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Dental trauma Flashcards

(50 cards)

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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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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
What treatment can be done for Enamel dentine fracture
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
What treatment can be done for enamel dentine pulp fracture
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
With young patients with enamel dentine pulp fracture what is important
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
What is done in a pulp cap
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
What is done in partial pulpotomy
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
What treatment is there for Crown root fracture
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
What is the root fracture treatment
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
How do you treat a concussion injury
No treatment just observe
33
How do you treat a subluxation injury
No treatmwnt just observe
34
Wha is the lateral luxation treatment
Minimal/ no occlusal interference -Allow to reposition spontaneously Severe displacement 1. Extraction 2. Reposition then splint for 4wks
35
What is the intrusion treatment (for permanent teeth cause I'm a retard)
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
In a intrusion injury how do you see direction of displacement
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
How can you tell that in a intrusion injury the apex is displaced towards/through labial bone plate
Apical tip of intruded tooth can be seen and tooth appears shorter (foreshortened) compared to contralateral tooth
38
How can you tell that in a intrusion injury the apex is displaced towards perm. tooth germ
Apex of intruded tooth cannot be visualised and tooth appears elongated compared to contralateral
39
What is the treatment for extrusion injury
Not interfering with occlusion -Spontaneous repositioning Excessive mobility or extruded >3mm -Extract
40
If there is avulsion of a primary a tooth what is the treatment
Dont replant
41
What is treatment for alveolar fracture
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
What are the long term complications of dental trauma to prim. tooth
Discolouration Discolouration and infection Delayed exfoliation
43
What do you do if there is discoloration and what types are there
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
What to do if there is discoloration and infection
Extract or endo once radiographic evidence of periapical pathology or Sinus, gingival swelling, abscess Increased mobility
45
What is the problem with delayed exfoliation
It messes up occlusion
46
What are the long term effects of trauma on developing perm tooth.
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
What enamel defects to perm teeth can happen in primary tooth trauma
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
What abormal crown/root morphology can happen to perm. tooth in primary tooth trauma
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
With the general aims and principles of treatment what are the immediate and permanent stuff
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
What is involved in a trauma stamp
Mobility TTP Colour Sinus Percussion note Radiograph

Paediatrics (6 decks)

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