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Endodontics > Introduction to Dental Related Trauma > Flashcards

Introduction to Dental Related Trauma Flashcards

1
Q

What is the benefit of photographic documentation of dental trauma patients

A
  • Allows monitoring of soft tissue healing
  • Assessment of tooth discolouration
  • Re-eruption of an intruded tooth
  • Development of infra-positioning of an ankylosed tooth
  • Provides medico-legal documentation
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2
Q

What is splinting in dentistry

A

This is when loose/weakened teeth are attached to other teeth to make them a single unit and therefore stronger

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3
Q

What kinds of teeth is short term, non rigid splinting recommended

A
  • Luxated, avulsed and root-fractured teeth

N.B. short term = 2 weeks - 4 months

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4
Q

What is the effect of splinting on the PDL

A

Flexible splinting promotes the healing of the PDL but this is not completely proven

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5
Q

What is the effect of splinting on the pulp

A

rigid splinting appears to slow down the pulpal revascularisation

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6
Q

When should antibiotics be considered in dental trauma patients

A
  • Up to clinician but there is only limited evidence for use of systemic antibiotics in the management of luxation injuries and no evidence that antibiotics improve outcomes for root-fractured teeth
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7
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

topical antibiotics are shown to help PDL recovery and decrease the extent of external root resorption

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8
Q

Why should you be careful when doing sensibility testing at the time of the injury

A

They can frequently give no response, indicating a transient lack of pulpal response and regular follow ups are required to make a pulpal diagnosis

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9
Q

What is pulp canal obliteration

A

Where hard tissue is deposited on the walls of the root canal and fills most of the pulp system, leaving it narrow and restricted

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10
Q

With which teeth is pulp canal obliteration the most common

A

In teeth with open apices that have suffered a severe luxation injury

NOTE: PCO USUALLY INDICATES ONGOING PULPAL VITALITY

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11
Q

What types of injury frequently show pulp canal obliteration

A
  • Extrusion
  • Intrusion
  • Lateral luxation
  • Following root fractures
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12
Q

What is the incidence of pulp necrosis in teeth with PCO

A

1-16%

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13
Q

Is endodontic intervention needed in teeth with PCO injuries

A
  • Often it is not needed unless pulpal necrosis is evidenced by periapical pathos’s and/or symptoms and when a negative response to EPT has been detected
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14
Q

Following splinting of teeth what patient instructions should be given

A
  • Follow up visits
  • Soft diet
  • Avoid biting on splinted teeth
  • Meticulous oral hygiene
  • Use antibacterial like chlorhexidine for 1-2 weeks
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15
Q

How frequent should the follow ups be for dental trauma/splinted teeth patients

A
  • 2 weeks
  • 4 weeks
  • 8 weeks
  • 4 months
  • 6 months etc etc
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16
Q

What are the emergency treatment options for a crown-root fracture with or without pulpal exposure

A
  • Fragment removal only
  • Fragment removal and gingivectomy
  • Orthodontic extrusion of apical fragment and RCT
  • Surgical extrusion
  • Decoronation
  • Extraction
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17
Q

When should the follow up for a crown-root fracture with or without pulpal exposure be

A

6-8 weeks and then 1 year

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18
Q

What is the prognosis of a crown-root fracture with pulpal exposure with surgical and orthodontic extrusion treatments

A

Surgical extrusion root resorption = 25% after 5 years

Orthodontic extrusion root resorption = 15% after 5 years

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19
Q

What is the % estimated risk of tooth loss with a root fracture luxation injury

A

21.5%

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20
Q

What is the % estimated risk of pulp necrosis with a root fracture luxation injury

A

30.9%

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21
Q

What is the % estimated risk of pulp canal obliteration with a root fracture luxation injury

A

> 69.8%

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22
Q

What is the treatment for an alveolar fracture

A
  • Manual repositioning or repositioning using forceps of the displaced segment
  • Stabilise the segment with flexible splinting for 4 weeks
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23
Q

What treatment is required for alveolar fracture patients in their follow up appointments and when should these appointments happen

A
  • Splint removal and radiographic control after 4 weeks

- Clinical and radiographic control after 6-8 weeks, 4 months, 6 months, 1 year and then yearly for 5 years

24
Q

What is a luxation injury

A

when the tissues, ligaments and sometimes bone that support your teeth become injured

25
Q

What is a concussion luxation injury

A

Concussion is an injury to tooth-supporting structures without abnormal loosening or displacement but with marked reaction to percussion

26
Q

What are the treatment options for concussion luxation injuries

A

Usually no need for treatment but should monitor the pulpal condition for at least 1 year

27
Q

What treatment should be done at the follow up appointments for concussion luxation patients

A

Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year

28
Q

What is a subluxation injury

A

This is when there is injury to the periodontal tissue that has caused increased mobility but hasn’t been displaced from its socket

29
Q

What are the clinical findings of a subluxation injury

A
  • Tooth is TTP and has increased mobility, hasn’t been displaced
  • Bleeding from gingival crevice may be noted
  • Sensibility testing may be negative initially indicating transient pulpal damage
  • Monitor pulpal response until a definitive pulpal diagnosis can be made
30
Q

What can usually be seen radiographically with subluxation injuries

A
  • Radiographic abnormalities are usually not found
31
Q

What treatment options are there for subluxation injuries

A
  • Normally no treatment needed but a flexible splint to stabilise the tooth for patient comfort can be used for up to 2 weeks
32
Q

What treatment should be done at the follow up appointments for subluxation and when

A 
2 weeks = splint removal, clinical and radiographic examination
4 weeks - clin. and rad. exams
6-8 weeks - " "
6 months - " "
1 year - " "
33
Q

What is the main prognosis of a subluxation injury

A

Pulp Necrosis

34
Q

What is an extrusive luxation injury

A

Injury caused by oblique forces characterised by partial displacement of the tooth out of its socket

35
Q

What treatment is there for extrusive lunation injuries

A
  • Exposed root surface of the displaced tooth is cleansed with saline before repositioning
  • Reposition tooth by gently re-inserting it into the tooth socket with axial digital pressure
  • Stabilise tooth for 2 weeks using a flexible splint
  • Monitoring the pulpal condition is essential to diagnose associated root resorption
  • In mature teeth where pulp necrosis is anticipated then RCT is indicated
36
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Follow up for extrusive luxation injury is the same ting with splint removal and then clinical and radiographic examination

37
Q

What are the most likely prognoses after an extrusive luxation injuries

A

> 56.5% for pulp necrosis

>21.7% for pulp canal obliteration

38
Q

What is a lateral luxation injury

A

When alveolar bone fractures and the PDL separates, tooth isn’t loose but is angled weirdly

39
Q

What are the treatment options for a lateral luxation injury

A
  • Rinse exposed part of the root surface with saline before repositioning
  • Apply LA
  • Reposition the tooth with forceps or with digital pressure to disengage from bony lock and gently reposition it into its original location
  • Stabilise the tooth for 4 weeks using flexible splint (4 weeks due to associated bone fracture)
  • Monitor pulpal condition to diagnose root resorption, if pulp becomes necrotic = RCT
40
Q

What is the most likely prognosis of a lateral laxation injury (after 10 years)

A

> 92.9% pulp necrosis

41
Q

What is an intrusion injury

A

occurs mainly in the primary dentition and usually result from an axially directed impact, which drives the tooth deeper into the alveolar socket

42
Q

What are the treatment options for intruded teeth

A
  • Spontaneous eruption (doing nothing)
  • Orthodontic repositioning
  • Surgical repositioning
43
Q

When is spontaneous eruption recommended with intruded teeth

A
  • In teeth with mature root development only when there is minor intrusion
44
Q

What benefits does spontaneous eruption treatment have

A

has fewer healing complications than orthodontic and surgical repositioning

45
Q

What should be done if there is no movement from spontaneous eruption of intruded teeth after a few weeks

A

Initiate orthodontic or surgical repositioning before ankylosis can develop

46
Q

When is surgical repositioning indicated for intruded teeth

A

Preferable in the acute phase and when the intrusion has major dislocation of more than 7mm

47
Q

When is orthodontic repositioning indicated

A

Treatment may be preferred for patients coming in for delayed treatment and enables repair of marginal bone in the socket along with the slow repositioning of the tooth

48
Q

AY BAWS CAN I HABE DE NOTE PLEASE

A

Splint removal and control after 4 weeks then regular monitoring

49
Q

How soon should endodontic therapy be initiated post-trauma

A

ideally 3-4 weeks

50
Q

What factors can determine treatment choice

A
  • Root development
  • Age
  • Intrusion level
51
Q

Name some of the prognoses of an intrusion injury after 10 years and try name their % estimated risk

A 
Tooth loss = 28.5%
Pulp necrosis >98.5%
PCO = unlikely
Ankylosis - 45.6%
Bone loss = 45.8%
52
Q

What is critical to maintain the condition of the cells for avulsed teeth

A

The storage medium and time out of the mouth and the dry time

After a dry time of 60minutes or more, all PDL cells are non-viable

53
Q

What is the treatment for avulsed teeth

A
  • Verify the tooth position clinically and rads (can just put tooth in with digital pressure if not already in mouth)
  • Clean area with saline, chlorhexidine
  • Flexible splinting for 2 weeks
  • Initiate RCT within 7-10 days prior to the splint removal
  • Administer antibiotics
  • Check tetanus status
54
Q

What antibiotics can be administered for avulsed teeth

A
  • Tetracycline is the first choice (doxycycline 2x/day for 7 days at appropriate dose for age and weight)
  • In young patients phenoxymethyl penicillin or amoxicillin at an appropriate dose for age and weight is the alternative to tetracycline
55
Q

What must be considered before the systemic administration of tetracycline in young patients

A

the risk of discolouration of permanent teeth

56
Q

If the extra-oral time of the tooth is more than 60minutes what treatment and prognosis differences are there

A
  • Poor prognosis and high chance of ankylosis
  • Same treatment e.g. cleaning, splinting, (RCT) and antibiotics
  • Except treatment of avulsed tooth with 2% sodium fluoride for 20 minutes
57
Q

Name some of the likely prognoses of avulsion after 10 years and try to name the % estimated risks

A
  • Tooth loss = 45.1%
  • Ankylosis = 74.2%
  • Inflammatory root resorption = 31.7%

Endodontics (9 decks)

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