11. Trauma Flashcards
List the 7 types of dental trauma injuries:
- Enamel infraction
- Enamel fracture
- Enamel-Dentine Fracture
- Enamel-Dentine-Pulp Fracture
- Crown-Root fracture without pulp exposure
- Crown-Root fracture with pulp exposure
- Root Fracture
Enamel Infraction
An incomplete fracture of the enamel only
Enamel infraction: signs and symptoms
Non tender
No radiographic signs
Enamel fracture
A complete fracture of the enamel
Enamel fracture: signs and symptoms
Non tender
Positive sensibility test response
Radio graphically visible
Enamel-DentineFracture
Fracture of the enamel into dentine
Enamel-dentine fracture: signs and symptoms
Not tender
Positive sensibility response
Radiographically visible
Enamel-dentine- pulp fracture: signs and symptoms
Non tender
Pulp sensitive to stimuli
Radiographically visible
Crown-Root fracture without pulp involvement: signs and symptoms
TTP
coronal portion mobile
Positive sensibility response
Crown-Root fracture with pulp involvement:signs and symptoms
TTP
coronal portion mobile
Root Fracture: signs and symptoms
Coronal portion mobile
TTP
bleeding
-ve sensibility
Crown couloir change (red/grey)
List the 4 possible traumatic periodontal injuries:
- Concussion
- Subluxation
- Luxation (lateral, intrusive, extrusive)
- Avulsion
Concusion:
Bruising of the socket
Subluxation:
Loosening of the tooth in the socket
Luxation:
Complete displacement of the tooth in the socket
Avulsion:
When the tooth is completely lost from the socket
Concussion: signs and symptoms
No displacement
Tooth TTP
normal mobility
No radiographic changes
Subluxation: signs and symptoms
No tooth displacement
tooth TTP
Increased mobility
Bleeding
-ve sensibility
Intrusive Luxation: signs and symptoms
Immobile tooth
-ve sensibility
Radiographically, loss of PDL
Lateral Luxation: signs and symptoms
Immobile tooth
-ve sensibility
Radiographically, widened PDL
Extrusive Luxation: signs and symptoms
Mobile tooth
-ve sensibility
Radiographically, increased PDL space
How can dental trauma be prevented?
Overjet reduction
Mouth guards
What are the 10 steps when managing dental trauma?
- Assess for signs of head trauma
- Assess for other injuries
- Assess for any aspirations of teeth
- E/O exam
- I/O exam
- Trauma table
- Sensibility tests
- Radiographs
- Diagnosis
- Treatment
What are signs of head trauma?
Loss of consciousness
Strange behaviours
Vommiting
Visual disturbance
What should you asses for E/O after dental trauma occurs?
Lacerations
Palpate for fractures
Assess any bruising as this can indicate a fracture
What should you assess in an I/O exam after dental trauma?
Soft tissues
Hard tissues
Occlusion
What are the 8 things assessed in a trauma table?
- Tooth/teeth involved
- Direct colour
- Trans colour
- Alveolar tenderness
- Sinus
- TTP
- Mobility
- Perfusion note
What situations would you always extract a primary tooth after trauma?
Excessively loose teeth
Teeth that damage permanent tooth
Infection risk teeth
Unrestoable teeth
What are the 2 possible treatment options for traumatised primary teeth?
XLA or Restore and Monitor
In the permanent dentition, if a traumatised tooth is restorable, what should you do?
If mobile - splint, restore and review
If non mobile - restore and review
What is the aim of a pulpotomy?
To remove any infected and inflamed pulpal tissue coronary to maintain the tooth’s vitality
What are the 7 steps for a pulpotomy?
- LA
- Rubber dam
- Amputate exposed pulp
- Arrest bleeding with cotton wool and saline
- Dress with calcium hydroxide or MTA
- Place a layer of RMGIC and cure
- Restore the tooth
What is the aim of placing a composite bandage following trauma?
To seal over any exposed dentinal tubules to minimise the risk of microbial invasion and prevent sensitivity
What is the aim of splinting a tooth?
To immobilise a traumatised tooth in the correct anatomical position to prevent further trauma and allow healing to occur.
What are the 6 steps when reviewing trauma?
- Pt hstiory
- Symptoms history
- Examination: E/O and I/O
- Trauma table
- Sensibility tests
- Radiographs
What are 4 common complications of trauma in the PRIMARY dentition?
- Pulpal necrosis
- Pulpal obliteration
- Root resorption
- Damage to successors
What are the 6 common complications following dental trauma in the PERMANENT dentition?
- Pulpal necrosis
- Resorption
- Ankylosis
- External resorption
- Internal resorption
- Discolouration
Pulpal necrosis: signs and symptoms
Persistent grey colour
Tenderness
Sinus
Suppuration
Swelling
PA inflammation
Pulpal obliteration: signs and symptoms
Yellow/opaque colour
Shrinking pulp chamber
Root resorption: signs and symptoms
Mobility
Shortened roots
Damage to successors: signs and symptoms
Hypomineralisation
Crown dilaceration
Root duplication
Root dilasceration
Arrest of formation
Ankylosis: signs and symptoms
No mobility
Metalic percussion note
No PDL present Radiographically
External root resorption: signs and symptoms
Mobility
Shortened external surface of roots
Internal root resorption: signs and symptoms
Pink spot on tooth
Round radiolucency in the root canal Radiographically
What causes discolouration of the crown?
Pulpal necrosis
RCT
trauma
List 6 Tx options for discoloured teeth:
Crown
Veneer
Post and core
Internal bleaching
External bleaching
Composite camouflage
Hat are the 2 key guidelines for dental trauma:
IADT
Dental Trauma Guide
