4- Outcomes of Dental Trauma

Question 1

If PDL involved, when do you need to review?

Answer 1

3-4 weeks

Question 2

Tooth is a bit loose but not displaced. What is this? What sign might not always be present.

Answer 2

Subluxation

bleeding may not always be present

Question 3

What does TTP indicate

Answer 3

PDL involvement

Question 4

Concussion. Signs and Symptoms.

Answer 4

No mobility, no bleeding

Question 5

Which type of injury have increased risk of damage to perm?

Answer 5

luxation injuries (intrusion, lat luxation)

• alveolar fracture
• lateral luxation
• intrusion
• avulsion

Question 6

What effects might luxation injuries cause?

Answer 6

impaction

enamel defects to perm depending on stage of development of child

Question 6

High impact, high velocity vs low would cause what kind of injuries

Answer 6

high impact, high velocity -> fracture w no displacement OR
displacement

Question 7

When is the outcome of dental trauma favourable?

Answer 7

When there is healing of the pulp, PDL, bone and tissues/structure involved in the trauma

Question 8

What does the outcome of dental trauma depend on? (3)

Answer 8

• type and severity of injury
• stage of dental development
• type of treatment

Question 9

When may the outcomes of dental trauma occur?

Answer 9

days, months or years after

Question 10

Describe the questions and information you should gather in your pt interview and examination to properly diagnose dental trauma. (9)

Answer 10

• Symptoms - ask patient
• Clinical:
• Soft tissue, bruising
• Visual assessment of position of tooth
• Colour of tooth
• Mobility
• Perio
• Percussion test (SOUND and presence/absence of PAIN)
• Sensibility test - cold test
• Radiographs

Question 11

Percussion in extrusion vs intrusion

Answer 11

extrusion - PDL severed → dull sound

intrusion - high metallic sound and pain

Question 12

2 types of endo diagnosis

Answer 12

pulpal

apical tissue

Question 13

What should you always do if you see a laceration on the lip?

Answer 13

soft tissue radiograph

Question 14

T or F: Children are more likely to experience fracture injuries

Answer 14

False - more likely subluxation injuries (bone softer than adults)

Question 15

Define acute apical periodontitis. Describe radiographic appearance.

Answer 15

symptomatic tooth (usually confirmed by TTP) without presence of RL

Examination of bone adjacent to root reveals intact lamina dura and consistent PDL space

Question 16

Define chronic apical periodontitis.

Answer 16

bone loss adjacent to tooth root

Question 17

What are some outcomes of dental trauma? (in 3 categories - 1, 3,

Answer 17

Nil

Pulpal

1. Discolouration
2. Pulp canal obliteration
3. Pulpal necrosis (Arrested development, Root resorption secondary to pulpal necrosis)

PDL - root resorption

1. Infection related resorption (Internal inflammatory root resorption, External inflammatory root resorption)
2. Ankylosis/replacement resorption
3. Surface Reparative resorption
4. Transient apical breakdown

Question 18

Types of discolouration? (4)

Answer 18

Bruising (transient - grey)

Pulp canal obliteration (yellow darkening)

Pulp necrosis (grey)

IRR (pink)

Question 19

T/F A tooth which has undergone pulp canal obliteration is non vital

Answer 19

False - it has to be vital because there is enough cells and nutrients to create this response to an irritant. Likely less responsive to sensibility test (perm teeth) via retracted pulp

Question 20

Tx for PCO

Answer 20

no tx if no signs of infection

Question 21

Internal root resorption (5- cause, clinical dx, radiographic dx, diff dx, tx)

Answer 21

cause: pulpal necrosis

clinical dx: may have pink discolouration of crown

radiographic dx: resorption in pulp space of internal dentinal wall, rounded symmetry radiolucency

diff dx: pink discolouration also seen during physiological resorption of pulp space in primary teeth

tx: RCT

Question 22

How does Ankylosis / Replacement Resorption happen?

Answer 22

after luxation injuries w signficant damage to PDL

repair with bony replacement and rate of repair dictates rate of root replacement → tooth becomes ankylosed

Question 23

Dx of Ankylosis/ Replacement Resorption (clinical -2, radiographic)

Answer 23

Clinical

• ankylotic sound: high pitched, metallic tone to percussion test
• submerging appearance in growing child/infraocclusion (might take adjacent teeth with it)

Radiographic:

• may show signs of replacement resorption, hard to see in early stages when only small areas affected

Question 24

Tx for Ankylosis/ Replacement Resorption (4)

Answer 24

• may leave to monitor and allow for bone to cover tooth
• decoronate subgingivally and bury root inside let bone heal/grow
• in non-vital teeth - RCT and dressing (DONT obturate until can be managed definitively)

Question 25

What are the main outcomes of trauma to primary teeth? (4)

Answer 25

1. discolouration
2. PCO
3. pulpal necrosis (+/- apical abscess)
4. root resorption

similar to perms, discolouration more common w primary

Question 26

Injuries to succedaneous teeth due to trauma or infection of predecessor (7)

Answer 26

1. enamel defects
2. dilaceration
3. malformation
4. arrested development
5. eruption disturbances
6. odontoma-like formation
7. duplication

Question 27

Dental trauma types

Answer 27

Question 28

Cervical resorption

(What is it, aetiology, clin dx, radio dx, tx)

Answer 28

• damage to root in cervical area
• aetiology: infected pulp or periodontium
• clinical dx: pink area near cervical margin
• radiographic dx: resorption in cervical area
• vital tooth tx - curettage and MTA/CaOH lining followed by restoration
• non-vital tx - RCT and as per vital tooth

Question 29

What happens in pulp necrosis? How do we diagnose it? What is the treatment?

Answer 29

arrested development - root resorption often occurs secondary to pulpal necrosis

clinical - discolouration, - cold test, TTP, sinus, abscess

radio - apical perio (evidence of inflammation)

tx: RCT

Question 30

What causes inflammatory root resorption?

Answer 30

colonised by multinuclear giant cells due to microbial products

Question 31

What is ERR? How does it occur? Dx? Tx?

Answer 31

in non-vital teeth

damage to PDL (usually w luxation injuries)

toxins from pulp space → dentinal tubules → inflammation and resorption of root surface

radio dx: punched out lesion

tx: RCT (must intervene, sometimes still end up losing tooth)

Question 32

Review times for dental trauma

Answer 32

1 week soft tissue

3-4 weeks PDL

6-8 weeks pulp

1 year

every year until 4-5yrs

Question 33

Where are perms placed in relation to primary? How does this affect outcome of luxation injuries?

Answer 33

palatally

when tooth is palatally displaced → root tips buccal, away from perm (less risk of damage)

and vice versa

**last yr- tooth shorter if apex towards labial  displaced away from perm

• tooth longer if apex towards palatal  bumped into perm

Question 34

What happens in surface reparative resorption?

Answer 34

post-injury the PDL grows back and reattaches, osteoclasts are gone

not clinically significant, happens more in apical areas, SMALL areas of resorption

Question 35

What happens in infection related resorption, what must be done?

Answer 35

toxins from pulp come to surface causing reaction of big punched out lesion on tooth AND corresponding RL on bone

need to extirpate and dress to half resorption

Question 36

When should elective pulpectomy be done and why?

Answer 36

avulsion injuries as chances of pulpal necrosis are high and should be done to prevent IRR

Question 37

What happens in ankylosis/replacement resorption? Why is it signficant in kids?

Answer 37

after PDL is severed, some repair happens, the rate of repair of bone vs tooth root surface is imbalanced, bone takes over and obscures the PDL space and grows into dentine and replaces it slowly over time in small patches

For a growing child under 18-20, as the bone grows, there is a possibility of ankylosis and infraocclusion. The rate/prominence depends on whether or not they are in a growth spurt.