Jamie, a 10 year old boy, has been brought in to see Dr Jones by his mother after falling over at school and hitting his front teeth. Jamie is crying and appears to be in shock.

Dr Jones starts off by taking a history. Jamie’s mum explains that Jamie was at school playing a game of tag about 30 minutes ago when he fell and hit his front teeth. One of his front teeth completely came out and two others fractured. Jamie’s mum presents the tooth that came out in a container of milk but says that the school was unable to find the fractured off sections of the other two teeth.

Jamie has no relevant medical history and has never had any dental complaints/treatment before. 

Dr Jones uses patient management techniques to calm Jamie down and Jamie allows Dr Jones to examine in his mouth. The UR1 is avulsed and the UL1 and UL2 have enamel-dentine fractures. Dr Jones carefully looks at the avulsed tooth in the milk container without touching the root and it appears to be relatively clean and intact. He determines that the most appropriate course of action is to re-implant the avulsed UR1. He explains the processes involved, risks, benefits and prognosis of this to both Jamie and his mother and they consent to this treatment. Dr Jones delivers local anaesthetic to the UR1 region and irrigates the socket with saline. He then carries out the re-implantation procedure and attached a flexible splint. Dr Jones then takes periapical radiographs of the affected teeth. He determines that the most appropriate treatment for the UL1 and UL2 enamel-dentine fractures is to restore them with composite. He explains the processes involved, risks, benefits and prognosis of this to both Jamie and his mother and they consent to this treatment.

Dr Jones prescribes Jamie Amoxicillin antibiotics and instructs Jamie to only eat soft food for up to 2 weeks, brush his teeth with a soft toothbrush after each meal and use a chlorhexidine (0.1 %) mouth rinse twice a day for 1 week. Dr Jones books Jamie in for root canal treatment of the UR1 7 days later.

1. Why is dental trauma high in children?
2. What other groups of individuals have high incidences of dental trauma? And why?
3. How many sets of dentitions do humans have in their life time?
4. At the age of 10 years old, which dentition would you expect Jamie’s upper central incisors and upper left lateral incisors to be? (hint: look at eruption dates of permanent teeth)
5. What is the purpose of local anaesthetic?
6. What is saline? Why did Dr jones irrigate the socket of the UR1 before re-implanting the tooth?

To help answer the questions below, use this link: https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/avulsion/

7. What are the different types of dental trauma?
8. What should patients do immediately if their tooth becomes avulsed?
9. Why is it important to not touch the root of an avulsed tooth?
10. Define prognosis
11. What is the most important factor that contributes towards the overall prognosis of avulsed teeth?
12. What are patient management techniques? Can you name any patient management techniques?
13. Why does Dr Jones prescribe Jamie antibiotics?
14. Why does Dr Jones instruct Jamie to only eat soft food for up to 2 weeks and brush his teeth with a soft toothbrush after each meal?
15. What properties does chlorhexidine (0.1 %) mouth rinse have? What are the benefits, risks, indications and contradictions to using chlorhexidine mouth rinse?
16. What is root canal treatment (RCT) and what are the processes involved?
17. Challenge: Why does the avulsed UR1 need RCT?

We encourage students to research and post answers in the comments below and Dental Scholar Emma Kindon, will be answering your questions and reviewing your answers in a live discussion on the upcoming Virtual Medical Society Meeting on the 19th May.