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BDS3 PAEDIATRICS > 2 - Dental trauma I > Flashcards

2 - Dental trauma I Flashcards

1
Q

How does primary tooth trauma typically occur?

A
  • falls
  • bumping into objects
  • non accidental (abuse)
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2
Q

List the injuries classified as injuries to the dental hard tissue and pulp.

A
  • 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
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3
Q

List the injuries classified as injuries to the supporting tissues.

A
  • concussion
  • subluxation
  • lateral luxation
  • intrusion
  • extrusion
  • avulsion
  • alveolar fracture
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4
Q

Define an enamel fracture.

A
  • fracture involving only the enamel
  • uncomplicated crown fracture
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5
Q

Define an enamel dentine fracture.

A
  • fracture involving enamel and dentine
  • pulp is not exposed
  • uncomplicated crown fracture
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6
Q

Define an enamel, dentine and pulp fracture.

A
  • fracture involving the enamel, dentine and pulp
  • pulp exposed
  • known as a complicated crown fracture
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7
Q

Define a crown-root fracture.

A
  • fracture involving the enamel, dentine and root
  • can be uncomplicated or complicated dependant on whether the pulp is exposed
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8
Q

Define a root fracture.

A

Root fractures within socket

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9
Q

Define a concussion injury.

A
  • PDL injury
  • tooth is tender to touch but not displaced
  • normal mobility
  • no bleeding in gingival sulcus
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10
Q

Define a subluxation injury.

A
  • tooth tender to touch but not displaced
  • increased mobility
  • bleeding from gingival crevice
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11
Q

Define a lateral luxation injury.

A
  • tooth displaced in palatal/lingual or labial direction (any direction other than axial)
  • can include alveolar socket fracture
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12
Q

Define an intrusion injury.

A
  • tooth displaced through (and into) bone
  • can impinge on permanent tooth bud
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13
Q

Define an extrusion injury.

A
  • partial displacement of tooth out of its socket
  • can cause a traumatic occlusion
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14
Q

Define an avulsion injury.

A
  • 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
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15
Q

Define an alveolar fracture.

A
  • fracture involving alveolar bone
  • may extend to adjacent bone
  • mobility of several teeth common
  • occlusal interference common
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16
Q

What are the most common types of injury in primary teeth?

A
  • luxation
  • avulsion and ED fracture
  • root fracture
  • crown-root fracture
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17
Q

What are the steps in a primary trauma examination?

A
  • reassurance
  • history
  • examination
  • diagnosis
  • emergency treatment
  • important information
  • further treatment and review
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18
Q

What is involved in a trauma history?

A
  • when did the injury happen?
  • where did the injury happen?
  • how?
  • any other symptoms or injuries?
  • lost teeth or fragments?
  • MH
  • DH
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19
Q

What is involved in a trauma examination?

A

Extraoral
- lacerations
- haematoma
- haemorrhage / CSF
- bony step deformities
- mouth opening

Intraoral
- soft tissues (laceration or haematoma)
- alveolar bone
- occlusion
- teeth

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20
Q

How does transillumination assist in a trauma examination?

A
  • may show fracture lines in teeth (crazing)
  • pulpal degeneration
  • caries
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21
Q

How does a tactile test with a probe assist in a trauma examination?

A
  • detect horizontal or vertical fractures in enamel
  • pulpal involvement
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22
Q

How does percussion assist in a trauma examination?

A
  • 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)
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23
Q

Define a traumatic occlusion.

A
  • when a patient can only bite on displaced teeth
  • demands urgent treatment
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24
Q

What is a trauma stamp?

A
  • record of special investigations on teeth that are traumatised, and surrounding/contralateral teeth
  • can be updated each visit
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25
Q

What are examples of observations made on a trauma sticker?

A
  • radiograph
  • mobility
  • colour
  • TTP
  • sinus
  • percussion
26
Q

What treatment should be undertaken during the emergency visit?

A
  • 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
27
Q

What is home care advice that can be given to parents?

A
  • 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
28
Q

How do you treat an enamel fracture?

A

Smooth sharp edges using soft-flex disc

29
Q

How do you treat an enamel dentine fracture?

A
  • cover all exposed dentine with GI or composite
  • lost tooth structure can be restored immediately or at a later visit
30
Q

How do you treat a complicated crown fracture?

A
  • partial pulpotomy
  • extract
31
Q

How do you treat a crown-root fracture?

A
  • 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

32
Q

How do you treat a root fracture?

A

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 (+/-)

33
Q

How do you treat subluxation?

A
  • no treatment
  • place under observation
34
Q

How do you treat lateral luxation?

A

Minimal occlusal interference - allow to spontaneously reposition

Severe displacement - extract or reposition +/- splint (flexible)

35
Q

How do you treat intrusion?

A
  • allow to spontaneously reposition, regardless of direction (6-12 months)
  • following radiograph, counsel patient regarding permanent tooth prognosis
36
Q

How does an intrusion through the labial bone present?

A
  • tooth appears foreshortened in radiograph
  • away from developing tooth germ therefore damage less likely
37
Q

How does an intrusion towards the tooth germ present?

A
  • tooth appears elongated in radiograph
  • more likely to be damage to permanent tooth, therefore counsel patient
38
Q

How do you treat extrusion?

A

No occlusal interference - allow to spontaneously reposition
Occlusal interference or >3mm - extract

39
Q

How do you treat avulsion of primary teeth?

A
  • DO NOT REPLANT
  • radiograph to confirm avulsion
40
Q

How do you treat alveolar fracture?

A
  • reposition segment
  • stabilise with flexible splint for 4 weeks
  • teeth may require extraction have stability achieved
41
Q

What are sequelae of trauma to primary teeth?

A
  • discolouration
  • infection
  • delayed exfoliation
42
Q

What does a colour change to grey suggest after trauma?

A

Intra-pulpal bleeding (vital)

43
Q

What does a colour change to yellow suggest after trauma?

A

Pulpal obliteration (vital with tertiary dentine formation)

44
Q

What does a colour change to pink suggest after trauma?

A

Internal resorption

45
Q

How do you treat a symptomatic and non vital primary tooth?

A
  • extract
  • endodontic treatment
46
Q

What problems does delayed exfoliation cause?

A
  • interferes with developing occlusion
  • ectopic eruption of permanent teeth
  • delay or prevent eruption of permanent teeth
47
Q

What type of injury is most likely to damage the permanent successor?

A

Intrusion

48
Q

What are common defects in permanent teeth which have been affected by primary trauma?

A
  • enamel defects
  • abnormal morphology
  • delayed eruption
  • ectopic position
  • arrested development
  • failure to form
  • odontome formation
49
Q

What are examples of enamel defects?

A
  • enamel hypominerlisation
  • enamel hypoplasia
50
Q

Define enamel hypomineralisation.

A
  • qualitative defect
  • normal thickness but poorly mineralised
  • white/yellow in colour
51
Q

How do you treat enamel hypomineralisation?

A
  • no treatment
  • composite masking +/- localised removal
  • tooth whitening
  • resin infiltration
52
Q

Define enamel hypoplasia.

A
  • quantitative defect
  • reduced thickness but normal mineralisation
  • yellow/ brown in colour
53
Q

How do you treat enamel hypoplasia?

A
  • no treatment
  • composite masking
54
Q

Define dilaceration.

A

Abrupt deviation of long axis of the crown or root of the tooth

55
Q

How do you treat dilaceration involving the crown?

A
  • surgical exposure and orthodontic treatment
  • improve aesthetics restoratively
56
Q

How do you treat dilaceration involving the root?

A

Combined surgical and orthodontic approach

57
Q

How do you treat delayed eruption?

A
  • radiograph if >6 months delay
  • surgical exposure and orthodontic alignment
58
Q

How do you treat ectopic tooth position?

A
  • extraction
  • surgical exposure and orthodontic realignment
59
Q

How do you treat arrested development of a permanent tooth?

A
  • extraction
  • endodontic treatment if root length favourable
60
Q

How do you treat odontomes?

A

Surgical removal

61
Q

How do you treat concussion?

A
  • no treatment
  • place under observation

BDS3 PAEDIATRICS (11 decks)

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