Trauma Flashcards by Kirsten Thomson

What is subluxation?

An injury to the tooth-supporting structures resulting in increased mobility but no tooth displacement. Bleeding from the gingival sulcus confirms the diagnosis.

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What is extrusion?

Partial displacement of the tooth out of its socket. The tooth will also be loose due to partial or total separation of the PDL. The alveolar socket bone is intact. The tooth may also have an element of protrusion/retrusion.

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What is lateral luxation?

Displacement of the tooth other than axially. Usually accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone. Tooth is frequently non-mobile although there has been partial/total separation of the PDL.

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What is intrusion?

Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.

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What is avulsion?

The tooth is completely displaced out of its socket. Clinically the socket is found empty or filled with coagulum.

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What is an enamel infraction?

An incomplete fracture (crack) of the enamel without loss of tooth structure.

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What is concussion?

An injury to the tooth-supporting structures that does not cause increased mobility or displacement of the tooth but does cause pain to percussion.

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What is the treatment for concussion?

Soft diet 1 week

Monitor pulpal condition 1yr

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What is the treatment for subluxation?

Usually just monitor & soft diet

Sometimes flexible splint for 2 weeks for patient comfort

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What are the different classifications of crown fracture?

Enamel
Enamel Dentine
Enamel Dentine Pulp

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What is the treatment for lateral luxation?

Saline rinse exposed root
Reposition under LA
Flexible splint 4 weeks

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What are the three treatment options for intrusion injuries?

Spontaneous eruption
Orthodontic repositioning
Surgical repositioning

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What is the treatment for extrusion?

Clean exposed root surface and reposition

Flexible splint 2 weeks

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How would you differentiate a root fracture from an extrusion injury?

Take an X-Ray and look for Radiographic signs of root fracture

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What is the treatment for a root fracture?

Rinse exposed root with saline
Reposition if coronal segment displaced
Check position with radiograph
Flexible splint 4 weeks (if apical/middle)
Flexible splint up to 4 months (if coronal)
Monitor pulp healing for 1 yr

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What is the treatment for an alveolar fracture?

Manual repositioning or using forceps of displaced segment

Flexible splint 4 weeks

What post-op advice would you give to someone who has experienced dental trauma?

Soft diet 2 weeks
Avoid contact sports
Chlorhexidine mouthwash 1x daily for 1 week

What information is recorded in a trauma stamp/when a patient presents with a trauma?

Tooth FDI
Mobility
Displacement 
TTP
Colour
Sinus/tender in sulcus
Thermal (Eth Cl)
Electric (EPT)
Radiograph

What treatment would you choose for an intrusion injury of less than 6mm?

Open Or Closed Apex:
Disimpact and allow to spontaneously erupt for 3wks
If no movement - orthodontic repositioning

How would you treat an intrusion injury of >6mm?

Open or closed apex:
Disimpact and surgically reposition
Flexible splint 4wks

What is ankylosis?

Fusion of the tooth to bone

What is the prognosis of a closed apex tooth with an intrusion injury?

5yr pulp survival - 0%

5yr resorption - 100%

What is the prognosis of a closed apex tooth that has been avulsed?

5yr pulp survival - 0%

Frequent root resorption

How should you monitor teeth that have been treated for traumatic injuries?

Clinical tests - trauma stamp
Sensibility tests - electric & thermal (at time of injury, 1m, 3ms, 6monthly for 2yrs)
Radiographs - root development, resorption, comparison

What injuries are treated with a flexible splint for two weeks?

Subluxation Extrusion Avulsion

What injuries are treated with a flexible splint for 4 weeks?

Luxation Avulsion (if PL rubbed off) Apical/middle third of root fracture

What injury is treated with a flexible or rigid splint for 4 weeks?

Dentoalveolar fracture

What injury is treated with a flexible splint for 4 months?

Coronal third root fracture

What advice should you give to someone with an avulsed tooth?

Hold by the crown Rinse under cold water Replant If unable to replant store in saliva, saline or milk

What does EADT and EAT stand for?

Extra-alveolar dry time | Extra-alveolar time

How would you treat an avulsion injury with an EADT >60 min?

``` Open and closed apex: Remove necrotic PL Soak in 2% NaF for 20mins Extirpate & obturate outside mouth Flexible splint 4 weeks Systemic antibiotics (and tetanus) ```

How would you treat an avulsion injury in a closed apex tooth that has been replanted by the patient?

Clean & verify position (clinically & radiographically) Flexible splint 2 weeks Systemic antibiotics Tetanus booster if avulsed tooth was in contact with soil RCT 7-10 days after replantation & before splint removal

How would you treat an avulsion injury on a closed apex tooth with an EADT of less than 60 minutes?

Replant Flexible splint 2wks Systemic antibiotics & tetanus (if in contact with soil) RCT 7-10 days after replantation and before splint removal (CaOH as intra-canal medicament 1 month then replace with GP)

How would you treat an avulsion injury on an open apex tooth with an EADT of less than 60 minutes?

Clean & apply topical antibiotics to socket Replant tooth Flexible splint 2wks Systemic antibiotics (& tetanus) Review at 2wks - RCT if revascularisation doesn't occur

What are the four types of root resorption?

External surface External inflammatory Internal inflammatory Replacement resorption (ankylosis)

Why is ns calcium hydroxide used initially in pulp treatment of open apex teeth?

To try and halt root resorption so tooth can eventually be obturated with GP. If no progressive resorption occurs for 12 months, obturate with GP. If progressive resorption occurs, ns CaOH can be changed every 6 months and dentist can plan ahead for prosthetic replacement.

What is the treatment for ankylosis?

No Rx

What is pulp canal obliteration?

Response of vital pulp. | Progressive hard tissue formation within the pulp cavity resulting in gradual narrowing.

What should you look for in a trauma examination?

Extra-Oral: Laceration, haematoma, haemorrhage/CSF, sub conjunctival haemorrhage, bony step deformities, mouth opening Intra-Oral: Soft tissue, alveolar bone, occlusion, teeth