International Association of Dental Traumatology: Dental Trauma Guide

Question 1

What are the different luxation injuries that can occur?

Answer 1

• concussion
• subluxation
• extrusion
• lateral luxation
• intrusion
• avulsion

Question 2

What hard-tissue fracture injuries can occur ?

Answer 2

• enamel infraction
• enamel fracture
• uncomplicated crown fracture
• complicated crown fracture
• uncomplicated crown-root fracture
• complicated crown-root fracture
• root fracture
• alveolar fracture

Question 3

When should you follow up with a primary patient who has experienced enamel fracture?

Answer 3

no follow up

Question 4

When should you follow up with a primary patient who has experienced enamel-dentine fracture?

Answer 4

8 week review

Question 5

When should you follow up with a primary patient who has experienced crown fracture?

Answer 5

• 1 week
• 8 weeks
• 1 year [radiograph if endo treatment carried out]

Question 6

When should you follow up with a primary patient who has experienced crown/root fracture?

Answer 6

• 1 week
• 8 weeks
• 1 year [radiograph if endo carried out]

Question 7

When should you follow up with a primary patient who has experienced root fracture?

Answer 7

• 1 week
• 4 weeks [splint removal]
• 8 weeks
• 1 year

Question 8

When should you follow up with a primary patient who has experienced alveolar fracture?

Answer 8

• 1 week
• 4 weeks [splint removal & take radiograph]
• 8 weeks
• 1 year [radiographs]

Question 9

What outcomes should you consider when a patient comes for clinical reviews after hard-tissue trauma?

Answer 9

• periodontal healing
• pulp healing
• pain
• discolouration
• tooth loss
• quality of life
• aesthetics
• trauma related dental anxiety

Question 10

When should you follow up with a primary patient who has experienced concussion?

Answer 10

• 1 week
• 8 weeks

Question 11

When should you follow up with a primary patient who has experienced subluxation?

Answer 11

• 1 week
• 8 weeks

Question 12

When should you follow up with a primary patient who has experienced extrusion?

Answer 12

• 1 week
• 8 weeks
• 1 year

Question 13

When should you follow up with a primary patient who has experienced lateral luxation?

Answer 13

• 1 week
• 4 weeks [splint removal]
• 8 weeks
• 6 months
• 1 year

Question 14

When should you follow up with a primary patient who has experienced intrusion?

Answer 14

• 1 week
• 8 weeks
• 6 months
• 1 year

Question 15

When should you follow up with a primary patient who has experienced avulsion?

Answer 15

• 1 week
• 8 weeks

Question 16

How long should a tooth that has experienced subluxation be splinted? [not always splinted]

Answer 16

2 weeks

Question 17

How long should a tooth that has experienced extrusion be splinted?

Answer 17

2 weeks

Question 18

How long should a tooth that has experienced lateral luxation be splinted?

Answer 18

4 weeks

Question 19

How long should a tooth that has experienced intrusion be splinted?

Answer 19

4 weeks

Question 20

How long should a tooth that has experienced avulsion be splinted?

Answer 20

2 weeks

Question 21

How long should a tooth that has experienced root fracture [apical/mid third] be splinted?

Answer 21

4 weeks

Question 22

How long should a tooth that has experienced root fracture [cervical third] be splinted?

Answer 22

4 months

Question 23

How long should a tooth that has experienced alveolar fracture be splinted?

Answer 23

4 weeks

Question 24

What is enamel infraction?

Answer 24

an incomplete fracture (crack or crazing) of the enamel, without loss of tooth structure

Question 25

What are the clinical findings of an enamel-dentine fracture?

Answer 25

- normal mobility - positive pulp sensibility test - not TTP

Question 26

How should an enamel-dentine fracture be treated?

Answer 26

- re-bond tooth fragment if pt has it [rehydrate in water or saline for 20 mins] - cover exposed dentine with GIC or composite resin - if exposed dentine is within 0.5mm of pulp place a COH lining & cover with GIC/comp

Question 27

What are the clinical findings of an enamel-dentine-pulp fracture?

Answer 27

- normal mobility - not TTP - exposed pulp is sensitive to stimuli - check for luxation or root fracture

Question 28

How should an enamel-dentine-pulp fracture be treated?

Answer 28

Immature roots & open apices: - partial pulpotomy or pulp capping with calcium hydroxide - re-bond tooth fragment or restore with GIC/composite

Question 29

What are the clinical findings of a crown-root fracture?

Answer 29

- pulp sensibility tests usually positive - TTP - coronal fragment is usually present and mobility

Question 30

What radiographs should be taken for a crown-root fracture?

Answer 30

- one periapical radiograph - occlusal radiograph

Question 31

What are the clinical findings of a concussion injury to a tooth?

Answer 31

- normal mobility - tooth is TTP & touch - normally responds to pulp sensibility testing

Question 32

How is concussion of a tooth treated?

Answer 32

no treatment is needed [monitor pulp for a year]

Question 33

What are the clinical findings of a subluxation injury to a tooth?

Answer 33

- increased mobility but not displaced - bleeding from gingival crevice - tender to touch or tapping - tooth may not initially respond to pulp testing

Question 34

How is a subluxation injury treated?

Answer 34

- normally no treatment needed - if there is excessive mobility or tenderness, use passive & flexible splint for 2 weeks - monitor pulp for 1 year

Question 35

What are the clinical findings of an extrusion injury?

Answer 35

- tooth appears elongated - increased mobility - no response to pulp sensibility tests

Question 36

What are the radiographic findings of an extrusion injury?

Answer 36

- increased PDL apically & laterally

Question 37

How should an extrusion injury be treated?

Answer 37

- reposition tooth by pushing it back into tooth socket under LA - passive & flexible splint 2 weeks - monitor pulp - RCT if pulp becomes necrotic

Question 38

What is lateral luxation?

Answer 38

Displacement of tooth in lateral direction, usually associated with a fracture or compression of the alveolar socket wall

Question 39

What are the clinical findings of a lateral luxation injury?

Answer 39

- tooth displaced in a palatal/lingual or labial direction - usually associated fracture of the alveolar bone - tooth is frequently immobile - high metallic (ankylotic) sound - no response to pulp sensibility tests

Question 40

What are the radiographic findings of an lateral luxation injury?

Answer 40

widened PDL space

Question 41

How should a lateral luxation injury be treated?

Answer 41

- reposition tooth - stabilise for 4 weeks with passive & flexible splint - monitor pulp - decide if tooth needs RCT or not [based on stage of root development]

Question 42

What is an intrusive luxation injury?

Answer 42

Displacement of the tooth in an apical direction into the alveolar bone

Question 43

What are the clinical findings of an intrusion injury?

Answer 43

- tooth displaced axially into alveolar bone - tooth is immobile - high metallic (ankylotic) sound - no response to pulp sensibility tests

Question 44

What are the radiographic findings of an intrusion injury?

Answer 44

- PDL space may not be visible for some of the root - cemento-enamel junction is located more apically

Question 45

How is an intrusion injury [to a tooth with incomplete root formation] treated?

Answer 45

- allow re-eruption without intervention - if no re-eruption within 4 weeks, initiate orthodontic repositioning - monitor pulp condition - decide if RCT is needed