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Endo I > Dental Trauma > Flashcards

Dental Trauma Flashcards

1
Q

most dental trauma occurs in _____ age range

A

7-14

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2
Q

most trauma occurs in the ____ region of the maxilla and mandible

A

anterior region

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3
Q

_____ dentition injuries greater importance

A

permanent

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4
Q

primary dentition injuries:

A
  • prevent injury to succedaneous tooth
  • patient comfort
  • avulsed primary teeth seldom replaced
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5
Q

prime rules of dental trauma:

A
  • trauma is never planned
  • timely treatment is basic to success
  • occurs at the least convenient time
  • trauma is for life
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6
Q

what are luxation injuries

A

-concussion
- subluxation
- extrusion
- lateral
- intrusive

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7
Q

describe patients and parents in trauma

A
  • patients are frightened and in pain
  • parents are emotional and irrational
  • both want immediate action
  • esthetic expectations unrealistic
  • perfect outcome demanded
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8
Q

what happens in resorption

A

ankylosis

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9
Q

what percentages of permanent dentition, primary dentition, adolescents 12 y/o are affected in trauma

A
  • permanent: 15.2%
  • primary: 22.7%
  • adolescents: 18.1%
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10
Q

how many people have had dental trauma

A

1 billion in the world

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11
Q

what percentage of children in the US will have dental trauma

A

4-14%

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12
Q

what is the epidemiology of dental trauma in children 5 years of age

A
  • 1/3 injuries in primary dentition
  • luxation more common
  • males more frequent than females
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13
Q

what is the epidemiology for dental trauma in adolescents 12 years of age

A
  • 20-30% will suffer dental trauma
  • uncomplication crown fracture
  • males more frequent than females
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14
Q

what are the traumatic injuries classification

A
  • concussion
  • subluxation
  • intrusion
  • extrusion
  • lateral luxation
  • avulsion
  • crown fracture
  • crown root fracture
  • root fracture
  • bone fracture
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15
Q

what is an uncomplicated crown fracture

A

crown fracture without pulp exposure

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16
Q

what do you do with uncomplicated crown fractures

A
  • if vital:
  • relax and restore
  • recall and test sensibility
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17
Q

what is a complicated crown fracture

A

pulp exposure
- enamel dentin and pulp are affected

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18
Q

what are the treatment options for complicated crown fracture

A
  • pulp cap: use bioceramic materials
  • pulpotomoy: preferred if open apex
  • RCT: preferred if apex closed or post necessary
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19
Q

describe a crown - root fracture

A

a fracture involving enamel, dentin, and cementum, with loss of tooth structure and exposure of pulp

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20
Q

what is the common fracture pattern of crown- root fx

A

fractures at an angle

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21
Q

what should you do with crown root fractures

A
  • anesthetize
  • remove fx element
  • determine pulpal exposure and restorability
  • if no exposure - restore
  • if exposed- VPT or RCT
  • if open apex- VPT
  • if closed apex - RCT
  • be certain there is not a second component of the fracture
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22
Q

what radiographs should be taken to see crown root fractures

A

take several angled X rays varying both vertical and horizontal angulations or CBCT

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23
Q

vertical fracture of crown ____ root

A

greater than&raquo_space;>

24
Q

what is not ALWAYS present with vertical root fractures

A

J shaped lesions

25
Q

if J shaped lesion is present is does not always mean:

A

root is cracked or fractured

26
Q

what percentage of the time does a J shaped lesion mean the root is cracked

A

28%

27
Q

what are the methods of diagnosing/documenting vertical root fractures

A
  • transillumination
  • restoration removal and staining
  • surgical exposure
28
Q

describe horizontal root fractures

A
  • the horizontal fx is often easily visualized on radiograph
  • seldom ever occurs on posterior teeth
  • excess mobility is a good clue
29
Q

selection and prognosis with HRF depends on:

A
  • level of fracture
  • restorability
  • periodontal health
  • vitality of pulp
  • stage of root development
  • time since injury
  • age of patient
  • cooperation of patient
  • availability for follow up
  • approximation opportunities
  • stabilization options
30
Q

treatment options are determiend on a _____ basis

A

case by case

31
Q

what should you do in HRF

A

try to reposition and splint 2-4 weeks
- check for sensibility every 30 days
- refer to a specialist

32
Q

describe alveolar fracture

A
  • the bone segment containing the involved tooth is mobile
  • splinting required for 4-6 weeks
  • complicates healing (slower)
  • discomfort may be greater/ longer lasting
  • should not affect final result in most cases
33
Q

what is the most common of all dental injuries and what is the percentage

A

luxation injuries
- 30-44%

34
Q

what is the order of least to greatest damage in a luxation injury

A
  • concussion
  • subluxation
  • extrusion
  • lateral
  • intrusive
35
Q

describe subluxation injury

A
  • tooth tender to touch and slightly mobile (1+) but not displaced
  • possible hemorrhage from gingival crevice
  • no radiographic abnormalities
  • damage to supporting structures
  • assess vitality in 2-4 weeks and follow up
36
Q

describe concussion injury

A
  • least severe of luxation injuries
  • no displacement of tooth not mobility
  • tooth tender to touch “bruised PDL”
  • no radiographic abnormalities
  • do nothing, assess vitality in 2-4 weeks follow up
37
Q

describe a lateral luxation injury

A
  • displaced laterally and often locked in bone
  • not tender to touch not mobile
  • alveolus fractured
  • increased PDL space best seen on eccentric or occlusal radiographs
  • anesthetize and reposition and flexible splint mandatory 4 weeks
  • assess vitality in 2-4 weeks to follow
38
Q

a flexible splint allows:

A

physiologic movement of the teeth in order to minimize ankylosis

39
Q

what is a flexible splint

A

.020 or 18 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar fracture had occurred, then 4-6 weeks

40
Q

describe extrusive luxation injury

A
  • elongated mobile tooth: class II mobility or greater
  • radiographs show increased apical periodontal space
  • manually reposition
  • flexible splint mandatory 14 days
  • assess vitality in 2-4 weeks and follow up
41
Q

describe intrusive luxation injury

A
  • external root resorption likely
  • most severe of luxations: tooth appears shorter- displaced into alveolar bone
  • PDL destruction/alveolar crushing- beware of ankylosis/resorption
  • pulp necrosis is all but certain in mature teeth
  • not tender to touch, not mobile
  • percussion test: sounds different
  • radiographs not always conclusive
  • slightly luxate with forceps or band and move orthodontically ASAP
  • splinting is place 14 days or more if alveolar fx is present
  • tooth with open apex may spontaneously re-erupt depending on the depth of penetration - less than 7 mm
  • 100% RCT intervention
42
Q

describe an avulsion

A
  • tooth is knocked completely out of mouth
  • viability of the PDL must be preserved for success
  • extra- oral dry time is critical 0-15 minutes for survivial of PDL
  • must be replaced in socket immediately or ASAP (15-20”) in order to prevent ankylosis and prevent external root resorption
43
Q

replanting tx is aimed at minimizing the inflammation from the two main consequences of avulsion:

A
  • attachment damage
  • pulpal necrosis and infection that usually results
44
Q

the single most important factor in achieving a favorable outcome is:

A

the SPEED at which a clean tooth is properly replanted (viable PDL 15”

45
Q

what is paramount in replant

A

keeping the attached PDL moist

46
Q

what mediums should you transport tooth in

A
  • save a tooth - hanks balanced salt solution
  • via span
  • milk or green tea
  • contact lens solution
  • place in vestibule (saliva) and report to dental office ASAP
47
Q

what are the first aid instructions for avulsed tooth

A
  • handle by crown only
  • pick off debris with tweezers
  • replant tooth at the site if possible
48
Q

once in the dental office in avulsed teeth

A
  • take films to make sure there is no alveolar fracture and that adjacent teeth are OK
49
Q

what is the order of treatment when you get into the dental office for avulsed teeth

A
  • take films
  • remove from transport media
  • gently clean socket
  • replant and check occlusion
  • take films
  • flexible splint
  • RX antibiotics
  • possible tetanus booster
50
Q

DO NOT: (in avulsed teeth)

A
  • submerge in tap water
  • allow tooth to dry
  • scrub root
  • handle by root
51
Q

what are other potential results of trauma

A
  • effects on pulpal spaces
  • resorption
  • ankylosis
52
Q

trauma may stimulate 2 different pulpal responses

A
  • generate massive amounts of tertiary dentin- end result in sclerosed and non negotiable canal
  • discontinue development and remain at the stage present at the time of injury
53
Q

describe ankylosis

A
  • a problem following trauma and long term rigid splinting
  • tooth is solidly fixed and has a high different ring when percussing. does not erupt with other teeth
54
Q

ankylosis may lead to

A

massive external replacement resorption and loss fo tooth

55
Q

what is internal ankylosis

A

appearance of aneurysm within canal

56
Q

describe replacement ERR

A
  • patients are generally asymptomatic
  • typically a history of avulsion or intrusion injury
  • bone may replace dentin in cases of PDL injury
  • ankylosis occurs and may be identified by XR and lack of mobility and high pitched metallic ring during percussion or possibly by submergence
57
Q
A

Endo I (13 decks)

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