What is a primary tooth concussion and how do you deal with it?
This post is an adaptation of the Concussion article found in the Dental Trauma Guide
Concussion is an injury to the tooth-supporting structures without increased mobility or displacement of the tooth, but with pain to percussion and without gingival bleeding.
Etiology
Diagnosis
Description: An injury to the tooth-supporting structures without increased mobility or displacement of the tooth, but with pain to percussion and without gingival bleeding.
The diagnostic signs of concussion are transient. It is therefore not possible to diagnose concussion if the examination is done several days after injury.
Visual signs: Not displaced.
Percussion test: Tender to touch or tapping.
Mobility test: No increased mobility.
Pulp sensibility test: Not reliable in primary teeth. Inconsistent results.
Radiographic findings: No radiographic abnormalities. Normal periodontal space.
Radiographs recommended: An occlusal exposure is recommended in order to screen for possible signs of displacement or the presence of a root fracture. The radiograph can furthermore be used as a reference point in case of future complications.
Treatment
There is no need for treatment, only observation.
Patient instructions
- Soft food for 1 week.
- Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week. This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet.
- Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula. Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment.
Follow-up
Clinical control at 1 week, 6-8 weeks.
References
- Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endod Dent Traumatol 1998; 114: 31-44.
- Flores MT. Traumatic injuries in the primary dentition. Review. Dent Traumatol 2002;18:287-298.
- Malmgren B, Andreasen JO, Flores MT, Robertson A, DiAngelis AJ, Andersson L, Cavalleri G, Cohenca N, Day P, Hicks ML, Malmgren O, Moule AJ, Onetto J, Tsukiboshi M. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol 2012; 28:174-82.
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I’m very surprised as to lack of any recommendations with respect to reducing the inflammatory response as a result of dental concussion, except for “soft diet”! as this form of trauma, similar to any other form of trauma, is accompanied with inflammatory responses in the periodontal tissue, in addition to intra-pulpal space, application of cold and any other form of systemic anti-inflammatory remedies may also be recommended. Indeed the most viable and available form of remedy for such traumatic injuries is to keep the tooth and adjacent tissue as cold as possible in order to minimize the inflammatory response, and the subsequent resorptive response from the body.
Nice article and well detailed about concussion and how do you deal with it, appreciate the effort