Trauma 1 and 2 - intro

Question 1

what is the most common trauma injury in preschoolers up to the age of 5 years old?

Answer 1

luxation

Question 2

what type of occlusion is a predisposing factor for dental trauma?

Answer 2

increased overjet with protrusion upper incisors

Question 3

what dental tissues are involved in healing post dental trauma?

Answer 3

pulp
PDL
apex formation
bone and gingivae/ mucosa

Question 4

do mature or immature teeth withstand trauma better? and why?

Answer 4

immature teeth
they have a bigger blood supply and open apex

Question 5

if an immature tooth loses vitality, what must be used to close its apex?

Answer 5

MTA - mineral trioxide aggregate

Question 6

what are the physiological properties of enamel?

Answer 6

hard and brittle

Question 7

what are the physiological properties of dentine?

Answer 7

porous
pulpodentinal complex - odontoblasts

Question 8

what must be performed if a tooths dentine is traumatised?

Answer 8

immediate seal

Question 9

what are the physiological components of gingivae?

Answer 9

gingival fibres
junctional epithelium
alveolar mucosa

Question 10

how many days does it take for junctional epithelium to reattach after trauma?

Answer 10

up to 5 days

Question 11

what is the difference between primary and secondary healing intention?

Answer 11

primary - wound closure by surgical treatment
secondary - wound left to heal by itself

Question 12

what are the physiological properties of pulp?

Answer 12

encased in hard tissue
can repair

Question 13

what is the function of root sheath of hertwig?

Answer 13

guides root formation

Question 14

what does the PDL connect and what is it composed of?

Answer 14

connects the tooth cementum to gingiva and alveolar bone

Question 15

had the PDL got good healing potential?

Answer 15

yes

Question 16

what are the 2 ways the PDL may be disrupted after dental trauma?

Answer 16

crush
separation

Question 17

what are the physiological properties of bone?

Answer 17

vascular
active remodelling

Question 18

what happens to dental bone when there is inflammation?

Answer 18

resorption
inflammatory mediators induce osteoclasts

Question 19

what may occur if there is displacement of the apex of a tooth?

Answer 19

ischaemia

Question 20

can revascularisation occur if the apex is displaced?

Answer 20

likely if apex is more than 1mm
rare if apex is less than 0.5mm

Question 21

what is a special consideration when there is trauma to a primary tooth?

Answer 21

the developing permanent dentition beneath

Question 22

how may a developing permanent dentition be damaged?

Answer 22

direct trauma
infection/ inflammation of primary teeth

Question 23

what are the classifications of dental trauma injuries following WHO1995?

Answer 23

dental injuries
periodontal injuries
soft tissue injuries
skeletal injuries

Question 24

what are the classifications of dental (tooth) injuries following WHO 1995?

Answer 24

enamel infraction (incomplete crack)
enamel #
enamel dentine # (uncomplicated)
enamel dentine pulp #(complicated)
crown root # without pulp involvement
crown root # with pulp involvement
root # (cervical or mid 1/3)

Question 25

how is an enamel infarction described?

Answer 25

incomplete # (crack) of the enamel without loss of tooth structure - not tender - no radiographic abnormalities

Question 26

how is an enamel # described and investigation results?

Answer 26

complete # of enamel - loss of enamel - no sign of exposed dentin - not tender - no mobility - positive sensibility test - enamel loss radiographically

Question 27

how is enamel dentine # (uncomplicated) described and investigation results?

Answer 27

confined to enamel and dentin with loss of tooth structure but not exposing pulp - no TTP - no mobility - positive sensibility test - enamel-dentin loss radiographically

Question 28

how is enamel dentin pulp # (complicated) described and investigation results?

Answer 28

involving enamel and dentin with loss of tooth structure and exposed pulp - no mobility - no TTP - exposed pulp sensitive to stimuli - enamel-dentin loss radiographically

Question 29

how is a crown root # without pulp involvement described and investigation results?

Answer 29

involving enamel, dentin and cementum with loss of tooth structure but not exposing the pulp - crown fracture extending below gingival margin - TTP - coronal fragment mobile - positive sensibility test for apical fragment - apical extension of fracture usually not seen radiographically

Question 30

how is crown root # with pulp involvement described and investigation results?

Answer 30

involving enamel, dentin and cementum and exposing the pulp - TTP - coronal fragment mobile - apical extension of fracture not seen radiographically

Question 31

how is root # (cervical or mid 1/3) described and investigation results?

Answer 31

coronal segment may be mobile and displaced - may be TTP - bleeding from gingival sulcus - sensibility testing initially negative - transient crown discolouration (red or grey) may occur

Question 32

if a tooth has a root # (cervical or mid 1/3rd), what may sensibility testing result in and indicate? and what must be monitored regularly?

Answer 32

sensibility testing may initially be negative which indicates transient or permanent neural damage pulpal status should be monitored

Question 33

what angle if the fracture in a tooth that is classified as a root # cervical or mid 1/3

Answer 33

horizontal or oblique plane

Question 34

how may horizontal fractures be detected?

Answer 34

PA 90 degree

Question 35

how may oblique fractures in the apical third be detected?

Answer 35

occlusal varying horizontal angles

Question 36

4 types of periodontal injuries?

Answer 36

concussion subluxation luxation avulsion

Question 37

describe concussion and investigation results

Answer 37

"bruised" no displacement TTP no radiographic abnormalities

Question 38

describe subluxation and its investigation results

Answer 38

"loosened" no displacement TTP increased mobility negative initial sensibility testing no radiographic abnormalities

Question 39

what must be monitored for a tooth with subluxation?

Answer 39

pulpal response as sensibility testing may be initially negative - transient pulpal damage

Question 40

describe extrusive luxation and its investigation results

Answer 40

tooth appears elongated excessively mobile negative sensibility result radiographically - increased PDL apically

Question 41

describe intrusive luxation and its investigation results

Answer 41

tooth displaced axially into alveolar bone immobile percussion may give a high, metallic (ankylotic) sound negative sensibility tests radiographically - absent PDL from all/ part of root, CEJ located more apically

Question 42

describe lateral luxation and its investigation results

Answer 42

tooth displaced palatal/ lingual immobile percussion gives a high, metallic (ankylotic) sound fractured alveolar process negative sensibility tests radiographically - widened PDL on eccentric or occlusal exposures

Question 43

how may you treat a primary tooth that has experienced lateral luxation?

Answer 43

if there is no occlusal interference - tooth can reposition spontaneously if tooth interferes with occlusion - selectively grind the tooth

Question 44

list 3 types of intra oral soft tissue injuries

Answer 44

grazes/ lacerations degloving contusions (bruises)

Question 45

list 3 extra oral soft tissue injuries

Answer 45

grazes/ lacerations contusions (bruises) inclusion of foreign bodies e.g., gravel, tooth fragments

Question 46

list 4 areas for skeletal injuries

Answer 46

alveolus mandible maxilla cranial

Question 47

describe an alveolar fracture and its investigation results

Answer 47

2 or more teeth moving as a block segment mobility and dislocation occlusal change sensibility testing may or may not be positive

Question 48

what may be seen radiographically with alveolar fractures? and what radiographs should be taken?

Answer 48

fracture lines located at any level from marginal bone to root apex and above apex in addition, 3 angulations and occlusal film, panoramics can be helpful

Question 49

what can be considered in prevention of trauma for a child with double digit overjet in mixed dentition?

Answer 49

2 phase overjet reduction with functional appliance provide mouthguards for sports

Question 50

what are the 3 types of gumshields?

Answer 50

stock type I boil and bite type II custom made type III

Question 51

describe a stock type I gumshield

Answer 51

bulky plastic constant biting force to retain

Question 52

describe a boil and bite type II gumshield

Answer 52

thermoplastic moulded within mouth deform over time

Question 53

describe a custom made type III gumshield

Answer 53

ethylene vinyl acetate vacuum formed over stone cast 5mm thick and extend to distal 6s can be built in multiple layers (laminations)

Question 54

what are features of an ideal gumshield?

Answer 54

covers teeth extends into labial sulcus greater extension more evenly impact force