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BDS3 PAEDIATRICS > 9 - Adult consequences of childhood trauma > Flashcards

9 - Adult consequences of childhood trauma Flashcards

1
Q

What are the predictors of outcomes of childhood dental trauma?

A
  • severity of injury
  • stage of root development
  • timing of treatment
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2
Q

When is the root formation complete for the upper 1?

A

10 years

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3
Q

When is the root formation complete for the upper 2?

A

11 years

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4
Q

When is the root formation complete for the upper 3?

A

13-15 years

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5
Q

When is the root formation complete for the upper 4?

A

12-13 years

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6
Q

When is the root formation complete for the upper 5?

A

12-14 years

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7
Q

When is the root formation complete for the lower 1?

A

9-10 years

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8
Q

When is the root formation complete for the lower 2?

A

10 years

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9
Q

When is the root formation complete for the lower 3?

A

12-14 years

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10
Q

When is the root formation complete for the lower 4?

A

12-13 years

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11
Q

When is the root formation complete for the lower 5?

A

13-14 years

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12
Q

Describe healing of a permanent tooth (open apex) that has been traumatised.

A
  • open apex experience regeneration
  • maintain pupal vitality
  • perseveration of blood supply
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13
Q

Describe healing of a permanent tooth (closed apex) that has been traumatised.

A
  • aim to maintain blood supply (not possible in avulsion)
  • prevent ingress of bacteria and toxins
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14
Q

What are the time frames when treatment planning trauma?

A
  • acute (3 hours)
  • subacute (3-24 hours)
  • delayed (>24 hours)
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15
Q

What is the timeframe for treating an avulsion injury?

A
  • immediate replantation
  • acute or subacute
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16
Q

What is the timeframe for treating an alveolar fracture injury?

A

Acute

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17
Q

What is the timeframe for treating an extrusion injury?

A

Acute or subacute

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18
Q

What is the timeframe for treating an lateral luxation injury?

A

Acute or subacute

19
Q

What is the timeframe for treating an root fracture?

A

Acute or subacute

20
Q

What is the timeframe for treating an concussion injury?

A

Subacute

21
Q

What is the timeframe for treating an subluxation injury?

A

Subacute

22
Q

What is the timeframe for treating an crown fracture?

A

Subacute or delayed

23
Q

What is the timeframe for treating an crown-root fracture?

A

Subacute or delayed

24
Q

What are the potential long term complications?

A
  • discolouration
  • loss of vitality
  • inflammatory root resorption (IRR, ERR, RRR)
  • unfavourable tooth position
  • defects in hard and soft tissue
25
Q

What causes yellow discolouration of teeth?

A
  • canal obliteration
  • tertiary dentine reduces light transmission
  • external bleaching can treat
26
Q

What causes pink discolouration of teeth?

A
  • rupture of blood vessels in severe trauma causes haemorrhage in pulp chamber
  • blood components flow into tubules
  • will reverse if tooth vital and pulp revascularises
  • if tooth non-vital, will progress to brown/grey
  • cervical root resorption can cause discolouration at cervical margin
27
Q

What causes brown/grey/black discolouration of teeth?

A
  • in non infected teeth, haemoglobin accumulates
  • in non-vital teeth, bacteria produce hydrogen sulphates which cause iron to become dark
28
Q

Describe pulpal necrosis following trauma.

A
  • sterile necrosis initially (no blood or bacteria)
  • subsequent infection can occur via PDL or cracks
  • can develop apical periodontitis
29
Q

What are diagnostic indicators of pulpal necrosis?

A
  • periapical radiolucency
  • discolouration of tooth (grey or brown)
  • infection related ERR apically
  • pupal sensitivity testing
  • TTP
  • sinus tract
30
Q

What are the treatment options for pupal necrosis following trauma?

A
  • primary endodontics
  • internal bleaching for discolouration
  • extraction with prosthetic replacement
31
Q

What injuries can cause unfavourable tooth position?

A
  • luxation
  • intrusion
  • extrusion
  • avulsion
32
Q

How do you manage small changes in tooth position due to trauma?

A
  • addition of composite resin
  • removal of tooth tissue
33
Q

How do you manage bigger changes in tooth position due to trauma?

A
  • extra-coronal restorations
  • orthodontic repositions
34
Q

What is infra-occlusion?

A
  • caused by ankylosis and RRR post-trauma
  • occurs in severe injuries to PDL
  • highest risk in trauma that occurs before puberty growth spurt
35
Q

How do you manage infra-occluded teeth?

A
  • orthodontic treatment is not commonly successful
  • best treated before infra-occlusion is greater 4mm
36
Q

What defects can occur in the hard and soft tissues after trauma?

A
  • loss of tissue in acute injury (lacerations or fractures)
  • early extraction can lead to bone loss
  • ankylosis can cause bone loss when extracted
  • endodontic failure
37
Q

How do you manage bone deficiencies post-trauma?

A
  • bone grafting
  • orthodontic extrusion therapy (if no ankylosis - tooth brings bone with it)
38
Q

How do you manage soft tissue deficiencies post-trauma?

A
  • mucoginigival surgery
  • connective tissue grafting to increase volume of tissue
39
Q

What makes extraction of traumatised teeth more difficult?

A
  • potential for further bone loss
  • drifting of teeth makes preserving tooth space difficult
  • vertical bone loss
  • implants are difficult to use
40
Q

What is classified as a simple acute trauma?

A
  • concussion
  • subluxation
  • enamel fracture
  • enamel-dentine fracture
  • root fracture (apical 2/3 with no displacement)
  • avulsion
41
Q

What is classified as a complex acute trauma?

A
  • extrusion
  • displaced root fracture or cervical 1/3
  • lateral luxation
  • dento-alveolar fracture
  • intrusion
  • immature apex
42
Q

What is protocol with a simple trauma?

A
  • exam and special investigations
  • refer to guidelines for treatment
  • advice is necessary (especially avulsion)
43
Q

What is protocol with a complex trauma?

A
  • exam and special investigations
  • stabilise and manage bleeding, pulpal exposure and pain
  • refer to guidelines
  • refer to adult trauma service

BDS3 PAEDIATRICS (11 decks)

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