dental trauma

Question 1

what is the most common trauma dental injury in 1) primary 2) permanent dentition?

Answer 1

1) luxation
2) crown fractures

Question 2

what is the most common cause of loss or permanent incisors in childhood?

Answer 2

trauma

Question 3

what is the most common complication of dental trauma?

Answer 3

pulpal necrosis

Question 4

what kind of dental problem can increase the incidence of trauma?

Answer 4

overjets

Question 5

prevention is hard, but what is one way?

Answer 5

mouthgaurds

Question 6

what is the best management of dental trauma?

Answer 6

-proper diagnosis
-tx planning
-follow up

Question 7

what are the first things we should do when someone presents with a TDI?

Answer 7

-check for head injury
-assess dental/facial injury
-does story make sense?
-do emergency tx
-clean up pt
-refer if needed
-document everything

Question 8

what injures can occur to the tooth?

Answer 8

crown or root fracture

Question 9

what would cause an injury to the tooth?

Answer 9

hard blow- e.g pavement or gold club

Question 10

what injuries occur to the socket?

Answer 10

intact tooth-but displaced or loosened in socket

Question 11

what would cause an injury to the socket?

Answer 11

soft blow- elbow, fist

Question 12

what is the main problem with dental injuries?

Answer 12

bacteria can enter the pulp- must always cover expose dentine asap

Question 13

what is the main problem with dents-alveolar injuries?

Answer 13

injuries that cause significant movement within the socket almost always sever the blood supply entering the pulp via the apical foreman- causing pulp necrosis

Question 14

what are 4 types of traumas?

Answer 14

-luxation
-avulsion
-crown fractures
-root fractures

Question 15

what is luxation?

Answer 15

luxation is the displacement of the tooth in the alveolar bone without total avulsion

Question 16

what are the types of luxation?

Answer 16

-concussion
-subluxation
-intrusive luxation
-extrusive or lateral luxation

Question 17

what is a concussion luxation?

Answer 17

injury to tooth without displacement or mobility of tooth. Alveolar bone is intact.

Question 18

is it likely for concussion luxation to give positive or negative sensitivity tests?

Answer 18

positive

Question 19

what is subluxation?

Answer 19

injury to the tooth causing mobility but no displacement

Question 20

is it likely for subluxation to give positive or negative sensitivity tests?

Answer 20

can initially be negative to sensitivity tests e.g ethyl chloride- due to transient pulpal damage- monitor until definitive diagnosis.

Question 21

what does concussion subluxation damage?

Answer 21

minor damage to the PDL- OH is important as bacteria entry risk increases

Question 22

how will concussion or subluxation appear on radiographs?

Answer 22

normal

Question 23

what is seen clinically with subluxation or concussion?

Answer 23

-tooth will be TTP
-haemorrage and oedema within ligament
-gingival bleeding and mobility only occur with subluxation

Question 24

when would you not check TTP with a subluxation?

Answer 24

if recent injury- vitality test 1 week post trauma

Question 25

what is the management of subluxation/concussion?

Answer 25

-periapical radiograph -soft diet for one week -advice to parents -splint for subluxation. -follow up -check immunisation- tetanus

Question 26

what is intrusive luxation?

Answer 26

when injury causes tooth to displace axially into alveolar bone.

Question 27

what teeth are commonly affected by intrusive luxation?

Answer 27

upper anteriors

Question 28

is intrusive luxation mobile?

Answer 28

no and TTP will likely cause metallic sound

Question 29

how will intrusive luxation likely respond to sensitivity tests?

Answer 29

negatively

Question 30

how will intrusive laxations appear radiographically?

Answer 30

-loss of apical pdl space -ACJ will be further apically than adjacent tooth

Question 31

how do you manage intrusive luxation?

Answer 31

-if crown visible and minor alveolar damage- leave to re-erupt - if root not fully formed. -if crown fully intruded- extract.

Question 32

what is extrusive luxation?

Answer 32

tooth will appear elongated and very mobile.PDL will partially or fully be separated from alveolar bone apically.

Question 33

how will extrusive luxation appear on radiographs?

Answer 33

increased apical pdl space

Question 34

will response to sensitivity tests be pos or neg for extrusive laxations?

Answer 34

likely negative

Question 35

what is the tx for extrusive luxation?

Answer 35

-reposition tooth -use splint 2 weeks -RCT if necrotic

Question 36

what is a lateral luxation?

Answer 36

-tooth is displaced most likely in palatal/labial/lingual direction. -mobile -TTP will likely give high metallic sound -alveolar bone will be fractured

Question 37

how will lateral luxation respond to sensitivity tests?

Answer 37

likely negative

Question 38

what is the tx for lateral luxation?

Answer 38

-reposition -splint for 4 weeks -monitor pulp- RCT if necrotic to prevent bone resorption

Question 39

what is avulsion?

Answer 39

complete displacement of tooth from alveolar bone

Question 40

when should you replant primary avulsed tooth?

Answer 40

NEVER- can damage permanent tooth

Question 41

if a parent or carer has replanted primary tooth, what should you do?

Answer 41

leave if viable and in situ

Question 42

how should you approach permeant tooth avulsion?

Answer 42

clean with saliva- and replant immediately. Bite on clean cloth gently

Question 43

how do you treat primary crown fractures without pulpal involvement?

Answer 43

-smooth fracture -restore with GI or composite resin

Question 44

how should you manage a more complication primary tooth fracture?

Answer 44

-remove loose fragments -rest of tooth can be extracted at later date -if small amount of root left in socket remain- leave in situ as will resorb

Question 45

how would you know if primary tooth has a root fracture?

Answer 45

-pulp necrosis -mobility -sinus formation

Question 46

how is a primary tooth with a root fracture treated?

Answer 46

remove coronal part of tooth- root will be resorbed

Question 47

what type of tooth trauma requires follow up?

Answer 47

all traumatised teeth -avoid predicting prognosis -reassure pt and parent -discuss all possible outcomes

Question 48

what is the management of permanent crown fracture close to pulp?

Answer 48

use lining and restore -if no one available use composite bandage

Question 49

what is the management of permanent crown involving the pulp?

Answer 49

-refer to dentist same day- always document everything.

Question 50

list the possible damage that can occur following trauma to primary/permenant teeth?

Answer 50

-pulpal necroris- grey discolouration and possible abcess -internal resorption of primary tooth -ankylosis (high metallic sound) of primary tooth -hypoplasia- less quantity -hypomineralisation- less mineralised -sensitivity -dilaceration of crown or root -resorption of permanent tooth germ

Question 51

what are the main aims when treating trauma to primary teeth?

Answer 51

prevent further damage to permanent teeth

Question 52

what are the main aims when treating trauma to permanent teeth?

Answer 52

maintain or regain vitality of dental pulp