Pediatric Dentistry · patient case question
What is the appropriate management today?
Patient case: A four-year-old who hit his front tooth
Patient: Male, 4 years old
Chief Complaint: Mother: “He fell at nursery and banged his front tooth, and now it has gone dark.”
Background: Fell onto a hard floor six weeks ago, striking tooth E (maxillary right primary central incisor). At the time the gum around the tooth bled a little. Healthy child, immunisations up to date.
Vital Signs: Afebrile · HR 96 bpm
Findings: At the time of injury: occlusion normal, no displacement, no increased mobility, tender to touch. Today: the tooth is grey, remains in normal position with normal mobility, is not tender to percussion, and there is no sinus tract or swelling. Radiograph shows no periapical or inter-radicular radiolucency and no root resorption.
Show answer and explanation
Correct answer: D. Monitoring visits
- A. Pulpotomy is indicated for a VITAL tooth with a carious or traumatic pulp exposure where the radicular pulp remains healthy. There is no exposure here and no evidence the pulp is irreversibly inflamed.
- B. Extraction of an asymptomatic primary incisor with no radiographic pathology is overtreatment, and it creates its own problems with speech development and parental distress.
- C. Pulpectomy is for irreversible pulpitis or necrosis in a restorable primary tooth. Neither is established at this point, and treating on the basis of colour alone would mean treating many teeth that never needed it.
- D. CORRECT. An ASYMPTOMATIC discoloured primary tooth after trauma requires OBSERVATION. Grey discoloration alone is not an indication for intervention: a substantial proportion of these teeth remain vital, and some lighten again over the following months. Review clinically and radiographically at intervals, watching specifically for the findings that DO warrant treatment — a sinus tract or abscess, pain, increasing mobility, a periapical or inter-radicular radiolucency, or pathological root resorption.
Note: Parents need explicit guidance at this appointment, because the appearance is alarming and the answer is to do nothing. Tell them what to watch for and what to return for: a gum boil, swelling, pain, or the tooth becoming loose. A discoloured but asymptomatic tooth is not a failure of care.
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