Lec 9

Question 1

what is the age range for most dental trauma?

Answer 1

7-14

Question 2

where does most dental trauma occur?

Answer 2

anterior region of maxilla and mandible

Question 3

primary dentition injury?

Answer 3

-prevent injury to succedaneous tooth
-comfort Pt
-never replace avulsed primary tooth

Question 4

what percentage of children in the US will have dental trauma?

Answer 4

4-14%

Question 5

trauma epidemiology for children under 5

Answer 5

-1/3 injuries in primary dentition
-luxation more common
-males more common

Question 6

trauma epidemiology for children 12 and up

Answer 6

-20-30% will suffer trauma
-uncomplicated crown fracture most common
-males more common

Question 7

what is an uncomplicated crown fracture?

Answer 7

crown fracture without pulp exposure
type 1 (enamel only)
type 2 (enamel & dentin)
-if vital, just restore and monitor

Question 8

what is a complicated crown fracture?

Answer 8

type 3 pulp exposure
treatment:
-pulp cap (bioceramic materials)
-pulpotomy if open apex
-RCT if apex closed
-post if needed

Question 9

what is a crown root fracture?

Answer 9

often fractures at an angle
fracture line hard to see, take many radiographs
treatment:
-remove fx
-restore if no pulp exposure
-vital pulp therapy if apex open
-RCT if apex closed
-make sure no 2nd component of fx

Question 10

what is a vertical root fracture?

Answer 10

fracture from crown to root
-may see J lesion on radiograph but not always
-expose surgically to document
-transillumination

Question 11

what is a horizontal root fracture?

Answer 11

easily seen on radiographs
-rare in posterior teeth
-excess mobility is an indicator
-salvage depending on fx location

Question 12

multifactorial treatment options for HRF?
-case by case basis

Answer 12

-level of fx
-restorability
-perio health
-vitality of pulp
-stage of root dev (old vs young)
-time since injury
-age and coop
-etc.

Question 13

always check vitality as a baseline

Answer 13

TRUE

Question 14

HRF healing after splint placed?

Answer 14

-hard tissue 33%
-connective tissue 36%
-bone and CT 8%
-non healing 23% (mickey mouse ears = RCT!)

Question 15

what are alveolar fractures?

Answer 15

bone fractures, will have mobile bone segment
-splint needed for 4-6 weeks
-slow healing
-lots of pain

Question 16

what are the most common types of dental injuries?

Answer 16

luxations 30-44%

Question 17

order of luxations least to greatest damage

Answer 17

concussion
subluxation
lateral luxation
extrusive luxation
intrusive luxation

Question 18

what is a concussion?

Answer 18

bump into tooth
-least severe luxation
-no displacement of tooth
-no mobility
-bruised PDL, tooth tender to percussion
-no radiographic anomalies
-asses vitality in 2-4 weeks and follow

Question 19

what is subluxation?

Answer 19

tooth slightly mobile but still in same position
-tooth sensitive to percussion
-slightly mobile (+1)
-no displacement
-possible bleeding
-no radiographic anomalies
-damage to some supporting structures
-asses vitality in 2-4wk and follow

Question 20

what is lateral luxation?

Answer 20

tooth displaced laterally and locked in bone
-not tender to percussion
-not mobile
-alveolus fractured
-increased PDL seen on radiographs
-numb and push tooth back in
-MUST SPLINT 4 weeks
-asses vitality 2-4 weeks and follow
-if lip laceration, take x ray bc piece may be in lip

Question 21

what is a flexible splint?

Answer 21

splint that allows physiological movement of the teeth to minimize ankylosis
-use ortho wire 18 gauge or fish line
-splint bond to 1 tooth on each side
-2 weeks or 4 weeks if alveolar fracture

Question 22

what is an extrusive luxation?

Answer 22

tooth comes down out of socket
-elongated mobile tooth (+2)
-no bone fracture
-increased apical periodontal space seen on radiographs
-manually reposition and MUST SPLINT 14 days
-asses vitality 2-4 weeks and follow

Question 23

what is an intrusive luxation

Answer 23

tooth is pushed deep into socket
-most severe luxation
-tooth appears shorter
-PDL destruction, alveolar bone crushed
-watch for ankylosis/resorption
-external resorption likely
-pulp necrosis certain, RCT 100% of the time!
-not mobile
-not tender to touch
-sounds different on percussion test
-radiographs not always conclusive
- slightly pull tooth with forceps and move with ortho asap
-splint for 14 days or more if alveolar fx
-tooth with open apex may spontaneously re-erupt

Question 24

what is an avulsion?

Answer 24

tooth knocked out completely
-PDL must be viable to save tooth
-tooth cannot be dried out for more than 30 min or PDL wont survive (15 min critical)
-must be placed back in socket to prevent ankylosis and external root resorption

Question 25

when to replant avulsed tooth?

Answer 25

most important factor: speed at which tooth can be cleaned and properly replanted for viable PDL (under 15 min) - do not if primary tooth

Question 26

first aid options for avulsed tooth

Answer 26

-save a tooth solution -via span -milk or green tea -contact lens solution -saliva in vestibule

Question 27

first aid for avulsed tooth

Answer 27

-handle by crown only -pick off debris with tweezers -replant in socket ASAP -do not rinse with water -take xray asap to check for alveolar fx -clean socket with saline -splint -antibiotics and tetanus if needed

Question 28

avulsed teeth DO NOTs

Answer 28

DO NOT -allow tooth to dry -scrub root -handle by root

Question 29

trauma effects

Answer 29

some effects are not permanent -pulpal sclerosis -ankylosis after long term splinting -resorption

Question 30

what sound will you hear if you do percussion test on ankylosed tooth?

Answer 30

high pitched metallic ring

Question 31

what does internal root resorption look like?

Answer 31

pregnant pulp aneurysm in canal

Question 32

what is external root resorption?

Answer 32

bone replaces dentin asymptomatic usually history of avulsion or luxation