Dental Trauma - supporting tissue injury

Question 1

What are the classifications of dental trauma injuries?

Answer 1

1) Dental hard tissues and pulp
2) Supporting tissues (PDL & bone)

Question 2

Name the types of dental hard tissue and pulp injury

Answer 2

1) Enamel fracture (Uncomplicated crown fracture)
2) Enamel & dentine fracture (Uncomplicated crown fracture)
3) Enamel, dentine and pulp fracture (Complicated crown fracture)
4) Crown-root fracture
5) Root fracture

Question 3

Name the types of supporting tissues (PDL and bone) injury

Answer 3

1) Concussion
2) Subluxation
3) Lateral luxation
4) Intrusion
5) Extrusion
6) Avulsion
7) Alveolar fracture

Question 4

Describe a concussion tooth injury

Answer 4

Injury to the tooth supporting structures without abnormal loosening or displacement of the tooth

Question 5

What are the findings in a concussion tooth injury

Answer 5

There is pain on percussion
No radiographic abnormalities

Question 6

What is the treatment for a concussion injury

Answer 6

No treatment

Follow-up:
Clinical and radiographic: 4 weeks and 1 year after injury

Question 7

What is a subluxation injury?

Answer 7

An injury to the tooth-supporting structures with abnormal loosening, but without tooth displacement

Question 8

What are the clinical findings in a subluxation injury

Answer 8

Increased mobility - but tooth not displaced
Tender to percussion
Bleeding from the gingival crevice may be present
Radiographic appearance usually normal

Question 9

What is the treatment for a subluxation injury?

Answer 9

Treatment:
Normally not required
Splint if:
excessive mobility or
tenderness when biting

Question 10

What is the follow up for a subluxation injury

Answer 10

Clinical and radiographic:
2 weeks post injury (including splint removal)
12 weeks post injury
6 months post injury
1 year post injury

Question 11

What is an extrusion injury?

Answer 11

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

Question 12

What are the clinical findings in an extrusion injury?

Answer 12

Clinical findings:
Tooth appears elongated
Usually displaced palatally
Tooth mobile
Bleeding from gingival sulcus

Radiographically:
increased apical and lateral periodontal space
Appears elongated incisal

Question 13

What is the treatment for extrusion?

Answer 13

Treatment:
Reposition the tooth by gently pushing It back into the tooth socket under local anaesthesia
Splint (passive and flexible) for 2 weeks. If marginal break down of tooth then further splinting for 4 week.

Question 14

What is the follow-up for an extrusion injury?

Answer 14

Follow-up (clinical and radiographic):
2 weeks post injury (including splint removal)
4 weeks, 8 weeks, 12 weeks, 6 months, 1 year
Then annually for at least 5 years

Question 15

What is a lateral luxation injury?

Answer 15

Displacement of a tooth in socket in a direction other than axially; accompanied by comminution or fracture of alveolar bone plate.

Question 16

What are the clinical findings in a lateral luxation injury?

Answer 16

Clinical findings:
Tooth appears displaced in socket
Tooth immobile
High ankylotic percussion tone
May be bleeding from gingival sulcus
Root apex may be palpable in sulcus
Radiographs show a widened PDL space

Question 17

What is the treatment for a lateral luxation injury

Answer 17

Treatment:
Reposition under local anaesthesia
Splint
Monitor
Endodontic evaluation (approx. 2/52 post-injury)

Question 18

What is the follow-up for a lateral luxation injury

Answer 18

Treatment:
Reposition under local anaesthesia
Splint - passive, inflexible, 4 weeks
Monitor - sensibility testing (likely negative)
Endodontic evaluation (approx. 2/52 post-injury

Question 19

What is an avulsion injury?

Answer 19

Tooth totally displaced from socket

Question 20

What are the clinical findings from an avulsion injury?

Answer 20

Clinical findings:
Socket empty or filled with coagulum