1. Dental Trauma Flashcards by J L

\_\_\_\_ >/= female
25% of the population 6 to 50 years of age anterior teeth
\_\_\_\_ year
\_\_\_\_ children - no seasonal variation 
\_\_\_\_ children - injuries during summer 
\_\_\_\_ highest frequency of emergencies

males
8 to 12
young
older
fridays

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• Equal among females now, bc of increase in sport participation
• 25% will have some sort of trauma on their ____
○ Most common age trauma = 8 to 12 y/o
§ The patient is growing and developing at this age - the roots are still open and they’re clsing, and even more importatntly -> the jaws are growing
§ If patients lose a tooth heree -> the ridge will resorb, and rest of jaw grows -> defect, difficult to place implants
□ For the ridge to grow and for bone to remain, the tooth must be present while the growth spurts happen
• Seasonal variation -> young children in the spring
○ Older children -> summer -> sports camps
○ Friday is the most common day
§ Why important: the weekend is starting
□ Private practice that you’re closing, and a pt walks up as you’re closing and in pain -> pulpitis
® Prescribe pain meds if you close the office and check at 8 to see them
® However, cannot do it with trauma injuries -> ____, legal issues and the consequences of waiting a few hours in traumatic injury is WORSE
◊ A TRUE EMERGENCY - must see the patient!
} Decides the fate of the teeth

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• ____ most common site
○ Centrals and laterals
• ____ are least common
○ Protected by max anterior, and when you fall you clench

max anteriors

man anteriors

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Classification
Dentofacial injuries

• Under the big group of dentofacial injuries
	○ \_\_\_\_ came up with the classification
	○ \_\_\_\_ changed the classification

WHO

andreason

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Dentofacial injuries

	• Group I
		○ \_\_\_\_ injuries
			§ Nothing to d with boens or teeth
	• Group IV
		○ \_\_\_\_ injuries
			§ Not the \_\_\_\_, bu the jaw and facial bones

soft tissue
skeletal
teeth

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• Group I injury
○ Patient falls, and breaks off an anterior -> ____ on lip
○ Responsibility when soft tissue injury:
§ Larg gash and bleeding -> numb, and ____ if need be
§ More important: when there is break in the tissue, need to take an ____ of the soft tissue
□ Foreign body (tooth, or gravel, etc.)
□ Make sure nothing is in the laceration!
® If you find soemthing -> remove the object

laceration
suture
x-ray

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Group IV injury
• Difference bt R and L eyes
○ R eye cannot open, red inside and outside
○ Scan -> facial bone is broken
§ Walks into office like this -> four teeth are in the patient’s hands (avulsed them)
□ What’s important: the patient!
□ Cannot place the teeth back in, you’re not liable?
□ Any facial injury -> ____
® Involvement of the brain, head, etc.

911 call

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Group 2 injury
TOOTH \_\_\_\_
- enamel infraction
- enamel fracture
- crown fractures (uncomplicated/no pulp exposure)
- crown fractures (complicated w/ pulp exposure)
- crown-root fractures
- root fractures

Group 3 injury
\_\_\_\_ INJURIES
- tooth concussion
- subluxation
- extrusive luxation
- lateral luxation
- intrusive luxation
- avulsion

fractures

luxation

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• This what we will attempt to treat
	• Group 2
		○ Fractures
			§ At various levels on tooth AND \_\_\_\_
			§ Tooth breaks at various levels along the length of the tooth
	• Group 3
		○ Luxation
			§ Movement of the tooth in the socket (or out of the socket)
			§ Tooth is \_\_\_\_, but it's not in \_\_\_\_

root
intact
place

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Abuse

• First thing in diagnosis -> \_\_\_\_
	○ Required when you get your license to go through child abuse education online, must renew the CE every time you get the license renewed (every 2 years)

• If you see an injury, and it doesn't fit with what the parent/child is saying
	○ Suspect child abuse -> you have to report it
• 260 records of child abuse in 70-75
	○ Out of those records -> 50% will have a \_\_\_\_ injury, and 20% will have \_\_\_\_
	○ The history could be 30% child abuse???

child abuse

facial
dental trauma

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Abuse

____ in seeking treatment ____ for injury differs from person to
person
____ for injury does not fit the clinical findings
____ to other people ____ b/w family members

• Suspect abuse?
• Kid fell a month ago -> now bringing the child
	○ Not how parent responds to normal injury
• If explanation differs
	○ Child and parent don't agree
	○ \_\_\_\_ between the patient and parent

delay
explanation
explanation
reaction
relationship
tension

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Abuse
Primary aim - the ____ of the patient

Secondary aim - provide ____ - counseling for the family so that the abuse stops

• Reason you have to call it in -> primary concern is the safety of the child
	○ Not worried about the teeth, etc

safety

treatment

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Treatment
____ concrete systems for treating traumatized teeth
Purpose is to provide a ____ for treatment

• Trauma is not studied by study designs -> cannot execute them!
	○ Must be go by data that is collected from trauma hospitals
• Provide a guideline, no concrete treatment plan
	○ You as a clinicain decide the final tx

guideline

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To prevent ____ clinical signs or symptoms
To ____ as close to original location as possible
To achieve evidence of continued ____

• Three aims of treatment:
	○ Get ht epatinet out of pain
	○ If the tooth has been dislocated/luxated -> want the tooth back in the oriignal position
	○ MOST \_\_\_\_: patient/jaw continues to \_\_\_\_
		§ Alveolar growth continues

adverse
reposition
alveolar growth

important
grow

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TREATMENT
Objective
Maintain esthetics & function Pulp - continued root & alveolar Tooth - continued alveolar
Follow up

• ???
• Very important set of words
	○ \_\_\_\_
		§ What happens w trauma injuries?
			□ Some of the repercussions of injuries -> pulp necrosis, etc.
				® Can happen as late as \_\_\_\_ years after the injury
				® Follow on a yearly basis
				® Some specific scheudles for specific injuries

follow-up

30-40

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• Specific things when you diagnose
○ CC
○ Dentla history
○ Med hisotry
○ Look inside the ____ before looking at tooth you think is ht eproblem
• Face is bloodied -> do not jump inot the mouth that’s causing the bleeding
○ Go trhough the process of dx
○ Aska bout the CC, history and then at the soft tissue, extraoral and intraoral
○ Must follow the sequence

mouth

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History of Present Illness (injury)

	• In a traumatic injury, some questions:
		○ Where
			§ Why important: \_\_\_\_, or tetanus
		○ How
		○ When
			§ If a tooth was knocked out of place \_\_\_\_ -> will be much harder to put back in plcae bc the area starts to heal
			§ Important in avulsion -> how \_\_\_\_ was it outside? Where was it outside?
		○ Unconscious?
			§ Yes -> call \_\_\_\_
		○ Bite disturbance
			§ \_\_\_\_ injury or tooth is out of place
		○ Hot and cold?
			§ Pulp is exposed
		○ Treated elsewhere?
			§ Placement of splint? Pulp cap?
		○ Hx of previous injuries

infection
yesterday
long
911
skeletal

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Clinical Examination

	• Minor luxation
		○ Tooth is slightly out of arch
		○ Check if tooth is in right position by checking for
			§ \_\_\_\_
				□ Using instruemnts
			§ \_\_\_\_
			§ \_\_\_\_
			§ \_\_\_\_ tests

mobility
percussion
palpation
vitality

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Clinical examination

Mobility/displacement
• Tooth is slightly out of the arch
○ Who is the best to answer whether normal or not -> the ____!
§ Age group -> ____ y/o

patient

8-12

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Clinical examination

Percussion/palpation

• \_\_\_\_ AND \_\_\_\_ percussion
	○ Test the entiere periradicular tissue
• Looking for soft tissue and skeletal injury
	○ May find \_\_\_\_
	○ Buccal and the palatal

vertical
lateral
tenderness

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Clinical examination

• Vitality tests
	○ Cold
	○ Hot
	○ EPT
• For trauma: \_\_\_\_
• Where do you get false positive and false negative?
	○ \_\_\_\_ teeth
		§ Plexus is immature and not formed
		§ Add injury to the tooth -> will you get accurate results?
			□ NO!
			□ Why do it -> bc this is the \_\_\_\_
				® On the day of injury -> this is what I got
				® Do testing from \_\_\_\_ on the top and bottom
					◊ Irrespective of how many teeth are involved in injury
						} EACH TOOTH IS TESTED FOR COLD AND EPT
					◊ If PM involved -> go \_\_\_\_ back
• Follow up patients
	○ Test the same teeth, and compare the results with those you got last time

cold and EPT
immature
baseline
canine to canine
further

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Clinical examination

Immature teeth/trauma

• Immature and traumatic teeth
	○ \_\_\_\_ and \_\_\_\_ reactions, but will still go through the tests

false positive

false negative

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Vitality test
- Trauma

• Discoloration of the tooth
	○ Injured, BV broke -> \_\_\_\_ (iron -> deposits in the tubules) -> gets browner w light and oxygen -> tooth gets darker and darker
	○ Can happen in the first week
		§ In concussion injuries -> some teeth will discolor \_\_\_\_ years down the line, adns ome immediately
		§ Some discolorations can \_\_\_\_ without treatment

• Intact tooth on the R with a small lesion
	○ Pt got hurt two hours ago
		§ Will a PA lesion form in two hours?
			□ Why is there a lesion there? -> \_\_\_\_ standing traumatic injury
			□ Lesion on recent trauma?
				® \_\_\_\_ -> not in original position -> x-ray -> \_\_\_\_, and they can come across as a lesion on an x-ray

RBCs
30
reverse
long
luxated
gaps

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Vitality test
- trauma

• Wuold you look at this lesion and immediately do an endo?
	○ Other than luxation -> possible breakdown of the apical area
		§ This isn't two days after, a few months after the injury -> looks like a lesion -> no response to heat/cold/EPT -> tooth was injured 6 mo to 10 yrs ago -> no cold or EPT or heat response -> see a lesion -> expect to be \_\_\_\_
			□ Quite often -> 20 cases in 73 -> went into pulp chamber -> saw \_\_\_\_!
				® Termed it as \_\_\_\_ (anderson)
					◊ As a clinicain when do you decide to treat? These cases were still vital!! Are you wrong in accessing tooth and doing an endo??
						} If you find vital pulp when you go in -> it can happen!!

necrotic
bleeding
transient apical breakdown

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Vitality test - immature teeth False negative: 1. Myelinated nerve fibers-maximum ____ years after tooth eruption 2. Lack of development of the ____ plexus in the Pulp-dentin border-final stages of root formation

5 | raschkow

Clinical examination - no probing • Only thing you will not do -> ____! ○ In traumatic injuries ○ Why? § Can introduce ____ and bacteria upon making the lesion worse § Tendency to push bacteria from sulcus into the PDL -> make the PDL sterile so healing can happen!

probing | infection

Radiographic examination • FOA ○ Large or small • CB scans are helpful, but worry about radiation ○ Take 4 x-rays to figure out whether there is an injury or not ○ Radiation in a CBCT scan -> 6-8 x-rays § What is being said -> trauamtic injury if the child is young, rather take a ____ scan than avoid the x-ray □ Gives ____ information from a CBCT than an x-ray • Check if apex is open or closed ○ Treatment depends on this!

CBCT | more

Radiographic examination - previous Hx • X ray on child who fell yesterday ○ Resorption on the left • External/internal ____ happens after trauma ○ The presentation of this resoprtion can happen as early as 2 weeks, to as late as 2 years ○ See somethignlike this -> ____ injury (on a recently traumatized kid) • R side ○ Ankylosis of the tooth § Tooth has been resorbed, and replaced by bone § Did an endo -> GP remains in the bone § Sequale of dnetal trauma -> ____ traumatic injury □ Did dyou get hurt before? Dental trauma before? ® Yes 2 years ago fell down -> fits the. Bill!

resorption old old

Radiographic examination - displacement • L: PAP ○ It's the ____ of the tooth, which presents as a PA lesion § 50% (???)

displacement

Radiographic examination - fractures • Horizontal fracture on the R ○ In order to be able to see -> befor eth CBCT -> take multiple ____ (per WHO) that are angulated in order for it show up § Only shows when -> when the beam travels right through the ____ □ Vertical angulation must be going directly thorugh the crack

x-rays | crack

Radiographic examination - multiple x-rays • The horizontal fractures are usually ____ in nature, not 90 degrees ○ Doesn't snap 90 to the long axis, usually oblique in th ebody of the tooth

oblique

Radiographic examination - multiple x-rays • For the fracture to show -> only when the beam travels thorugh the cracked line at one point it will show up ○ Misleading: looks like apex is fracture, but it's running ____ § This is why ____ is a better idea than x-ray □ X ray doesn't give adaequeate amount

oblique | CBCT

Radiographic examination - CBCT • R: waved line -> tooth fracture • ____ -> see an obvious fracture (on the L) ○ Buccal and lingual extent of the crack • Don't see much on. The x-ray ○ When take the scan -> alveolar bone on the lingual (BR) has fractured (white arrow) § MORE info and MORE valuable than an x-ray

CBCT

Examination & Diagnosis ``` Follow-up schedule ____ weeks ____ weeks ____ months ____ months ____yrs ``` • General follow up schedule that you need to follow for the injury ○ Might see changes in the schuelde based on the injury that occurs

``` 4 6-8 6 12 1 year - yearly for 5 ```

``` Layers of tissue from pulp proper to the outside: • ____ inside the tooth • ____ • ____ • ____ • ____ • ____ (attaches ot the bone) ``` • Precementum and predentin are important ○ Cementum and dentin are calcified tissues ○ Precementum and predentin -> not as ____ § A thin layer on the ____ of the dentin, or ____ of cementum which covers the hard tissues § Acts as protective layer -> scratch it off or cause an injury (inside PD or outside PC) -> stimulates ____ -> resorbs and attaches to the hard tissues and starts to resorb § When an injury happens -> significant defect as a result of injury on PC or PD -> resorption, but still don't know how much injury must happen □ Theory: accidentally walk into door and cause some injury, but doesn't lead to resorption □ Doesn't know what surface area must be occurring!

``` pulp predentin dentin cementum precementum PDL ``` calcified inside outside osteoclasts

Classification - crown fractures ``` • Enamel infraction ○ ____ lines that you see on every tooth ○ Are they caused by trauma? We don't know § Always there? possibly • Do a backlight ○ Enamel infractions • Do we treat? ○ ____! ```

craze | no

Enamel infraction Objective Maintain ____ & function Pulp - continued ____ & alveolar Treatment ____ Follow up - ____ weeks - ____ year • Test the teeth again (canine to canine) in 6-8 weeks - 1year ○ Not just the teeth with enamel infractions

``` esthetics root none 6-8 1 ```

Enamel fracture • Happens within the body of the enamel ○ ____ is NOT exposed ○ Can reattach on the tooth again, or do ____ (take a bur and round off the edges), or do a composite restoration and give the hspae of the tooth back • WILL NOT DO: ○ Compposite restoration and build the tooth back -> in t he rporcude of placing the compositei -> § YOU CAN ____ § MAKE SURE THE TOOTH IS NOT IN ____ § After placing and shaping -> POLISH, and grind away so it shines □ What has jus thappened ot the pulp -> under trauma -> when you polish, you create HEAT -> will cook the pulp further □ DON'T ____ THE TEETH ® Do it ____ weeks later and then polish it

``` dentin enameloplasty etch traumatic occlusion polish ```

Enamel fracture • Charts with injuries ○ X = number o fyears after injury ○ Y = pulp necrosis that has happened § Portion of enamel fallen off -> risk of necrosis is very ____ § Happened in the first year, after -> no ____ of these injuries

low | repercussions

Enamel fracture Enamel Fracture Objective Maintain ____ & function Pulp - continued root & alveolar Treatment ____ ____ Follow up - ____ • Bring esthetcis back by enamelplasty or bonded restoration ○ Polish it later (____ weeks later)

esthetics enameloplasty bond 6-8 weeks - year 6-8

``` • Crown fractures ○ Two types: § Uncomplicated □ No ____ § Complicated □ ____ exposure ```

complications | pulp

Uncomplicated fracture • What is exposed instead in uncomplicated? ○ ____ - tubular in nature, direct highway to the pulp § Leave exposed for long periods -> ____ rinjure the pulp by toxins, bacteria traveling into the pulp § Have tubules exposed -> restorative procedure that will ____ the tubules

dentin further block

Uncomplicated fracture • Can do a composite, or if the piece is still available can attach the piece back ○ Closing the dnetinal tubules ○ Close w ____ composite, and can do it at a later time if you want ○ WANT TO ____ THE TUBULES the ____ of the visit

flowable seal day

Uncomplicated fracture • Dentin is exposed • ____ is not formed yet • How to know if tx is working? ○ When patient comes backa dn the ____ contineus to form -> pulp is still vital § Cold and EPT should be ____ □ But if false neg -> as longa s apex ____ -> can be certain the pulp inside is vital and viable

apex apex vital closes

Uncomplicated fracture • Almost exactly the same as enamel infraction ○ Pulp doesn't not get ____ ○ Less than 5% of the time and within the first year ○ Not a big deal as long as you close th ____ and don't cause further injury to the pulp

necrotic | tubules

Uncomplicated fracture Enamel Fracture Objective Maintain ____ & function Pulp - continued root & alveolar Treatment ____ ____ Follow up - ____

esthetics bond restore 6-8 weeks - 1 year

Complicated fracture • ____ is exposed • Sometimes is horizontal, someitmes its oblique ○ Important to figure out wehre the ____ and ____ extens are

pulp buccal lingual

Complicated fracture • Key: ____ IS EXPOSED ○ Dnetinal tubules covering th epulp, but very ____ ○ ____ is happening

pulp thin bleeding

Complicated fracture Cvek • Remmeber Cvek ○ Dentist who looked into traumatic injruies with complicated fractures ○ Took rats -> through steel balls on their teeth -> exposed the pulps -> left exposed for as long as ____ hours -> found that when he sacrified the rats and made histology slides -> inlfam in exposed trauam was only ____ mm off the exposed pulp § Eveyrhting below that was histoloigcally normal; restricted ot the superficial region of the pulp □ Why? ® Difference bt caries on molar vs fractured pulp on the anterior: ◊ ____ can't seat ◊ Fracture in the front -> lip, tongue is rubbinga gainst, etc. -> constantly ____ it } Molar w deep groove -> bacteria is seated } "____" injury -> most of the time inflammation is limited ot the coornal protion of the pulp

1200 2-4 bacteria cleaning

Complicated fracture Treatment modalities ____ Cvek or partial pulpotomy ____ Pulpectomy with RCT Or ____ Pulp revasularization • DPC ○ Pulp is exposed ○ Wash the pulp w saline, and plcae restoration on top of that expowed pulp ○ What are you capping § ____ § 2-4mm of inalmmation is capped with material -> chances of that workign ____ -> capping an inflamed pulp

direct pulp capping full pulpotomy apexification inflammation

Cvek pulpotomy • Cvek partial pulpotomy • When have pulp exposure (2-4mm) -> opne expoesed pulp ____ -> round bur (HS) -> take the pulp down (excise) 2-4mm down ○ In vital pulp therapy, vs cvek in truama § 1: in VPT -> partial pulp on a carious lesion, the pulp has been chroncially exposed to trauma § Here, this is acute traum -> for sure we know it's ____mm of the pulp □ In carious, we don't know where the lesion stops □ WE ARE GUESSING THAT WE ARE IN GOOD PULP ® In cvek -> MORE ____ -> histologically he proved that the inflammation is within the top 2-4mm of the pulp ○ Calcium hydroxide, or bio ceramic material to cap the pulp directly -> build I tup and etch bound with composite § YOU WILL NOT ____!!

further 2-4 reliable polish

Cvek pulpotomy • Take the pulp down -> ____ on it -> what happens to the pulp if you leave it alone -> forms pulpdentin junction again -> forms a ____ layer under the material Pulp chamber is reformed -> ____, but it's healthy! That is reformed

bioceramic dentin smaller

Cvek Pulpotomy - preservation of the pulp • ____ of the pulp is KEY for cvek ○ Becomes important in injuries with apices that are open ○ Apices need to ____ by you doing cvek pulpotmy ○ If apex comes closed, and then pulp is exposed -> if resotre tooth with a c omposite -> don't need a crown, cvek is still a better option § What's best to fill tooth -> ____ pulp § If you can rpeserve, it's the best thing to do! • If placing a crown, need a post -> ____ is th eright treamtnet

preservation close vital endo

Cvek pulpotomy • How often will the pulp necrose under cvek ○ 3% of the time ○ ____% of the time the pulp will REMAIN VITAL • First line tx: ____ PULP for a complicated crown fracture

97 | cvek

Complicated fracture • Comes 1000 hours later, pulp is necoritc and forming a lesion and open apex ○ Apexification and revascularization ○ Pulp became necrotic while apex wasn't ____ § One tx option: apexification □ Put a ____ of bioceramic material (bc it's hard to obturaete that's open at apex) -> fill the rest w ____ or composite

closed plug GP

Pulp revascularization * Another option: revascularization * Tooht necortic with open apex -> invovles creating a ____ in the apical 2/3 of the tooth and putting a plup here (____ up) and lallowing the blood clot to become ____ tissue * Roots continue to ____ and there is tissue within the tooth * ____ tooth this way rather than apexificiation bc the walls have thickened

``` blood clot farther live grow strong ```

Objective Maintain ____ & function Pulp - continued root & alveolar Treatment Immature (vital) (____) (Nonvital) ____ Mature (vital) (____) (Nonvital) ____ Follow up - ____

esthetics apexogenesis revascularization, apexification cvek, RCT RCT 6-8 weeks - 1 year

• Immature tooth ○ Vital = ____ § Formation of the apex that the body does § Allows for apexogeneis by doing a cvek/full pulpotomy or a DPC □ Best choice: ____ ○ Nonvital (far after truama occurs) § ____ § ____ ``` • Mature tooth ○ Complicatied § Vital = ____ § IF need a restoration -> ____ § Nonvital => ____ • Get patient back in 6-8 weeks to do the diagnostic tests ```

apexogenesis cvek revascularization apexification cvek root canal treatment root canal treatment

Treatment Choice ____ of Development of the root / age ____ between accident and when u see the patient ____ treatment ____ Injury

stage time restorative periodontal

Crown-root fracture Chisel type: extrusion * ____ -> starts in crown, ends up in the root * ____ apex, and child -> preserve what is remaining in the mouth * Ortho ____ is an option, or a ____ and build with the composite * Keep the ____ in the mouth

oblique open extrusion tooth

Crown-root fracture Objective Maintain esthetics & function Pulp - continued root & alveolar Treatment Immature - save pulp for ____ growth. Mature - ____ - ____, maintain until alveolar growth - OR - ____ Follow up for ____ restoration • Crown root fracture ○ Immature -> save pulp bc you wanna save the bone ○ Mature -> RCT, extrude, extract/implant

alveolar RCT extrusion implant perm

1. Dental Trauma Flashcards

(61 cards)