Pediatric Primary Care Case Studies (103 page)

Educational Objectives

1.    Understand the diagnosis and management of the following types of dental trauma:

•   Avulsion of primary incisors

•   Avulsion of permanent incisors

•   Crown fracture of a permanent incisor with no pulp exposure

•   Crown fracture of a permanent incisor with pulp exposure

2.    Describe the primary care provider’s role in management of dental trauma.

   Case Presentations and Discussion

Child #1

Maria Lopez is a 3-year-old Latino female who avulsed the maxillary right primary central incisor 3 hours ago. Her mother reports that Maria was running through the living room when she tripped on the carpet and fell face first into the coffee table. She was not reported to have lost consciousness. After wiping away some of the tears and blood, mom saw that Maria’s upper front tooth was missing. She found it on the floor and called her primary healthcare provider. However, due to logistical complications, she was not able to get to the office for approximately 3 hours. When she does arrive, Maria seems calm and cooperative.

Child #2

Prashant Kumar is a 10-year-old Indian American male who avulsed his maxillary left permanent incisor about 15 minutes ago. Prashant and his family are visiting his cousin’s house where there is a swimming pool. While running around the pool, he slipped and hit his mouth on the concrete. The avulsed tooth fell into the pool, but his sister found it
moments later. Since they were vacationing far away from their dentist, his father chose to go to a nearby urgent care center.

Child #3

Johnny Smith is a 12-year-old white male who, upon leaving school, fell off his bicycle. It was a rather minor crash but, after dusting himself off, he realized he had hit the handlebars with his mouth. He felt his maxillary incisors with his tongue and realized that two of them were broken. He quickly went to the school’s healthcare office. The school nurse noticed that, although two teeth were fractured, only one of them showed any blood from the broken area. Mom was called and immediately came to the school.

What questions would you like to ask all three children and parents to help in the development of a diagnosis and treatment plan?

As with all head injuries, you will want to know the following information:

•   Time of injury

•   Where and how the injury occurred

•   History of neurologic signs or symptoms before arriving at your clinic

   Loss of consciousness

   Headache

   Nausea or vomiting

   Disorientation, dizziness, or confusion

   Unexplained sleepiness

   Bleeding or fluid from ears, eyes, or nose

•   General medical history

•   History of other traumatic injuries

What physical examination data will you collect for all these cases in addition to the observed dental trauma?

Physical examination for head injuries should include the following assessments:

•   Vital signs.

•   Sign and symptoms of child abuse or possible abuse.

•   Neurological examination:

   Begin by noting any signs or symptoms of neurological trauma as reported by the caregiver.

   Loss of consciousness