Dental Trauma 1

Question 1

what are the most common primary tooth to get traumatised

Answer 1

maxillary primary incisors

Question 2

what is the peak incidence of childhood trauma

Answer 2

2-4 years of age

Question 3

how can trauma occur

Answer 3

falls
bumping into objects
non-accidental

Question 4

what are the types of dental hard tissue and pulp injuries

Answer 4

enamel fracture
enamel and dentine fracture
enamel, dentine and pulp fracture
crown-root fracture
root fracture

Question 5

what are the types of supporting tissue injuries

Answer 5

concussion
subluxation
lateral luxation
intrusion
extrusion
avulsion
alveolar fracture

Question 6

what is concussion

Answer 6

tooth tender to touch but not been displaced

Question 7

what is subluxation

Answer 7

tooth tender to touch, has increased mobility but not displaced

Question 8

what is lateral luxation

Answer 8

tooth displaced usually palatally or in labial direction

Question 9

what is intrusion

Answer 9

tooth displaced through labial bone plate

Question 10

what is extrusion

Answer 10

partial displacement of tooth out of socket

Question 11

what is avulsion

Answer 11

tooth completely out of socket

Question 12

what is the most common injury in the primary dentition

Answer 12

luxation

Question 13

what does the appointment look like for trauma patient

Answer 13

reassurance
history
examination
diagnosis
emergency treatment
important information
further treatment and review

Question 14

what do you ask for with trauma history

Answer 14

when
where
how
any other symptoms or injuries
lost teeth/fragments

Question 15

what aspects of medical history influences treatment

Answer 15

congenital heart disease
history of rheumatic fever or immunosuppression
bleeding disorders
allergies
tetanus immunisation status

Question 16

what do we look for extraorally

Answer 16

lacerations
haematoma
haemorrhage/CSF
subconjunctival haemorrhage
bony step deformities
mouth opening

Question 17

what do we look at intraorally

Answer 17

soft tissues
alveolar bone
occlusion
teeth

Question 18

what would a detailed intraoral exam consist of

Answer 18

soft tissue damage
tooth mobility
transillumination - show fracture lines
tactile test with probe
percussion
occlusion

Question 19

what would a dull note on percussion indicate

Answer 19

root fracture

Question 20

what is included in the trauma stamp

Answer 20

mobility
colour
TTP sinus
percussion note
radiograph

Question 21

what radiographs are used for trauma

Answer 21

periapical
anterior occlusal
lateral pre-maxilla
panoramic
soft tissue

Question 22

what is the most appropriate treatment option in emergency situation

Answer 22

observation unless aspiration risk, ingestion or occlusal interference

Question 23

what should the homecare instructions be after trauma

Answer 23

analgesia
soft diet for 10-14 days
brush teeth with soft toothbrush after every meal
topical chlorhexidine mouthwash applied twice daily for one week
warn re signs of infection

Question 24

how do you manage enamel fracture

Answer 24

smooth sharp edges

Question 25

how do you manage enamel/dentine fracture

Answer 25

cover exposed dentine with GI/composite

Question 26

how do you manage enamel-dentine-pulp fracture

Answer 26

partial pulpotomy or extract

Question 27

how do you manage crown-root fracture

Answer 27

remove loose fragment and determine if crown restorable if restorable - cover exposed dentine with GI or if pulp exposed then pulpotomy or endo treatment if unrestorable then extract loose fragments

Question 28

how do you manage a root fracture

Answer 28

coronal fragment fine = no treatment coronal displaced but not too mobile = leave to spontaneously reposition even if some occlusal interference coronal fragment displaced and excessively mobile = extract only coronal fragment/reposition loose coronal fragment and splint

Question 29

how do you manage concussion

Answer 29

no treatment - just observe

Question 30

how do you manage subluxation

Answer 30

no treatment just observe

Question 31

how do you manage lateral luxation

Answer 31

if minimal/no occlusal interference - allow to reposition spontaneously severe displacement - extraction, reposition and splint

Question 32

how do you manage intrusion

Answer 32

allow to reposition

Question 33

what radiographs are used for intrusion

Answer 33

periapical lateral premaxilla

Question 34

when a tooth is intruded and the apical tip can be seen but tooth appears shorter compared to contralateral tooth, what has happened

Answer 34

it has been displaced towards/through labial bone plate

Question 35

when a tooth is intruded and apex cannot be visualised and tooth appears longer that contralateral tooth what has happened

Answer 35

apex displaced toward permanent tooth germ

Question 36

how do you manage extrusion

Answer 36

not interfering with occlusion - spontaneous repositioning excessive mobility/extruded >3mm - extract

Question 37

how do you manage an avulsed primary tooth

Answer 37

take radiograph but do not replant

Question 38

how do you manage alveolar fracture

Answer 38

reposition segment stabilise with flexible splint to adjacent uninjured teeth for 4 weeks teeth may need to be extracted after alveolar stability has been achieved

Question 39

what do you do after managing trauma

Answer 39

follow up appointment

Question 40

what do you need to warn patients of

Answer 40

possible sequelae to traumatised primary tooth and permanent successor

Question 41

what are the direct complications of trauma to the primary tooth

Answer 41

discolouration discolouration and infection delayed exfoliation

Question 42

what does a mild grey discolouration indicate

Answer 42

it is immediate but may maintain vitality

Question 43

what does opaque/yellow discolouration mean

Answer 43

pulp obliteration

Question 44

how do you manage asymptomatic discolouration

Answer 44

no treatment and review as no signs of pulpal necrosis or infection

Question 45

what would symptomatic discolouration and infection present as

Answer 45

sinus, gingival swelling and abscess increased mobility periapical pathology on radiograph

Question 46

how do you treat symptomatic discolouration and infection

Answer 46

extract or endo treatment

Question 47

what type of trauma causes the most disturbance to permanent teeth

Answer 47

intrusion

Question 48

what injuries can occur in the permanent tooth as a result of primary trauma

Answer 48

enamel defects abnormal crown/root morphology delated eruption ectopic tooth position arrested development complete failure of tooth to form odontome formation

Question 49

what is enamel hypomineralisation

Answer 49

qualitative defect of enamel with normal thickness but poor mineral

Question 50

what does enamel hypomineralisation look like

Answer 50

white/yellow defect

Question 51

what are the treatment options for enamel hypomineralisation

Answer 51

no treatment composite masking tooth whitening

Question 52

what is enamel hypoplasia

Answer 52

reduced thickness but normal mineralisation

Question 53

what does enamel hypoplasia look like

Answer 53

yellow/brown defects

Question 54

what is the treatment for enamel hypoplasia

Answer 54

no treatment composite masking

Question 55

what is dilaceration

Answer 55

abrupt deviation of long axis of crown or root portion of tooth

Question 56

how do you manage crown dilaceration

Answer 56

surgical exposure and ortho realignment improve aesthetics restoratively

Question 57

how do you manage root dilaceration

Answer 57

combined surgical and orthodontic approach

Question 58

why can delated eruption occur as a response to premature loss of primary tooth

Answer 58

due to thickened mucosa

Question 59

when would you radiograph a delayed erupted tooth

Answer 59

if > 6 month delay compared to contralateral tooth

Question 60

how do you manage delayed eruption

Answer 60

surgical exposure and orthodontic realignment

Question 61

what are the treatment options for ectopic tooth position

Answer 61

surgical exposure and ortho realignment extraction

Question 62

what are the treatment options for arrested development

Answer 62

endo treatment extraction

Question 63

what do you need to do if tooth fails to form

Answer 63

tooth germ might need removed

Question 64

what treatment is there for an odontome

Answer 64

surgical removal