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Paediatrics > Dental trauma > Flashcards

Dental trauma Flashcards

1
Q

Peak incidence age of dental trauma

A

2-4 yrs

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2
Q

What is the most common teeth traumed

A

Maxillary prim. incisors

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3
Q

What can the aetiology be

A

Falls

bumping into things

non-accidental

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4
Q

What are the classifications of injuries for supporting tissues (supporting bone and the perio tissues)

A

Concussion

Subluxation

Lateral luxation

Intrusion

extrusion

Avulsion

Alveolar fracture

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5
Q

What Dental hard tissues and pulp injuries are there

A

Enamel fracture

Enamel & dentine fracture

Enamel, dentine and pulp fracture

Crown root fracture

Root fracture

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6
Q

What is a enamel fracture

A

A uncomplicated crown fracture that involves enamel only

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7
Q

What is a enamel and dentine fracture

A

A uncomplicated crown fracture that involves enamel and dentine with pulp not being involved

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8
Q

What is a enamel dentine and pulp fracture

A

Complicated fracture involving enamel dentine and pulp is exposed

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9
Q

What is a crown root fracture

A

Fracture involves enamel, dentine and root; the pulp may or may not be involved (complicated or uncomplicated)

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10
Q

What is a root fracture

A

An injury where the root is fractured it can be at various levels and the location determines the clinical findings

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11
Q

What is a concussion injury

A

PDL injury in which the tooth is tender to touch but has not ben displaced, the tooth has normal mobility with no bleeding into the suculus

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12
Q

What is a subluxation injury

A

PDL injury where the tooth is tender to touch and has increased mobility but has not been displaced, bleeding from the gingival crevice can be noted

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13
Q

What are classified as luxation injuries

A

(most common injury in primary dentition)
Lateral luxation

Intrusion

Extrusion

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14
Q

What is lateral luxation

A

Displacement of a tooth not axially usually in the palatal/lingual or labial direction with fracture of the alveolar socket

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15
Q

What is a intrusion injury

A

Dispalcement of the tooth into alveolar bone with fracture of the alveolar socket, tooth usually displaced through the labial bone plate or it can impinge on the perm. tooth bud

In a axial direction

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16
Q

What is a extrusion injury

A

Partial displacement of tooth out of its socket

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17
Q

What is avulsion injury

A

Tooth completely out the socket

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18
Q

What is a alveolar fracture injury

A

Fracture involves the alveolar bone (labialand palatal/lingual) and may extend to the adjacent bone

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19
Q

What are the %’s of injury prevalances

A

Luxation 62-69%

Avulsion & ED fracture 7-13%

Root fracture 2-4%

Crown root fracture 2%

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20
Q

What are the steps in patient management

A

1)Reassurance
2)Trauma/med/dental History
3)Trauma Examination
4)Diagnosis
5)Emergency treatment
6)Important information
7)Further treatment and review

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21
Q

What can you look for in a trauma examination

A

Extra oral first eg. brusies and lacerations

Intra oral:

Soft tissue damage
-Penetrating wounds, foreign bodies

Tooth mobility
-May indicate tooth displacement, root or bone fractures

Transillumination
-May show fracture lines in teeth (crazing), pulpal degeneration, caries

Tactile test with probe
-May help detect horizontal and/or vertical fractures, pulpal involvement

Percussion
-Duller note may indicate root fracture

Occlusion
-Traumatic occlusion demands urgent treatment

22
Q

In emergency treatment what is the most appropriate option

A

Aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive ‘dentine bandage’
Treat exposed pulp tissue
Reduction and immobilisation of displaced teeth
Tetanus prophylaxis
Antibiotics?

23
Q

What important info can you give to parent/carer

A

Analgesia

Soft diet for 10-14 days
-Normal diet but cut everything small, chew with molars

Brush teeth with soft toothbrush after every meal

Topical chlorhexidine gluconate 0.12% mouthrinse applied topically twice daily for one week

Warn re signs of infection

24
Q

What treatment can you do for enamel fracture

A

Either bond fragment to tooth or Smooth sharp edges of tooth

Take 2 periapicals to rule out fracture or luxation

Follow up 6-8wks, 6mnths, 1 yr

25
Q

What treatment can be done for Enamel dentine fracture

A

Cover all exposed dentine with glass ionomer/ composite, if near pulp line it.

Lost tooth structure can be restored immediately with composite or at a later visit

26
Q

What treatment can be done for enamel dentine pulp fracture

A

Evaluate exposure (size of pulp exposure, time since injury, associated PDL injury) AIM TO PRESERVE PULP VITALITY

Then choose either:

Pulp cap
Partial pulpotomy
Full coronal pulpotomy
If nonvital extract

27
Q

With young patients with enamel dentine pulp fracture what is important

A

In young patients with open apices, it is very important to preserve pulp vitality by pulp capping or partial pulpotomy in order to secure further root development

28
Q

What is done in a pulp cap

A

Tiny exposure of about 1mm within 24hr window and should not be TTP and vital

-Trauma sticker and radiographic assessment
-LA and rubber dam
-Clean area with water and disinfect with sodium hypochlorite
-Apply calcium hydroxide (dycal) or MTA white to pulp
-Restore tooth

29
Q

What is done in partial pulpotomy

A

LArger expposure >1mm or 24hrs+ since exposure

-Trauma sticker and radiographic assessment
-LA and rubber dam
-Clean area with saline and disinfect with sodium hypochlorite
- Remove 2mm of pulp
-Place saline soaked Cotton wool pellet over exposure until haemostasis
(If bleeding doesnt stop= full coronal pulpotomy)
-Apply caOH then GI then restore

30
Q

What treatment is there for Crown root fracture

A

Remove the loose fragment and determine if crown can be restored

If the fracture involves only a small part of the root and the stable fragment is large enough to allow coronal restoration:
-No pulp exposed: cover exposed dentine with glass ionomer
-Pulp exposed: pulpotomy or endodontic treatment

If unrestorable:
-Extract

31
Q

What is the root fracture treatment

A

Coronal fragment not displaced:
-No treatment

Coronal fragment displaced but not excessively mobile:
-Leave coronal fragment to spontaneously reposition even if some occlusal interference

Coronal fragment displaced, excessively mobile and interfering with occlusion:
-Option A: Extract only the loose coronal fragment
-Option B: Reposition the loose coronal fragment +/- splint

32
Q

How do you treat a concussion injury

A

No treatment just observe

33
Q

How do you treat a subluxation injury

A

No treatmwnt just observe

34
Q

Wha is the lateral luxation treatment

A

Minimal/ no occlusal interference
-Allow to reposition spontaneously

Severe displacement
1. Extraction
2. Reposition then splint for 4wks

35
Q

What is the intrusion treatment (for permanent teeth cause I’m a retard)

A

Teeth with immature root development
Allow re-eruption without intervention (spontaneous repositioning) for all intruded teeth independant of the degree of intrusion.
If no re-eruption within 4 weeks, initiate orthodontic repositioning

Teeth with mature root development
Allow re-eruption without intervention if the tooth is intruded <3 mm. If no re-eruption within 4 weeks, reposition surgically and splint for 2 weeks
If the tooth is intruded 3-7 mm, reposition surgically or orthodontically.
If the tooth is intruded beyond 7 mm, reposition surgically.
Root canal treatment should be initiated within 2 weeks

36
Q

In a intrusion injury how do you see direction of displacement

A

Not parallax as only one radiograph is used

An occlusal or periapical exposure will normally show the position of the displaced tooth and its relation to the permanent successor. If the tooth is totally intruded, an extra-oral lateral exposure may be indicated to make sure that the tooth has not penetrated the nasal cavity

37
Q

How can you tell that in a intrusion injury the apex is displaced towards/through labial bone plate

A

Apical tip of intruded tooth can be seen and tooth appears shorter (foreshortened) compared to contralateral tooth

38
Q

How can you tell that in a intrusion injury the apex is displaced towards perm. tooth germ

A

Apex of intruded tooth cannot be visualised and tooth appears elongated compared to contralateral

39
Q

What is the treatment for extrusion injury

A

Not interfering with occlusion
-Spontaneous repositioning

Excessive mobility or extruded >3mm
-Extract

40
Q

If there is avulsion of a primary a tooth what is the treatment

A

Dont replant

41
Q

What is treatment for alveolar fracture

A

Reposition segment

Stabilize with a flexible splint to the adjacent uninjured teeth for 4 weeks

Teeth may need to be extracted after alveolar stability has been achieved

42
Q

What are the long term complications of dental trauma to prim. tooth

A

Discolouration

Discolouration and infection

Delayed exfoliation

43
Q

What do you do if there is discoloration and what types are there

A

If no signs of pulp necrosis or infection do nothing

Mild grey: Immediate discolouration may maintain vitality (pulp is bleeding)

Opaque/yellow: Pulp obliteration (Pulp is heping to lay down increased entine to protect itsself)

44
Q

What to do if there is discoloration and infection

A

Extract or endo once radiographic evidence of periapical pathology or Sinus, gingival swelling, abscess
Increased mobility

45
Q

What is the problem with delayed exfoliation

A

It messes up occlusion

46
Q

What are the long term effects of trauma on developing perm tooth.

A

Enamel defects (45%)

Abnormal root/crown morphology (8%)

Delayed eruption (1%)

Ectopic tooth position

Arrested development

Completet failure of tooth to form

Odontome formation

47
Q

What enamel defects to perm teeth can happen in primary tooth trauma

A

Enamel hypomineralisation:
-Qualitative defect of enamel
i.e. normal thickness but poorly mineralised
-White/yellow defect
Treatment:
No treatment
-Composite masking +/- localised removal
-Tooth whitening

Enamel hypoplasia:
-Quantitative defect of enamel
i.e. reduced thickness but normal mineralisation
-Yellow/brown defects
Treatment:
-No treatment
-Composite masking

48
Q

What abormal crown/root morphology can happen to perm. tooth in primary tooth trauma

A

Dilaceration
Abrupt deviation of the long axis of the crown or root portion of the tooth

Crown dilaceration management options:
Surgical exposure and orthodontic realignment
Improve aesthetics restoratively

Root dilaceration/angulation/duplication:
Combined surgical and orthodontic approach

49
Q

With the general aims and principles of treatment what are the immediate and permanent stuff

A

immediate:
+/- Pulp treatment
Restoration
-Minimally invasive e.g. acid etch restoration

perm.:
-Apexigenesis
-Apexification
-Root filling +/- root extrusion
-Gingival and alveolar collar modification if required
-coronal restoration

50
Q

What is involved in a trauma stamp

A

Mobility
TTP
Colour
Sinus
Percussion note
Radiograph

Paediatrics (6 decks)

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