Article
Read before you refer
An 8-year-old child was referred to hospital following a collision with another child 2 days prior to her presentation. Gingival bleeding and an increase in mobility were noted at the time of incident, but there were no other injuries. Radiographs taken by the patient's GDP on initial presentation following the injury appeared to demonstrate a crown–root fracture of the UR2. It was on the basis of this preliminary diagnosis that the patient was referred to our care.
On examination, the UR2 was grade 1 mobile, of normal colour, displaced, and responded positively to sensibility testing. There was no visible, or probable, fracture line consistent with that demonstrated on the radiograph. The lack of consistency between clinical presentation and assessment from the existing radiograph raised suspicion regarding the preliminary diagnosis. A decision was made to perform further radiographic assessment.
Further radiographic assessment confirmed that there were no obvious fractures consistent with that which had appeared on previous radiography by the referring GDP. Together with findings from clinical assessment, the diagnosis was re-evaluated to be a subluxation injury of the UR2. The radiolucency on the initial radiograph was concluded to be an artefact. The patient will be reviewed as per International Association of Dental Traumatology (IADT) guidelines,1 with close follow up and her parents have also been advised of potential future complications.
In line with this, the IADT guidelines recommend one parallel peri-apical radiograph and two additional radiographs of the tooth taken with different vertical and/or horizontal angulations (including occlusal) for suspected crown–root fractures to assist with detection of fracture lines in the root. Had these guidelines been read before referral, and the recommendations been followed, an accurate diagnosis may have been reached in primary care, saving the patient from further radiographic exposure and inconveniences in being brought to our care. This example is an excellent reminder of the importance of exercising caution when interpreting special investigations, and the benefit of appropriate use of guidelines.
