brother
==Post-Injury Actions: The child was picked up, reassured, and brought directly for treatment.==
==Insurance/Legal Considerations: It is important to record the specific location of the accident (e.g., school, park, or under supervision) for potential insurance claims or legal purposes.==

Medical and Trauma Screening

Loss of Consciousness: No
Previous Dental Trauma: No
Medical History: Fit and healthy; fully immunized
Non-dental Injuries: None reported
==Concussion Screening: There was no loss of consciousness, vomiting, altered dizziness, or other signs of concussion.==
==Pain History: The patient reports that the area hurts.==

Clinical Examination Findings³

==Extra-oral Examination:==
- Presence of dried blood on the mouth.
- The top lip appears slightly swollen.
==Intra-oral Examination:==
- ==Soft Tissues: Systematic check for degloving, lacerations, or horizontal tears.==
- Gingival Assessment:
  - Bleeding at the gingival crevice of 51 and 61
  - Soft tissue injuries: Mild gingival bruising only around the upper incisors. No significant lacerations or displacement of soft tissue.
Tooth Displacement:
- Tooth 61 is palatally luxated and appears slightly extruded
Mobility:
- Tooth 51: Grade I mobility
- Teeth 61 and 62: No mobility (for 61, the root apex is likely locked into bone)
Tenderness to Percussion/Palpation:
- Teeth 51 and 61 are tender to touch
==Sensibility Testing: Not performed as it is highly unreliable in primary dentition and for patients of this age.==

Radiographic Diagnosis

Radiographic Imaging⁴

Views Obtained: Maxillary occlusal and 3 Periapical (PA) radiographs
==Rationale: A full trauma series or anterior PAs are difficult to obtain due to the limited cooperation of a young child; a Maxillary Occlusal (Maxoc) is often the primary modality used.==

Radiographic Findings

Tooth 51:
- Normal Periodontal Ligament (PDL) space and continuous PDL; no signs of displacement.
Tooth 61:
- Root appears foreshortened due to the angulation of the tooth
- Tooth is displaced
- Widened PDL space at the apex.
==Tooth 62: PDL can be traced around the root; no significant findings.==

Clinical Diagnosis⁵

Tooth 61: Lateral luxation in a palatal direction (The tooth is displaced palatally and locked into the bone).
Tooth 51: Subluxation (Injury to the PDL resulting in mobility and crevicular bleeding without displacement).

[!example] Differential Diagnosis Note

A concussion injury would involve tenderness without mobility or bleeding; subluxation involves micro-tears and bleeding without displacement.

Trauma Management Plan

Treatment Plan by Tooth⁶

Tooth 61

If there is occlusal interference: Extraction (Exo)
If there is no occlusal interference: Conservative management (leave and monitor).
==Decision Criteria: Extraction is indicated if there is significant occlusal interference preventing the child from biting together. If an anterior open bite exists, the tooth may be left.==
==Contraindications: Do not reposition primary teeth due to the risk of iatrogenic damage to the underlying permanent tooth bud.==
==Monitoring: Long-term review is required to monitor for necrosis or resorption. If infection (e.g., a parulis/sinus tract) develops, the tooth must be extracted to protect the permanent successor.==

Tooth 51

Conservative management (Symptomatic management only).

General Post-Trauma Instructions

Soft diet to allow the area to heal.
Analgesia as required (e.g., Panadol).
Ongoing review and clinical monitoring
==Oral Hygiene:==
- Chlorhexidine gel applied with a finger if brushing is too painful on the first day.
- Gentle brushing with chlorhexidine gel starting from day two for one week.
==Home Monitoring: Parents should lift the lip nightly to check for signs of infection, such as a “gum boil” or draining sinus.==
==Habits: Use of a dummy (pacifier) is acceptable and may even help slowly guide a luxated tooth back toward its original position through light pressure.==

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Quartz 4

Explorer

W2 Case 3_integrated

Case 3: Dental Trauma

Patient Profile¹

Clinical Overview

Trauma History and Clinical Assessment

Injury History²

Medical and Trauma Screening

Clinical Examination Findings³

Radiographic Diagnosis

Radiographic Imaging⁴

Radiographic Findings

Clinical Diagnosis⁵

[!example] Differential Diagnosis Note

Trauma Management Plan

Treatment Plan by Tooth⁶

General Post-Trauma Instructions

Graph View

Table of Contents

Quartz 4

Explorer

W2 Case 3_integrated

Case 3: Dental Trauma

Patient Profile1

Clinical Overview

Trauma History and Clinical Assessment

Injury History2

Medical and Trauma Screening

Clinical Examination Findings3

Radiographic Diagnosis

Radiographic Imaging4

Radiographic Findings

Clinical Diagnosis5

[!example] Differential Diagnosis Note

Trauma Management Plan

Treatment Plan by Tooth6

General Post-Trauma Instructions

Footnotes

Graph View

Table of Contents

Patient Profile¹

Injury History²

Clinical Examination Findings³

Radiographic Imaging⁴

Clinical Diagnosis⁵

Treatment Plan by Tooth⁶