Adult Dental Trauma Flashcards
(110 cards)
1
Q
health burden of dental trauma
A
longer to treat and is more expensive than many other bodily unjuries treated on outpatient basis
2
Q
dental trauma impact on quality of life
A
an untreated dental trauma affects an individual 20 times more, compared to those who have never suffered dental trauma
dominating problems: chewing, eating food and school activities
3
Q
3 outcome predictors of dental trauma
A
- severity of injury sustained
- stage of root development
- timing of treatment (EADT)
4
Q
when considering complications of dental trauma consider them in context to
A
damage to pulp, blood supply and PDL
5
Q
risk calculator for dental trauma
A
IADT International Association of Dental Traumatology Guide
- Prognosis for teeth with traumatic dental injuries
- Associated with Copenhagen trauma database
- Data from 2191 traumatised permanent teeth from 1282 pts
6
Q
enamel-dentine crown fractures
relative risks of a complications pulp necorsis at 10 years
A
5.1%
7
Q
enamel-dentine crown fractures
relative risks of a complications pulp canal obliteration at 10 years
A
1.3%
8
Q
2 complications of enamel dentine crown fractures
A
pulp necorsis
pulp canal obliteration
9
Q
enamel-dentine-pulp crown fractures
relative risks of a complications (X) at 10 years
A
pulp canal obliteration
20%
10
Q
3 complications from concusssion dental trauma
A
pulp necrosis
pulp canal obliteration
external root resorption
11
Q
realtive risk of pulp necrosis post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 3.5%
2 years - 3.5%
10 years - 3.5%
12
Q
realtive risk of pulp canal obliteration post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 4.4%
3 years - 7.2%
10 years - 10.3%
13
Q
realtive risk of external root resorption post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 5.2%
3 years - 8 %
10 years - 8%
14
Q
3 complications post subluxation injury
A
pulp necrosis
external root resorption
bone loss
15
Q
relative risk of pulp necrosis post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 12.5%
3 years - 12.5 %
10 years - 12.5%
16
Q
relative risk of external root resorption post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 2.7%
3 years - 2.7%
10 years - 2.7%
17
Q
relative risk of bone loss post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
at 1, 3 and 10 years
A
1 year - 0.9%
3 years - 0.9%
10 years - 0.9%
18
Q
4 complications post extrusion injury
A
pulp necorsis
pulp canal obliteration
external root resorption
bone loss
19
Q
relative risk of pulp necorsis post extrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
A
1 year - 56.5%
3 years - 56.5%
10 years - >56.5%
20
Q
relative risk of pulp canal obliteration post extrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
A
1 year - 21.7%
3 years - 21.7%
10 years - >21.7%
21
Q
relative risk of external root resorption post extrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
A
1 yera - 27%
3 years - 27%
10 years - 27%
22
Q
relative risk of bone loss post extrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
A
1 year - 17.4%
3 years - 17.4%
10 years - 17.4%
23
Q
6 complications of lateral luxation injuries
A
pulp necrosis
pulp canal obliteration
ankylosis
internal root resorption
external root resorption
bone loss
24
Q
relative risk of pulp necrosis post lateratl luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
A
1 year - 65.1%
3 years - 72.8%
10 years - 75.3%
25
relative risk of pulp canal obliteration post lateral luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
1 year - 12.8%
3 years - 12.8%
10 years - 18.3%
26
relative risk of replacement root resorption post lateratl luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
1 year - 1
3 years - 1
10 years -1
27
relative risk of internal root resorption post lateratl luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
1 year - 1
3 years - 3.3
10 years - 3.3
28
relative risk of bone loss post lateratl luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
1 year - 5.8
3 years - 5.8
10 years - 5.8
29
new term for ankylosis
replacement root resorption
rare but seen in severe injuries
30
relative risk of infection related resorption post lateratl luxation injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
after 1, 3 and 10 years
1 year - 31.3
3 years - 33.6
10 years - 33.6
31
new term for external root resorption
infection related root resorption
32
7 complications of dento-alveolar fractures
tooth loss
pulp necorsis
pulp canal obliteration
replacement root resorption
internal root resorption
infections related root resorptioon
bone loss
33
relative risk of tooth loss post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 1.8%
3 - 8.4%
10 - 10.2%
34
relative risk of pulp necorsis post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 38.4%
3 - 42.4%
10 - 44.7%
35
relative risk of pulp canal obliteration post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 38.4%
3 - 42.4%
10 - 44.7%
36
relative risk of replacement root resorption post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 1.3%
3 - 2.1%
10 - 2.1%
37
relative risk of internal root resorption post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 1.8%
3 - 2.7%
10 - 4.2%
38
relative risk of infection related root resorption post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 5
3 - 5
10 - 5
39
relative risk of boone loss post dento-alveolar fracture
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 7.7
3 - 7.7
10 - 7.7
40
6 complications of intrusion injuries
tooth loss
pulp necrosis
replacement root resorption
internal root resorption
infection related root resorption
bone loss
41
relative risk of tooth loss post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 0
3 - 5.3
10 - 28.9
42
relative risk of pulp necorsis post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 100
3 - 100
10 - 100
43
relative risk of replacement root resorption post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 10.3
3 - 26.1
10 - 37.5
44
relative risk of internal root resorption post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 4.8
3 - 4.8
10 - 4.8
45
relative risk of infection related root resorption post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 5
3 - 5
10 - 5
46
relative risk of bone loss post intrusion injury
(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)
1, 3 and 10 years
1 - 42.9
3 - 57.1
10 - 63.3
47
prognosis of avulsed tooth depends on
EADT (extra alveolar dry time)
48
eruption and root completeion age of upper 1
7-8 years
10 years
49
eruption and root completeion age of upper 2
8-9 years
11 years
50
eruption and root completeion age of upper 3
11-12 years
13-15 years
51
eruption and root completeion age of upper 4
10-11 years
12-13 years
52
eruption and root completeion age upper 5
10-12 years
12-14 years
53
eruption and root completeion age of lower 1
6-7 years
9-10 years
54
eruption and root completeion age of lower 2
7-8 years
10 years
55
eruption and root completeion age of lower 3
9-10 years
12-14 years
56
eruption and root completeion age of lower 4
10-12 years
12-13 years
57
eruption and root completeion age of lower 5
11-12 years
13-14 years
58
properties of open apex
* Maintain pulpal vitality
* Preservation of blood supply
* **Regeneration**
59
properties of closed apex
* Maintain pulpal vitality
* Preservation of blood supply
Prevent ingress of or eliminate bacteria and toxins
60
what complications are common with delayed or no trauma tx
pulp necrosis and root resorption
61
3 time approaches to trauma tx
acute
subacute
delayed
62
acute trauma tx
\<3 hours
63
subacute trauma tx
3-24 hours
64
delayed trauama tx
\>24 hours
65
how is the decision made on which trauma tx approach to use
based on pt discomfort, risk of infection, rate of complications
66
recommeneded tx timining protocol for avulsion
immediate re-implantation or acute (or subacute)
not usually professional - bystander put tooth back in socket (then go sub-acute) or stroage medium (then acute)
67
recommeneded tx timining protocol for alveolar fracture
acute (evidence base questionable)
68
recommeneded tx timining protocol for external or lateral luxation
acute or subacute
69
recommeneded tx timining protocol for root fracture
acute or subacute
70
recommeneded tx timining protocol for concussion or subluxation
subacute
71
recommeneded tx timining protocol for crown or crown-root fracture
subacute or delayed
72
5 potential long term complication categories of dental trauma
* Discolouration
* Loss of vitality
* Inflammatory root resorption
* Internal
* External
* Replacement
* Unfavourable tooth positions
* Defects in hard and soft tissues (due to trauma at time or complications)
73
external discolouration cause
accumulation of staining media
74
internal discolouration possible causes
* Optical and light transmission properties of enamel and dentine
* Following trauma may be yellow, pink/red or grey/black
75
how to dx tooth discolouration
Diagnosed by visual inspections during dental examination
76
yellow discolouration
* Indicative of canal obliteration
* Tertiary dentine reduces light transmission
* Monitor for signs/symptoms of loss of vitality
* Often maintain vitality so check for other signs/symptoms not just colour change
* Consider local external bleaching
77
pink discolouration
* Rupture of blood vessels during severe trauma may cause haemorrhage in pulp chamber (at time)
* Blood components flow into dentinal tubules, causing discolouration of the surrounding dentine
* Initially pink
* Cervical root resorption may also present as pink discolouration at the cervical margin of the crown
* Potential lateral complication of trauma
* Expect to return to normal colour in approx. 3 months
* Often initial presentation of cervical root resorption in absence of radiographs
78
brown-grey-black discolouration
* In non-infected traumatised teeth accumulation of the haemoglobin molecules or other haematin molecules causes discolouration
* In non-vital teeth hydrogen sulphates produced by bacteria convert iron to dark coloured iron sulphates
* Important to understand if the trauma has causes loss of vitality or not
79
reversal of pink discolouration
* No necrosis discolouration may reverse over time as the pulp revascularizes (2-3 months)
* If pulpal necrosis discoloration will worsen over time
80
loss of vitality after trauma can be due to
pulp necrosis and apical periodontitis
81
pulp necrosis and apical periodontitis
* Occurs following trauma if revascularisation fails
* For closed apex need transient apical breakdown which allows capillaries to grow into that area (will not happen for avulsion)
* Pulp tissue will undergo sterile necrosis
* Subsequent bacterial infection may then occur
* After 3-4 weeks radiographic indication of pulp necrosis
* Development of apical periodontitis
* Apical radiolucency on radiograph
82
6 diagnostic indicators of pulp necrosis
negative sensibility test is not enough on its own - need 1/more of these
* Periapical radiolucency
* Discolouration of the tooth crown (usually Grey/Brown)
* Infection related external root resorption
* No response to pulp sensitivity tests (wait for period after trauma)
* Tenderness to percussion and palpation in the vestibule develops after an asymptomatic period
* Presence of a fistula (sinus tract)
83
tx options for pulpal necrosis
* primary endodontics
* internal bleaching
* extraction and prosthetic replacement
84
unfavourable tooth positions
* Altered (unfavourable) tooth positions may result following displacement injuries
* E.g. luxation, intrusion, extrusion, avulsion (learn definitions)
Repositioning and splinting within 24 hours to minimise risk of complications
85
restorative tx for minimal changes in tooth position
addition of composite resin
removal of tooth tissue
86
restorative tx for significant alterations in apico-coronal tooth position
extra-coronal resotrations (veneers/crowns)
87
orthodontic tooth repositioning used when
* Late presentation injuries
* Injuries incorrectly repositioned
Increased risk associated with orthodontics
* root resorption
* Loss of vitality
these risks are amplified after trauma - need no complications following injury to be suitable
(teeth cannot be ankylosed)
88
unfavourable tooth position as a result of childhood trauma
* Occurs if ankylosis/replacement root resorption results from injury
* Most likely in severe injuries to PDL e.g. intrusion, avulsion with prolonged EADT
* Trauma prior to pre-pubescent growth spurt highest risk (continued alveolar growth)
* Extreme downward and forward growth of maxilla (circa 8-9)
* Causes tooth to be severely infra-occluded (apical in comparison to adj teeth)
89
tx infra-occluded teeth
Not amenable to orthodontic repositioning
Best undertaken before \>4mm infra-occlusion present (more than 4mm means severely compromised prosthetic tx)
Depends on number of factors:
* Prognosis of teeth
* Degree of infra-occlusion
* Wishes of the patient (and co-operation)
* Lip line
need no root resorption ongoing (if has then poor prognosis)
90
defects in hard and soft tissues categories
loss of tissue during acute injury
developing deficiencies
91
e.g. defects in hard and soft tissue during acute injury
gingival lacerations/abrasions
alveolar fractures
92
e.g. developing deficiencies caused defects in hard and soft tissue
* Early extraction with significant bone remodelling
* Ankylosis
* Lack of development of alveolar process and gingival margin discrepancy
* Bone loss during extraction
* Endodontic failures
93
managment of hard tissue defects in adults
bone grafting procedures
orthodntic extrusion therapy (as long as no ankylosis/replacment resorption)
94
management of soft tissue injuries in adults
mucogingival surgery
connective tissue grafting to increase volume of keratinsed mucosa
95
considerations for implant tx for adult trauma
complex
aesthetically challenging
96
management of hard and soft tissue defects (children)
* extraction of teeth
* Bone loss
* Coronectomy (crown down to 1mm below alveolar bone level)
* Aims for continued bone deposition
* Osteogenic distraction (hard and many complications)
* Camouflage
97
complication of tooth extraction post childhood trauma
* May be difficult
* Potential for further bone loss
* Socket preservation
* Vertical bone loss more difficult to deal with
* Implants challenging
98
how to tx child who needs extraction post trauma
* Extractions and socket preservation
* Interim PU/-
* Implants
* Fixed restoration
99
how to avoid complications after trauma tx
correct and timely tx (guidelines)
follow up
onwards referral to specialist at early stage
100
potential difficulties in getting pts to attend trauma follow up appointments
* 81% of dental trauma occurs \< age 30 years
* Alcohol related injuries frequent
* Psychopathology prevalent
* Non-transfer of dental records in UK
* aid by encouraged shared accountability
* Pt information (written where possible)
* Appropriate sharing of radiographs to allow serial comparison
101
when to refer a paeds trauma pt
open apex
or any acute trauma
102
when to refer adult trauma pt
acute and complex injuries
103
6 simple trauma injuries
concussion
subluxation
enamel infraction
enamel-dentine fracture
root fracture (apical 2/3 no displacement)
avulsion (following initial re-implantation and splinting)
104
6 complex trauma injuries
extrusion
displaced or cervical 1/3 root fracture
lateral luxation
dento-alveolar fracture
intrusion
immature apex (paeds)
105
how to manage simple trauma
* appropriate examination and special investigations to allow classification of injuries
* refer to international association of dental traumatology guidelines
* [www.dentaltraumaguide.org](http://www.dentaltraumaguide.org) or American Association of Endodontics Guidelines ‘The Treatment of Traumatic Dental Injuries’
* Advice if necessary, following this for adult pts
106
how to manage complex trauma
* Appropriate examination and special investigations to allow classification of injuries
* Stabilise and manage any bleeding, pulpal exposures and pain
* Refer to guidelines
In NHSGGC onwards referral adult dental trauma services
* if injury less than or = to 5 days old -\> appointmenmt same day
* if injury is longer than 5 days old but no long term complication -\> next available appointment (with trauma on call)
107
complex trauma injury appointment timescale if injury less than or = 5 days old
appointmenmt same day
108
complex trauma appointment timescale if injury is older than 5 days old but no long term complications
next available appointment (with trauma on call)
109
4 traumas may require specialist tx to avoid long term complications
Inflammatory root resorption
* External cervical root resorption *(pink lesion, usually maintain vitality so surgical tx)*
* Internal inflammatory root resorption
* External inflammatory resorption (change/alteration in pulp or bone) -\> endo
Altered tooth positions
* May require multi-disciplinary care
Root fractures exhibiting developing pathology
* No pathology -\> not necessary extraction
* Need pathology
* Loss vitality to fracture line – endo tx
* Develop pathology apically – extract or apical surgery (specialist input)
* Identify any pathology developing at fracture line and tx tooth to prevent loss of vitality
Loss of \>1 tooth as a result of trauma
* High priority category for implant treatment in NHS
110
implant criteria on NHS
* Loss more than 1 tooth as a result of trauma
* Non smoker
* Maintain good OH (low risk perio)
* Medically fit
