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trauma Flashcards

1
Q

at what ages is dental trauma most likely to be seen in the primary dentition?

A

2-4 years

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2
Q

at what ages is dental trauma most likely to be seen in the permanent dentition?

A

7-8 years

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3
Q

what are three types of soft tissue injuries that can occur to the lips, gingivae and oral mucosa?

A
  • lacerations
  • contusions
  • abrasion
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4
Q

what is a laceration?

A

wound in skin or mucosa penetrating into the soft tissues

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5
Q

what is contusion

A

Bruise without breaking skin or mucosa represented as a subcutaneous or submucosal tissue haemorrhage

Can be isolated to soft tissue or can indicate an underlying bone fracture

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6
Q

what is abrasion?

A

Superficial wound produced by rubbing or scraping of the mucosa or skin leaving a raw bleeding surface which is still covered partially by epithelium

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7
Q

identify the soft tissue injury

in this case, what further questions should you ask the parents? what special investigations should be used?

A

laceration of the upper lip

fracture of the UR1 can be seen

ask - were all the tooth fragments accounted for?

possibly embedded in the lips

use radiographs - soft tissue view with low exposure can be used

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8
Q

what are the treatment principles of soft tissue injuries?

A
  • cleaning and debridement of the wound
    • with 0.3% chlorhexidine or saline
  • assess for any foreign bodies and remove if present
    • soft tissue radiographs may be needed
  • reposition any displaced tissues
  • sutures if needed
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9
Q

what sutures should be used for deeper layers?

A

resorbable sutures

  • vicryl
  • vicryl rapide
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10
Q

what sutures should be used for skin layers?

A
  • ethilon (nylon)
  • prolene (polypropylene)
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11
Q

what post-op management should you discuss with the patient and parents after a soft tissue injury?

A
  • good oral hygiene with soft brush
  • mouthwash 0.2% chlorhexidine if can be spat out
    • if not - ask parent to apply
  • soft diet
  • review
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12
Q

what is the most common injury in primary dentition?

A

luxation injuries

due to strong bone around primary teeth

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13
Q

how can primary trauma increase risk of problems in the permanent dentition?

A

energy from acute impact can easily be transmitted to developing tooth germ

inflammation from pulpal injuries in the traumatised tooth may add further injury

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14
Q

what is the diagnosis and treatment?

A

uncomplicated crown fracture in enamel URA

as is primary dentition - sufficient to smooth any sharp edges

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15
Q

diagnosis and possible treatments?

A

uncomplicated crown fracture in enamel and dentine

  • treatments
    • if no dentine exposed - then smooth off sharp edges
    • if dentine exposed - dress with GIC
    • if larger fracture - can restore with composite
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16
Q

what is the management of uncomplicated crown fractures in the primary dentition?

A
  • if confined to enamel
    • smooth any sharp edges
  • if dentine exposed
    • seal exposed dentine with GIC
    • if larger fracture - restore with composite if patient is compliant
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17
Q

what is a complicated crown fracture?

A

a fracture involving enamel and dentine and exposes the pulp

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18
Q

what is the management for a complicated crown fracture?

A
  • partial pulpotomy (if possibly)
    • calcium hydroxide applied over pulp and dressed with GIC
    • restored with composite
  • if child cannot tolerate pulpotomy or tooth beyond restoring then extraction
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19
Q

diagnosis and treatment

A
  • complicated crown root fracture URA
    • treatment : extraction
  • uncomplicated crown fracture in enamel ULA
    • treatment : smooth sharp edges
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20
Q

what is a crown root fracture?

A

fracture involving enamel, dentine, cementum +/- pulp

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21
Q

what is the management for a crown root fracture in the primary dentition?

A
  • fragment removal only
    • if only involves small part of the root and remaining fragment restorable
    • extraction
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22
Q

what is a root fracture?

A

fracture involving dentine, cementum and pulp

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23
Q

what is the management of a root fracture in primary dentition?

A
  • leave if no displacement
  • if displaced then extract coronal fragment only
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24
Q

diagnosis and treatment? when should we follow up?

A

lateral luxation (palatally) URA, ULA with associated soft tissue traum labially

  • treatment options
    • If no occlusal interferance - can allow to reposition spontaneously
    • if only slight interference - can consider slightly grinding teeth
    • Gentle repositioning
    • Extraction
      • If root has gone palatally and there is risk to predecessor
  • Follow up in 1 week, 2-3 weeks, 6-8 weeks (radiograph), year (radiograph)
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25
Q

what is lateral luxation?

A

tooth displacement in a direction other than axially

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26
Q

what is the management for lateral luxation in primary denition?

A
  • if only minor occlusal interferences
    • slight grinding
  • if more severe occlusal interferencees
    • gentle repositioning under LA
  • if tooth severely displaced or patient cannot tolerate any other treatment
    • extraction
27
Q

diagnosis and treatment

A

extrusion of ULA

  • treatment options
    • if interfering with occlusion
      • extraction
28
Q

what is extrusive luxation?

A

partial displacement of tooth out of its socket

29
Q

what is the management for extrusive luxation in primary dentition?

A
  • minor extrusion <3mm
    • careful repositioning or leave for spontaneous realignment
  • major extrusion or fully formed primary tooth
    • extraction
30
Q

diagnosis and treatment

A

intrusion of ULA

  • treatment
    • if tooth apex is displaced towards or through labial bone plate
      • leave for spontaneous re-eruption
    • if displaced towards developing follicle
      • extract
31
Q

what is intrusive luxation?

A

displacement of tooth into alveolar bone

32
Q

what is management of intrusive luxation in the primary dentition?

A

treatment

  • if tooth apex is displaced towards or through labial bone plate
    • leave for spontaneous re-eruption
  • if displaced towards developing follicle
    • extract
33
Q

how can you tell radiographically how the tooth is displaced in intrusion injuries?

A
  • if apex displaced towards or through labial bone
    • apex can be visualised
    • appears shorter than the contralateral tooth
  • if apex displaced into the developing follicle
    • apical tip cannot be visualised
    • tooth appears elongated
34
Q

diagnosis and treatment

A

avulsion injury ULA

  • leave
  • monitor eruption of UL1

enamel fracture URA

  • smooth sharp edges
35
Q

what complications can follow trauma to the primary dentition?

A

tell patients and document

36
Q

what is the most common type of injury in the permanent dentition?

A

uncomplicated crown fractures

37
Q

what are predisposing factors for trauma in the permanent dentition?

A
  • increased overjet
  • maxillary incisors proclined
  • incompetent lips
38
Q

diagnosis and treatment

A

uncomplicaated crown fractures into enamel UL1 UR1

treatment : restore with composite

39
Q

diagnosis and treatment

A

uncomplicated crown fracture UR3 very close to pulp however

  • treatment :
    • retraction cord under LA
    • orthodontic extrusion
    • place calcium hydroxide base and cover with glass ionomer cement
      • the restore with composite
40
Q

what is the management for amn uncomplicated crown fracture in the permanent dentition?

A
  • if confined to enamel
    • rebonding of any lost fragments
    • contouring or restoration with composite
  • dentine exposed
    • rebonding of any lost fragments
    • sesal exposed dentine with GIC then restore with composite
    • if close to pulp (within 0.5mm)
      • calcium hydroxide lining
      • dress with GIC
      • restore if no clinical / radiographic signs of necrosis
41
Q

diagnosis and treatment

A

complicated crown fracture UL1,2

  • RCT
  • possibly pulp cap

uncomplicated crown fracture UR1

  • restore
42
Q

what is the management for a complicated crown fracture in the permanent dentition?

A
  • immature teeth (open apices)
    • pulp cap (calcium hydroxide)
    • partial pulpotomy
  • mature teeth (complete root formation and closed apices)
    • RCT
    • partial pulpotomy or pulp cap where exposure us small, recent and clean
43
Q

diagnosis

A

complicated crown root fracture UL1

44
Q

what is the management of crown root fractures in the permanent dentition?

A
  • RCT in most cases
  • removal of coronal fragment and restoration of remaining tooth substance
  • fragment removal and gingivectomy
  • orthodontic extrusion
  • surgical extrusion
  • extraction
45
Q

diagnosis

A
  • UR1 well aligned mid 1/3 root fracture - appears to be healing
  • UL1 mid 1/3 root fracture - resorption in fracture line - not healing
    • also has a crown fracture
46
Q

what is the management for root fractures in the permanent dentition?

A
  • reposition if displaced
  • check position radiographically
  • flexible splint 4 weeks
    • 4 months if cervical third fracture
  • if pulp necrosis occurs then RCT up to fracture line
47
Q

what is subluxation

A
  • TTP
  • increased mobility
  • but not been displaced
48
Q

what is the management of lateral luxation in permanent dentition?

A
  • reposition tooth out of bony lock then gentle reposition into original location
  • flexible splint 4 weeks
  • monitor pulp vitality
  • if pulp necrosis - RCT
49
Q

what is the management for extrusive luxation in the permanent dentition?

A
  • reposition tooth back into socket and itss original position
  • flexible splint for 2 weeks
  • monitor pulp vitality
    • mature teeth
      • will most likely require RCT
    • immature teeth
      • only need RCT if signs of pulp necrosis
50
Q

management for intrusion with immature teeth in the permanent dentition?

A

allow spontaneous re-eruption

if no movement within a few weeks then orthodontic reposition or surgical repositioning if intruded >7mm

51
Q

management for intrusion with mature teeth in the permanent dentition

A
  • if intruded <3mm
    • allow spontaneous re-eruption
    • if no movement after 2-4 weeks, surgical or orthodontic repositioning
  • if intruded 3-7mm
    • orthodontic or surgical repositioning and splint for 4 weeks
  • if intruded >7mm
    • surgical repositioning and splint 4 weeks
  • if total intrusion
    • surgical repositioning and splint 4 weels
  • RCT most likely required in all repositioning cases
52
Q

what is concussion?

A

tooth TTP but no displacement or mobility

53
Q

what is the treatment for concussion in the permanent dentition?

A

no treatment needed but pulpal vitality needs to be monitored

54
Q

what is the treatment for subluxation?

A

if excessively mobible then flexible splint 2 weeks, otherwise no treatment required

55
Q

what should happen at the scene when there is avulsion of a permanent tooth?

A
  • prognosis very dependent on what occurs at scene
  • keep calm
  • handle avulsed tooth by the crown
  • if dirty - wash tooth gentle under cold running water for max 10 seconds
  • try and replant the tooth straight away and ask patient to bite on handkerchief to hold in place
  • if cannot be replanted then place in a glass of milk or could be kept inside the patients mouth
  • attend dental clinic asap
56
Q

what is the management of an avulsed tooth with complete root development once the tooth has been replanted at the scene

A

flexible splint for 2 weeks

RCT 7-10 days after replantation and before splint removal

57
Q

what is the management of an avulsed tooth with complete root development if the tooth has not been replanted but has been kept in a suitable storage medium - has been dry for less than 60 minutes

A
  • LA
  • clean socket with salina
  • replant tooth
  • flexible splint for 2 weeks
  • RCT
58
Q

what is the management of an avulsed tooth with complete root development if the tooth has not been replanted and has been dry for more than 60 minutes

A
  • LA
  • clean socket with saline
  • replant tooth
  • flexible splint 4 weeks
  • RCT before/after replantation
  • very poor prognosis
  • if evidence of ankylosis or resorption then extraction
59
Q

what is the management of an avulsed tooth with incomplete root development if the tooth has been replanted at the scene

A

flexible splint for 2 weeks

if loss of vitality or pulp necrosis then RCT

60
Q

what is the management of an avulsed tooth with complete root development if the tooth has not been replanted but has been kept in a suitable storage medium - has been dry for less than 60 minutes

A
  • LA
  • clean socket with saline
  • replant tooth
  • flexible splint 2 weeks
  • review
61
Q

what is the management of an avulsed tooth with complete root development if the tooth has not been replanted and has been dry for more than 60 minutes

A
  • LA
  • clean socket with saline
  • replant tooth
  • flexible splint for 4 weeks
  • RCT before/after replantation
62
Q

what are the properties of an ideal splint?

A
  • easy to maintain oral hygiene
  • allows access to teeth for
    • pulp tests
    • colour
    • RCT
  • easy to place and remove
  • functional splint
63
Q

what complications may follow trauma to the permanent dentition?

A
  • pulp necrosis
    • arrested development
    • pain
    • infection
  • discolouration
  • pulp obliteration
  • pathological root resorption
  • inflammatory resorption
    • external
    • internal
    • cervical
    • replacement (ankylosis)

z paeds (5 decks)

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