1. Dental Trauma Flashcards
\_\_\_\_ >/= female 25% of the population 6 to 50 years of age anterior teeth \_\_\_\_ year \_\_\_\_ children - no seasonal variation \_\_\_\_ children - injuries during summer \_\_\_\_ highest frequency of emergencies
males 8 to 12 young older fridays
• Equal among females now, bc of increase in sport participation
• 25% will have some sort of trauma on their ____
○ Most common age trauma = 8 to 12 y/o
§ The patient is growing and developing at this age - the roots are still open and they’re clsing, and even more importatntly -> the jaws are growing
§ If patients lose a tooth heree -> the ridge will resorb, and rest of jaw grows -> defect, difficult to place implants
□ For the ridge to grow and for bone to remain, the tooth must be present while the growth spurts happen
• Seasonal variation -> young children in the spring
○ Older children -> summer -> sports camps
○ Friday is the most common day
§ Why important: the weekend is starting
□ Private practice that you’re closing, and a pt walks up as you’re closing and in pain -> pulpitis
® Prescribe pain meds if you close the office and check at 8 to see them
® However, cannot do it with trauma injuries -> ____, legal issues and the consequences of waiting a few hours in traumatic injury is WORSE
◊ A TRUE EMERGENCY - must see the patient!
} Decides the fate of the teeth
NO
• ____ most common site
○ Centrals and laterals
• ____ are least common
○ Protected by max anterior, and when you fall you clench
max anteriors
man anteriors
Classification
Dentofacial injuries
• Under the big group of dentofacial injuries ○ \_\_\_\_ came up with the classification ○ \_\_\_\_ changed the classification
WHO
andreason
Dentofacial injuries
• Group I ○ \_\_\_\_ injuries § Nothing to d with boens or teeth • Group IV ○ \_\_\_\_ injuries § Not the \_\_\_\_, bu the jaw and facial bones
soft tissue
skeletal
teeth
• Group I injury
○ Patient falls, and breaks off an anterior -> ____ on lip
○ Responsibility when soft tissue injury:
§ Larg gash and bleeding -> numb, and ____ if need be
§ More important: when there is break in the tissue, need to take an ____ of the soft tissue
□ Foreign body (tooth, or gravel, etc.)
□ Make sure nothing is in the laceration!
® If you find soemthing -> remove the object
laceration
suture
x-ray
Group IV injury
• Difference bt R and L eyes
○ R eye cannot open, red inside and outside
○ Scan -> facial bone is broken
§ Walks into office like this -> four teeth are in the patient’s hands (avulsed them)
□ What’s important: the patient!
□ Cannot place the teeth back in, you’re not liable?
□ Any facial injury -> ____
® Involvement of the brain, head, etc.
911 call
Group 2 injury TOOTH \_\_\_\_ - enamel infraction - enamel fracture - crown fractures (uncomplicated/no pulp exposure) - crown fractures (complicated w/ pulp exposure) - crown-root fractures - root fractures
Group 3 injury \_\_\_\_ INJURIES - tooth concussion - subluxation - extrusive luxation - lateral luxation - intrusive luxation - avulsion
fractures
luxation
• This what we will attempt to treat • Group 2 ○ Fractures § At various levels on tooth AND \_\_\_\_ § Tooth breaks at various levels along the length of the tooth • Group 3 ○ Luxation § Movement of the tooth in the socket (or out of the socket) § Tooth is \_\_\_\_, but it's not in \_\_\_\_
root
intact
place
Abuse
• First thing in diagnosis -> \_\_\_\_ ○ Required when you get your license to go through child abuse education online, must renew the CE every time you get the license renewed (every 2 years) • If you see an injury, and it doesn't fit with what the parent/child is saying ○ Suspect child abuse -> you have to report it • 260 records of child abuse in 70-75 ○ Out of those records -> 50% will have a \_\_\_\_ injury, and 20% will have \_\_\_\_ ○ The history could be 30% child abuse???
child abuse
facial
dental trauma
Abuse
____ in seeking treatment ____ for injury differs from person to
person
____ for injury does not fit the clinical findings
____ to other people ____ b/w family members
• Suspect abuse? • Kid fell a month ago -> now bringing the child ○ Not how parent responds to normal injury • If explanation differs ○ Child and parent don't agree ○ \_\_\_\_ between the patient and parent
delay explanation explanation reaction relationship tension
Abuse
Primary aim - the ____ of the patient
Secondary aim - provide ____ - counseling for the family so that the abuse stops
• Reason you have to call it in -> primary concern is the safety of the child ○ Not worried about the teeth, etc
safety
treatment
Treatment
____ concrete systems for treating traumatized teeth
Purpose is to provide a ____ for treatment
• Trauma is not studied by study designs -> cannot execute them! ○ Must be go by data that is collected from trauma hospitals • Provide a guideline, no concrete treatment plan ○ You as a clinicain decide the final tx
no
guideline
To prevent ____ clinical signs or symptoms
To ____ as close to original location as possible
To achieve evidence of continued ____
• Three aims of treatment: ○ Get ht epatinet out of pain ○ If the tooth has been dislocated/luxated -> want the tooth back in the oriignal position ○ MOST \_\_\_\_: patient/jaw continues to \_\_\_\_ § Alveolar growth continues
adverse
reposition
alveolar growth
important
grow
TREATMENT
Objective
Maintain esthetics & function Pulp - continued root & alveolar Tooth - continued alveolar
Follow up
• ??? • Very important set of words ○ \_\_\_\_ § What happens w trauma injuries? □ Some of the repercussions of injuries -> pulp necrosis, etc. ® Can happen as late as \_\_\_\_ years after the injury ® Follow on a yearly basis ® Some specific scheudles for specific injuries
follow-up
30-40
• Specific things when you diagnose
○ CC
○ Dentla history
○ Med hisotry
○ Look inside the ____ before looking at tooth you think is ht eproblem
• Face is bloodied -> do not jump inot the mouth that’s causing the bleeding
○ Go trhough the process of dx
○ Aska bout the CC, history and then at the soft tissue, extraoral and intraoral
○ Must follow the sequence
mouth
History of Present Illness (injury)
• In a traumatic injury, some questions: ○ Where § Why important: \_\_\_\_, or tetanus ○ How ○ When § If a tooth was knocked out of place \_\_\_\_ -> will be much harder to put back in plcae bc the area starts to heal § Important in avulsion -> how \_\_\_\_ was it outside? Where was it outside? ○ Unconscious? § Yes -> call \_\_\_\_ ○ Bite disturbance § \_\_\_\_ injury or tooth is out of place ○ Hot and cold? § Pulp is exposed ○ Treated elsewhere? § Placement of splint? Pulp cap? ○ Hx of previous injuries
infection yesterday long 911 skeletal
Clinical Examination
• Minor luxation ○ Tooth is slightly out of arch ○ Check if tooth is in right position by checking for § \_\_\_\_ □ Using instruemnts § \_\_\_\_ § \_\_\_\_ § \_\_\_\_ tests
mobility
percussion
palpation
vitality
Clinical examination
Mobility/displacement
• Tooth is slightly out of the arch
○ Who is the best to answer whether normal or not -> the ____!
§ Age group -> ____ y/o
patient
8-12
Clinical examination
Percussion/palpation
• \_\_\_\_ AND \_\_\_\_ percussion ○ Test the entiere periradicular tissue • Looking for soft tissue and skeletal injury ○ May find \_\_\_\_ ○ Buccal and the palatal
vertical
lateral
tenderness
Clinical examination
• Vitality tests ○ Cold ○ Hot ○ EPT • For trauma: \_\_\_\_ • Where do you get false positive and false negative? ○ \_\_\_\_ teeth § Plexus is immature and not formed § Add injury to the tooth -> will you get accurate results? □ NO! □ Why do it -> bc this is the \_\_\_\_ ® On the day of injury -> this is what I got ® Do testing from \_\_\_\_ on the top and bottom ◊ Irrespective of how many teeth are involved in injury } EACH TOOTH IS TESTED FOR COLD AND EPT ◊ If PM involved -> go \_\_\_\_ back • Follow up patients ○ Test the same teeth, and compare the results with those you got last time
cold and EPT immature baseline canine to canine further
Clinical examination
Immature teeth/trauma
• Immature and traumatic teeth ○ \_\_\_\_ and \_\_\_\_ reactions, but will still go through the tests
false positive
false negative
Vitality test
- Trauma
• Discoloration of the tooth ○ Injured, BV broke -> \_\_\_\_ (iron -> deposits in the tubules) -> gets browner w light and oxygen -> tooth gets darker and darker ○ Can happen in the first week § In concussion injuries -> some teeth will discolor \_\_\_\_ years down the line, adns ome immediately § Some discolorations can \_\_\_\_ without treatment • Intact tooth on the R with a small lesion ○ Pt got hurt two hours ago § Will a PA lesion form in two hours? □ Why is there a lesion there? -> \_\_\_\_ standing traumatic injury □ Lesion on recent trauma? ® \_\_\_\_ -> not in original position -> x-ray -> \_\_\_\_, and they can come across as a lesion on an x-ray
RBCs 30 reverse long luxated gaps
Vitality test
- trauma
• Wuold you look at this lesion and immediately do an endo? ○ Other than luxation -> possible breakdown of the apical area § This isn't two days after, a few months after the injury -> looks like a lesion -> no response to heat/cold/EPT -> tooth was injured 6 mo to 10 yrs ago -> no cold or EPT or heat response -> see a lesion -> expect to be \_\_\_\_ □ Quite often -> 20 cases in 73 -> went into pulp chamber -> saw \_\_\_\_! ® Termed it as \_\_\_\_ (anderson) ◊ As a clinicain when do you decide to treat? These cases were still vital!! Are you wrong in accessing tooth and doing an endo?? } If you find vital pulp when you go in -> it can happen!!
necrotic
bleeding
transient apical breakdown
