Dentition and Common Oral Lesions

Published on 06/06/2015 by admin

Filed under Pediatrics

Last modified 06/06/2015

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34 Dentition and Common Oral Lesions


The development of the teeth begins in utero and continues well into adolescence. The 20 primary teeth (also known as deciduous or milk teeth) typically erupt between the ages of 6 months and 2 years. The exfoliation of the primary dentition and the eruption of the 32 permanent teeth usually begin at around age 6 years. On each side of the mouth, the mature permanent dentition consists of maxillary and mandibular central incisors, lateral incisors, canines, two premolars, and three molars (Figure 34-1).

Dental Trauma

The most common traumatic injuries in pediatric dentistry are luxation injuries to the maxillary central incisors followed by the maxillary lateral incisors and mandibular incisors. Luxation injuries range from simple concussion, in which the tooth and ligament may be injured without being displaced or knocked loose, to avulsion, in which the tooth in its entirety is displaced from the socket. They also include intrusion, extrusion, subluxation, and lateral luxation injuries in which the tooth may be displaced in any direction with varying degrees of injury to the periodontal ligament.

The most common mechanism of injury for dental trauma is falls, especially in toddlers who are learning to walk. Fractures are also common sequelae of dental trauma, and they may be uncomplicated (involving only enamel or enamel and dentin) or complicated (involving pulp) and involve the crown or the root. Dental fractures are more common in boys and in children whose maxillary teeth more substantially override the mandibular teeth.

A thorough physical examination of the mouth in dental trauma should reveal evidence of soft tissue injury (to the lips, frenula, tongue, buccal and lingual mucosa, hard and soft palate); fracture of the teeth (with attention to whether enamel, dentin, or pulp is exposed); loose, displaced, or missing teeth; pain, tenderness, or sensitivity; or malocclusion. The clinician must always consider the possibility of child abuse and be alert for suspicious signs such as bruising or a torn upper labial frenulum. Radiographic imaging may be appropriate to reveal fractures to the teeth and supporting bone or to locate missing tooth fragments (which may have been swallowed, aspirated, or completely intruded into the alveolar socket).

The focus of management in dental trauma is to prevent aspiration, infection, and injury to the permanent dentition. In injuries of the primary teeth, children with fractured, loose, or severely displaced teeth should be referred for immediate dental management; for most, however, routine follow-up is appropriate. For children with injuries to permanent teeth, maintaining the viability of the periodontal ligament is of paramount importance; thus, most children with luxation injuries of the permanent teeth require immediate referral to a pediatric dentist. In the case of an avulsed permanent tooth, the viability of the tooth is inversely proportional to the time to reimplantation. Parents should be advised to handle the tooth by the crown, gently rinse it with tap water or saline, place it back into the socket, and ask the child to maintain pressure with a finger or by biting on gauze or a clean cloth to keep the tooth in place. Transporting the tooth in milk or Hank’s balanced salt solution will also keep the tooth viable.