Adult Consequences Of Childhood Trauma

Question 1

What are some predictors for outcome of childhood trauma

Answer 1

Severity of injury - IADT DENTAL TRAUMA GUIDE

Stage of root development

Timing of tx

Question 2

Recommended timing for avulsion?

Answer 2

Immediate reimplantation or acute/subacute

Question 3

Recommended timing for alveolar fracture?

Answer 3

Acute phase

Question 4

Timing for extrusion or lateral luxation?

Answer 4

Acute or subacute

Question 5

Timing for root fracture

Answer 5

Acute or subacute

Question 6

Timing for concussion or subluxation?

Answer 6

Subacute

Question 7

Timing for crown or crown-root fractures?

Answer 7

Subacute or delayed

Question 8

What timing is acute, subacute and delayed?

Answer 8

Acute 0-3hrs

Subacute 3-24hrs

Delayed >24hrs

Question 9

What are some potential long term complications of childhood trauma to a tooth?

Answer 9

Discolouration

Loss of vitality

Inflammatory root resorption

Unfavourable tooth positioning

Hard / soft tissue defects

Question 10

Why might a tooth be yellow? What would you do?

Answer 10

Indicative of canal obliteration

Monitor for signs or symptoms of loss of vitality

Consider local external bleaching

Question 11

Why might a tooth be pink? How treat?

Answer 11

Haemorrhage in pulp chamber with blood flowing into dentinal tubules

Cervical root resorption may occur

If tooth is not necrotic may recover in 2-3 months as it revascularises

If necrotic then discolouration will worsen

Question 12

Why might tooth be brown/grey/black?

Answer 12

Non infected traumatised tooth with accumulation of haemoglobin

Hydrogen sulphate produced by bacteria concert iron to dark iron sulphate

Possible loss of vitality

Question 13

Why might pulp necrosis and apical periodontitis follow trauma?

Answer 13

When revascularisation fails

Pulp tissue necrotises and bacterial infection occurs

3-4 week time period necrosis will show radiographically

Question 14

What indicates a tooth may be necrotic?

Answer 14

Loss of the lamina dura

Widening of the PDL

Grey/brown tooth discolouration

Periapical radiolucency

Infection related root resorption

No response to pulp sensitivity testing

TTP

Draining sinus

Question 15

How treat pulp necrosis?

Answer 15

Primary endodontic treatment with internal bleaching

XLA and replace

Question 16

What issue might unfavourable tooth position lead to? Best thing to do?

Answer 16

Increased risk of traumatic injury such as luxation or intrusion

Reposition and splint within 24 hours to prevent unfavourable tooth position

If minimal change, add composite or remove tooth tissue

If large change needed, orthodontically treat or use extra coronal restorations

Question 17

What is an infra occluded tooth? How treat?

Answer 17

Ankylosed tooth which is stuck between two others as the alveolar bone grows over

Full assessment required
XLA if below contact point

Question 18

How might hard and soft tissue discrepancies be managed in an adult patient?

Answer 18

Bone grafting

Ortho extrusion with chain

Mucogingivalnsurgery

Connective tissue grafting

Implants

Question 19

What are simple injuries?

Answer 19

Concussion

Subluxation

Enamel infraction

ED fracture

Root fracture in apical 2/3 with no displacement

Avulsion after reimplantation and splinting

Question 20

What are complex injuries

Answer 20

Alveolar fracture

Immature apex (paeds)

Displaced or cervical root fracture

Intrusion and extrusion

Lateral luxation

Question 21

What to do for simple trauma?

Answer 21

Appropriate exam and investigations to allow classification

Refer to international association of dental trauma guidelines

Www.dentaltraumaguide.org

Question 22

What complications of trauma may require specialist intervention?

Answer 22

Inflammatory root resorption

Altered tooth positioning

Root fractures with developing pathology

Loss of >1 tooth