DETNAL TRAUMA

Question 1

What is the most common TDI in the primary dentition?

Answer 1

Luxation injuries are the most common & more common in boys!

Question 2

does dental trauma matter in the long run

Answer 2

• yes, trauma is the most common cause of loss of permanent incisors in childhood

Question 3

what is the most common complication of trauma

Answer 3

PULPAL NECROSIS resulting in long term restorative problems

Question 4

what are the 3 peak times dental trauma can occur

Answer 4

1. 2-4 years
2. 8-10 years
3. 14-16 years

Question 5

what are the PREVENTION STRATEGIES for dental trauma incidences (3)

Answer 5

• it can be difficult to manage a child from stopping trauma to teeth
• increased incidence with INCREASED OVERJET
• mouthguards

Question 6

what is the main points of management for trauma

Answer 6

PROPER DX, TX PLANNING and follow-up are important to assure a favourable outcome

Question 7

what are the 8 steps that we do first when presented with trauma

Answer 7

• check for head injury
• assess the dental/facial injury
• does the story fit?
• where are the bits?
• do emergency dental treatment to STABILISE injnuries
• clean up patient
• review and treat or refer to specialist
• DOCUMENT EVERYTHING

Question 8

what are the 2 types of injury that may occur from a BLOW to the teeth

Answer 8

INJURIES TO THE TOOTH:
- CROWN fracture
- ROOT fracture
- these may be from impact against something hard ie the road or golf club etc

INJURIES TO THE SOCKET:
- tooth intact but displaced or loosened within its socket
- result of an impact with something softer ie fist elbow etc

Question 9

what is the main problem with DENTAL INJURIES

Answer 9

it is that bacteria can invade pulp, so cover all exposed dentine quickly and monitor vitality of tooth

Question 10

what is the main problem with DENTO-ALVEOLAR injuries

Answer 10

it is that any significant movement within the socket will almost certainly sever all the blood vessels entering the pulp via the apical foramen so the pulp horns become NECROTIC

Question 11

List the 4 types of dental trauma

Answer 11

• LUXATION
• AVULSION
• CROWN FRACTURES
• ROOT FRACTURES

Question 12

LUXATIONS IN THE PRIMARY TEETH CAN BE SPLIT INTO 4 SUB-GROUPS. WHAT ARE THEY:

Answer 12

(luxation is the most common injury to the primary teeth involving displacement of the teeth and the alveolar bone)

• CONCUSSION
• SUBLUXATION
• INTRUSIVE LUXATION
• EXTRUSIVE AND LATERAL LUXATION

Question 13

LUXATIONS - what is concussion

Answer 13

concussion is an injury to the tooth without displacement or mobility of the tooth (OH needs to be stressed here as increased risk of bacterial entry)

Question 14

LUXATIONS - what is subluxation

Answer 14

this occurs when the tooth is mobile but is not displaced. (OH needs to be stressed here as increased risk of bacterial entry)

Question 15

When we test concussed/subluxated teeth what are the results?

Answer 15

these type of injured teeth are TTP, there is haemorrhage and oedema within the ligament, but gingival bleeding and mobility occur only if the teeth have ben SUBLUXATED!!!!

IF TOOTH MOBILE, DO NOT CHECK TTP IF RECENT INJURY. VITALITY CHECK 1 WEEK POST TRAUMA!

Question 16

what is the management of concussion and subluxation(5)

Answer 16

• periapical radiograph
• soft diet for one week
• advice to parents, possible sequelae
• follow up
• check immunization ie tetanus

Question 17

LUXATION - what is INTRUSIVE LUXATION

Answer 17

• most common injury to upper primary incisors
• newly erupted incisors often take the full force of ANY fall
• usually a palatal and superior displacement of the crown

Question 18

what is the management of intrusive luxation

Answer 18

• if the crown is visible with minor alveolar damage - leave the tooth to re-erupt
• if the whole tooth is intruded - XLA
• decision is solely based on the presentation of the injuries and assessment of the child

INCREASED SEVERITY = INCREASED RISK OF XLA!!!

Question 19

luxations - describe management of extrusive and lateral luxations

Answer 19

• treatment is dependant on the mobility and extent of displacement
• if there is excessive mobility, the tooth should be extracted

Question 20

luxations - what is the management of avulsion

Answer 20

• avulsed primary teeth should NOT be replanted
• lack of pt cooperation
• may damage the developing permanent tooth
• carer/parent may replant tooth - if stable and viable leave in situ

Question 21

what is avulsion (seperate from luxation)

Answer 21

this is a complete displacement of a tooth from its socket in the alveolar bone

Question 22

luxations - what happens if avulsion occurs in a permanent tooth

Answer 22

• REPLANT IMMEDIATELY
• to rinse or not to rinse?
• bite gently on clean hanky/cloth
• unable to replant - advice?

Question 23

FRACTURES OF THE PRIMARY INCISORS - what is the management of treating a CROWN fracture not involving the pulp

Answer 23

if possible restore with GI or comp resin

Question 24

what are the complications of crown/root fractures(3)

Answer 24

• they are more likely to involve the pulp and extend BELOW the gingival margin
• there may be multiple fractures in individual teeth
• fracture not always immediately evident!

Question 25

what is the management of FRACTURES TO PRIMARY INCISORS (NOT crowns) - (4)

Answer 25

- loose fragments should be removed - remaining tooth can be extracted at a later date - small pieces of root remaining in socket after a fracture may be SAFELY left in situ - ROOT FRACTURE - signs of pulpal necrosis, excessive mobility or sinus formation remove CORONAL proportion as root will resorb/exfoliate anyway.

Question 26

what are the SEQUELAE after trauma to primary teeth(4)

Answer 26

- all traumatised teeth require follow up - difficult to accurately predict prognosis esp with permanent teeth so guarded prognosis! - reassure patient and parents - discuss with parents possible outcomes

Question 27

management of fractures to permanent teeth (5)

Answer 27

- initial management matters! - time is of the essence - ensure injury is stabilised and reduce chance of infection! - get specialist help if needed - treat the uncomplicated crown fracture close to pulp, if no one available, stabilise trauma with a composite bandage. if pulp involved refer to be seen by a dentist SAME DAY DOCUMENT (often legal cases)

Question 28

what is the possible damage to primary and permanent teeth due to trauma.... (6)

Answer 28

- necrosis of the pulp of the primary tooth with grey discolouration and possible abscess formation - internal resorption of the primary tooth - ankylosis of the primary tooth (fused bone due to the root) - hypoplasia or MIH of successory teeth (adult teeth) - dilaceration of the crown or root - resorption of the permanent tooth gem

Question 29

MAIN AIMS OF MANAGING TRAUMA IN A KID....

Answer 29

- the main aim of managing trauma to PRIMARY incisors is to prevent further damage to the developing permanent incisors - the main aim of managing trauma to PERMANENT incisors is the maintain or possible regain VITALITY OF THE DENTAL PULP.