Dental Trauma 3

Question 1

what are important considerations with soft tissue trauma

Answer 1

impact of injury on surrounding bone, neurovascular bundle and root surface
nature of trauma - separation/crushing

Question 2

what is concussion

Answer 2

injury to tooth supporting structures without abnormal loosening or displacement of tooth

Question 3

what are clinical findings of concussion

Answer 3

pain on percussion

Question 4

what is the treatment for concussion

Answer 4

none

Question 5

what is follow up for concussion

Answer 5

clinical and radiographic after 4 weeks then 1 year

Question 6

what is subluxation

Answer 6

injury to tooth supporting structures with abnormal loosening but without tooth displacement

Question 7

what are clinical findings of subluxation

Answer 7

increased mobility
tender to percussion
bleeding from gingival crevice may be present

Question 8

what is treatment for subluxation

Answer 8

none
splint if excessive mobility or tenderness when biting

Question 9

what is follow up for subluxation

Answer 9

2 weeks
12 weeks
6 months
1 year

Question 10

how do you monitor concussion and subluxation

Answer 10

trauma stamp
sensibility tests
radiographs

Question 11

what do you look for on follow up radiographs

Answer 11

root development
comparison with contralateral tooth
resorption

Question 12

what is on the trauma stamp

Answer 12

sinus
colour
mobility
TTP percussion
ethyl chloride
EPT
radiograph

Question 13

what is extrusion

Answer 13

an injury in which the tooth suffers axial displacement partially out of socket

Question 14

what are the clinical findings of extrusion

Answer 14

tooth appears elongated
displaced palatally
tooth mobile
bleeding from gingival sulcus

Question 15

how do you treat extrusion

Answer 15

reposition tooth by gently pushing back into socket under LA
splint

Question 16

what is follow up for extrusion

Answer 16

2 weeks
1 month
2 months
3 months
6 months
1 year
annually for 5 years

Question 17

what is lateral luxation

Answer 17

displacement of a tooth in a socket in a direction other than axially, accompanied by comminution or fracture or alveolar bone plate

Question 18

what are the clinical findings of lateral luxation

Answer 18

tooth appears displaced in socket
tooth immobile
high ankylotic percussive tone
may be bleeding from gingival sulcus
root apex palpable in sulcus

Question 19

what is lateral luxation treatment

Answer 19

reposition under LA
splint for 4 weeks
monitor

Question 20

what happens if a tooth with incomplete root formation has lateral luxation

Answer 20

spontaneous revascularisation can occur
if necrotic pulp and inflammatory external resorption then endo treatment

Question 21

what happens if a tooth with complete root formation has lateral luxation

Answer 21

necrotic pulp so start endo treatment
place corticosteroid antibiotic into canal or calcium hydroxide as intra canal medicament

Question 22

what is follow up for lateral luxation

Answer 22

2 weeks
4 weeks - splint removal
2 months
3 months
6 months
1 year
annually for 5 years

Question 23

what is intrusion

Answer 23

tooth forced into socket in axial direction and locked in bone

Question 24

what is clinical findings with intrusion

Answer 24

crown appears shortened
bleeding from gingivae
ankylotic high, metallic percussion tone

Question 25

how do you treat an intruded tooth with immature root formation

Answer 25

spontaneous repositioning if no eruption within 4 weeks then ortho monitor pulp necrotic pulp = endo

Question 26

how do you treat an intruded tooth with mature root formation

Answer 26

if <3mm then spontaneous repositioning if no eruption within 8 weeks the surgical reposition and splint for 4 weeks or ortho reposition if 3-7mm then surgical/ortho reposition if >7mm then reposition surgically

Question 27

how do you treat an intruded tooth with complete root formation

Answer 27

start endo treatment at 2 weeks

Question 28

what is follow up for intrusion

Answer 28

2 weeks 4 weeks 2 months 3 months 6 months 1 year annually for 5 years

Question 29

what is avlusion

Answer 29

tooth totally displaced from socket

Question 30

what is clinical findings with avulsion

Answer 30

socket empty or filled with coagulum

Question 31

what are the critical factors for an avulsed tooth

Answer 31

extra alveolar dry time extra alveolar time storage medium

Question 32

what emergency advice do we give for avulsed teeth

Answer 32

ensure permanent tooth hold by crown place immediately into socket rinse in milk/saline/saliva bite on gauze to hold in place seek immediate dental advice

Question 33

what do you store an avulsed tooth in

Answer 33

milk HBSS saliva saline water

Question 34

what factors influence management of avulsed tooth

Answer 34

maturity of root PDL cells condition

Question 35

how do you manage an avulsed tooth with closed apex

Answer 35

clean injured area verify tooth position and apical status place splint suture gingival lacerations consider antibiotics and check tetanus post op instructions follow up

Question 36

at what extra alveolar dry time will the PDL cells likely be non-viable

Answer 36

>60mins

Question 37

when do you start endo treatment on avulsed tooth with closed apex

Answer 37

2 weeks

Question 38

what medication is placed inside an avulsed tooth when doing RCT

Answer 38

calcium hydroxide up to 1 month corticosteroid/antibiotic paste for 6 weeks

Question 39

what is follow up for avulsed teeth

Answer 39

2 weeks 4 weeks 3 months 6 months 1 year annually for 5 years

Question 40

what is emergency treatment for open apex avulsed tooth

Answer 40

clean injured area verify position place splint suture lacerations consider antibiotics and check tetanus provide post op instructions follow up

Question 41

what happens to an avulsed open apex tooth if EAT >60 mins

Answer 41

PDL cells non-viable ankylosis related root resorption

Question 42

what is the goal with open apex avulsed teeth

Answer 42

revascularisation

Question 43

what is follow up for open apex avulsed tooth

Answer 43

2 weeks 1 month 2 months 3 months 6 months 1 year annually for 5 years

Question 44

when would you not replant an avulsed tooth

Answer 44

immunocompromised very immature apex EAT >90mins very immature lower incisors

Question 45

what is alveolar fracture

Answer 45

fracture of alveolar bone which may or may not involve alveolar socket

Question 46

what are the clinical findings with alveolar fracture

Answer 46

complete alveolar fracture extending from buccal to palatal bone in maxilla and buccal to lingual bone in mandible segment mobility and displacement with several teeth moving together occlusal disturbance gingival laceration

Question 47

how do you treat alveolar fracture

Answer 47

reposition any displaced segment stabilise by splinting suture gingival lacerations monitor pulp condition of all teeth

Question 48

what is the follow up for alveolar fracture

Answer 48

monitor clinically and radiographically 4 weeks 6-8wks 4 months 6 months 1 year annually for 5 years

Question 49

what advice do you give for alveolar fractures

Answer 49

soft diet for 7 days avoid contact sport whilst splint in place careful oral hygiene with use of chlorhexidine mouthwash

Question 50

when would you splint a tooth for 2 weeks

Answer 50

subluxation extrusion avulsion

Question 51

when would you splint a tooth for 4 weeks

Answer 51

intrusion lateral luxation root fracture - mid root and apical third dento alveolar fracture

Question 52

when would you splint a tooth for 4 months

Answer 52

root fracture in cervical third

Question 53

what are the types of chairside splint

Answer 53

composite and wire composite orthodontic brackets and wire acrylic titanium trauma splint

Question 54

what are the types of lab made splint

Answer 54

vacuum formed acrylic

Question 55

what is a composite and wire splint

Answer 55

stainless steel wire 0.4mm passive flexible

Question 56

when is an acrylic splint useful

Answer 56

when few abutment teeth

Question 57

what are the main post trauma complications

Answer 57

pulp necrosis and infection pulp canal obliteration root resorption breakdown of marginal gingiva and bone

Question 58

what is pulp canal obliteration

Answer 58

progressive hard tissue formation within pulp cavity gradual narrowing of pulp chamber and pulp canal

Question 59

what are the types of external root resorption

Answer 59

surface inflammatory resorption cervical ankylosis

Question 60

what is internal root resorption

Answer 60

internal infection related inflammatory root resorption

Question 61

what is external surface resorption

Answer 61

superficial resorption lacunae repaired with new cementum response to localised injury not progressive

Question 62

what is external infection related inflammatory root resorption

Answer 62

non-vital tooth initiated by PDL damage indistinct root surface happens rapidly

Question 63

how do you manage external infection related inflammatory root resorption

Answer 63

remove stimulus endodontic treatment

Question 64

what is ankylosis related root resorption

Answer 64

initiated by severe damage to PDL and cementum bone repair does not occur severe luxation or avulsion root remodels

Question 65

how do you treat ankylosis related root resorption

Answer 65

plan for loss

Question 66

what is internal infection related inflammatory root resorption

Answer 66

due to progressive pulp necrosis can see symmetrical expansion of root canal walls and tramlines are indistinct

Question 67

how do you treat internal infection related inflammatory root resorption

Answer 67

remove stimulus and do endodontic treatment