2 - Dental trauma I Flashcards
How does primary tooth trauma typically occur?
- falls
- bumping into objects
- non accidental (abuse)
List the injuries classified as injuries to the dental hard tissue and pulp.
- enamel fracture (uncomplicated crown fracture)
- enamel and dentine fracture (uncomplicated crown fracture)
- enamel, dentine and pulp fracture (complicated crown fracture)
- crown-root fracture
- root fracture
List the injuries classified as injuries to the supporting tissues.
- concussion
- subluxation
- lateral luxation
- intrusion
- extrusion
- avulsion
- alveolar fracture
Define an enamel fracture.
- fracture involving only the enamel
- uncomplicated crown fracture
Define an enamel dentine fracture.
- fracture involving enamel and dentine
- pulp is not exposed
- uncomplicated crown fracture
Define an enamel, dentine and pulp fracture.
- fracture involving the enamel, dentine and pulp
- pulp exposed
- known as a complicated crown fracture
Define a crown-root fracture.
- fracture involving the enamel, dentine and root
- can be uncomplicated or complicated dependant on whether the pulp is exposed
Define a root fracture.
Root fractures within socket
Define a concussion injury.
- PDL injury
- tooth is tender to touch but not displaced
- normal mobility
- no bleeding in gingival sulcus
Define a subluxation injury.
- tooth tender to touch but not displaced
- increased mobility
- bleeding from gingival crevice
Define a lateral luxation injury.
- tooth displaced in palatal/lingual or labial direction (any direction other than axial)
- can include alveolar socket fracture
Define an intrusion injury.
- tooth displaced through (and into) bone
- can impinge on permanent tooth bud
Define an extrusion injury.
- partial displacement of tooth out of its socket
- can cause a traumatic occlusion
Define an avulsion injury.
- tooth is completely displaced from the socket
- can be whole (with root) or part of tooth (root fracture)
- risk of imbedding into soft tissues
- risk of inhalation/ingestion
Define an alveolar fracture.
- fracture involving alveolar bone
- may extend to adjacent bone
- mobility of several teeth common
- occlusal interference common
What are the most common types of injury in primary teeth?
- luxation
- avulsion and ED fracture
- root fracture
- crown-root fracture
What are the steps in a primary trauma examination?
- reassurance
- history
- examination
- diagnosis
- emergency treatment
- important information
- further treatment and review
What is involved in a trauma history?
- when did the injury happen?
- where did the injury happen?
- how?
- any other symptoms or injuries?
- lost teeth or fragments?
- MH
- DH
What is involved in a trauma examination?
Extraoral
- lacerations
- haematoma
- haemorrhage / CSF
- bony step deformities
- mouth opening
Intraoral
- soft tissues (laceration or haematoma)
- alveolar bone
- occlusion
- teeth
How does transillumination assist in a trauma examination?
- may show fracture lines in teeth (crazing)
- pulpal degeneration
- caries
How does a tactile test with a probe assist in a trauma examination?
- detect horizontal or vertical fractures in enamel
- pulpal involvement
How does percussion assist in a trauma examination?
- duller note indicates root fracture
- higher note indicates that the tooth may have a bony lock (ie previous trauma and tooth has healed, fused to socket)
Define a traumatic occlusion.
- when a patient can only bite on displaced teeth
- demands urgent treatment
What is a trauma stamp?
- record of special investigations on teeth that are traumatised, and surrounding/contralateral teeth
- can be updated each visit
What are examples of observations made on a trauma sticker?
- radiograph
- mobility
- colour
- TTP
- sinus
- percussion
What treatment should be undertaken during the emergency visit?
- observation is most appropriate
- only treat if risk of aspiration, ingestion or occlusal interference (+++ mobile teeth)
- treatment depends on child’s maturity and ability to cope, avoid eliciting fear
What is home care advice that can be given to parents?
- analgesia
- soft diet for up to 2 weeks (cut normal diet up very small, chew with molars)
- brush teeth with soft brush after every meal
- topical chlorhexidine gluconate (applied with gauze, twice daily, separate to mealtimes)
- warn regarding infection signs
How do you treat an enamel fracture?
Smooth sharp edges using soft-flex disc
How do you treat an enamel dentine fracture?
- cover all exposed dentine with GI or composite
- lost tooth structure can be restored immediately or at a later visit
How do you treat a complicated crown fracture?
- partial pulpotomy
- extract
How do you treat a crown-root fracture?
- remove loose fragment
- determine if crown can be restored
Restorable with pulp exposed - pulpotomy or RCT
Restorable no pulp exposed - cover dentine with GI
Unrestorable - extract loose fragments, firm root fragments left in situ
How do you treat a root fracture?
Coronal fragment not displaced - no treatment
Coronal fragment displaced, but no excessively mobile - allow to spontaneously reposition
Coronal fragment displaced, severe mobility and occlusal interference - extract the loose fragment, or reposition and splint (+/-)
How do you treat concussion?
- no treatment
- place under observation
How do you treat subluxation?
- no treatment
- place under observation
How do you treat lateral luxation?
Minimal occlusal interference - allow to spontaneously reposition
Severe displacement - extract or reposition +/- splint (flexible)
How do you treat intrusion?
- allow to spontaneously reposition, regardless of direction (6-12 months)
- following radiograph, counsel patient regarding permanent tooth prognosis
How does an intrusion through the labial bone present?
- tooth appears foreshortened in radiograph
- away from developing tooth germ therefore damage less likely
How does an intrusion towards the tooth germ present?
- tooth appears elongated in radiograph
- more likely to be damage to permanent tooth, therefore counsel patient
How do you treat extrusion?
No occlusal interference - allow to spontaneously reposition
Occlusal interference or >3mm - extract
How do you treat avulsion of primary teeth?
- DO NOT REPLANT
- radiograph to confirm avulsion
How do you treat alveolar fracture?
- reposition segment
- stabilise with flexible splint for 4 weeks
- teeth may require extraction have stability achieved
What are sequelae of trauma to primary teeth?
- discolouration
- infection
- delayed exfoliation
What does a colour change to grey suggest after trauma?
Intra-pulpal bleeding (vital)
What does a colour change to yellow suggest after trauma?
Pulpal obliteration (vital with tertiary dentine formation)
What does a colour change to pink suggest after trauma?
Internal resorption
How do you treat a symptomatic and non vital primary tooth?
- extract
- endodontic treatment
What problems does delayed exfoliation cause?
- interferes with developing occlusion
- ectopic eruption of permanent teeth
- delay or prevent eruption of permanent teeth
What type of injury is most likely to damage the permanent successor?
Intrusion
What are common defects in permanent teeth which have been affected by primary trauma?
- enamel defects
- abnormal morphology
- delayed eruption
- ectopic position
- arrested development
- failure to form
- odontome formation
What are examples of enamel defects?
- enamel hypominerlisation
- enamel hypoplasia
Define enamel hypomineralisation.
- qualitative defect
- normal thickness but poorly mineralised
- white/yellow in colour
How do you treat enamel hypomineralisation?
- no treatment
- composite masking +/- localised removal
- tooth whitening
- resin infiltration
Define enamel hypoplasia.
- quantitative defect
- reduced thickness but normal mineralisation
- yellow/ brown in colour
How do you treat enamel hypoplasia?
- no treatment
- composite masking
Define dilaceration.
Abrupt deviation of long axis of the crown or root of the tooth
How do you treat dilaceration involving the crown?
- surgical exposure and orthodontic treatment
- improve aesthetics restoratively
How do you treat dilaceration involving the root?
Combined surgical and orthodontic approach
How do you treat delayed eruption?
- radiograph if >6 months delay
- surgical exposure and orthodontic alignment
How do you treat ectopic tooth position?
- extraction
- surgical exposure and orthodontic realignment
How do you treat arrested development of a permanent tooth?
- extraction
- endodontic treatment if root length favourable
How do you treat odontomes?
Surgical removal
