4- Outcomes of Dental Trauma Flashcards
If PDL involved, when do you need to review?
3-4 weeks
Tooth is a bit loose but not displaced. What is this? What sign might not always be present.
Subluxation
bleeding may not always be present
What does TTP indicate
PDL involvement
Concussion. Signs and Symptoms.
No mobility, no bleeding
Which type of injury have increased risk of damage to perm?
luxation injuries (intrusion, lat luxation)
- alveolar fracture
- lateral luxation
- intrusion
- avulsion
What effects might luxation injuries cause?
impaction
enamel defects to perm depending on stage of development of child
High impact, high velocity vs low would cause what kind of injuries
high impact, high velocity -> fracture w no displacement OR
displacement
When is the outcome of dental trauma favourable?
When there is healing of the pulp, PDL, bone and tissues/structure involved in the trauma
What does the outcome of dental trauma depend on? (3)
- type and severity of injury
- stage of dental development
- type of treatment
When may the outcomes of dental trauma occur?
days, months or years after
Describe the questions and information you should gather in your pt interview and examination to properly diagnose dental trauma. (9)
- 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
Percussion in extrusion vs intrusion
extrusion - PDL severed → dull sound
intrusion - high metallic sound and pain
2 types of endo diagnosis
pulpal
apical tissue
What should you always do if you see a laceration on the lip?
soft tissue radiograph
T or F: Children are more likely to experience fracture injuries
False - more likely subluxation injuries (bone softer than adults)
Define acute apical periodontitis. Describe radiographic appearance.
symptomatic tooth (usually confirmed by TTP) without presence of RL
Examination of bone adjacent to root reveals intact lamina dura and consistent PDL space
Define chronic apical periodontitis.
bone loss adjacent to tooth root
What are some outcomes of dental trauma? (in 3 categories - 1, 3,
Nil
Pulpal
- Discolouration
- Pulp canal obliteration
- Pulpal necrosis (Arrested development, Root resorption secondary to pulpal necrosis)
PDL - root resorption
- Infection related resorption (Internal inflammatory root resorption, External inflammatory root resorption)
- Ankylosis/replacement resorption
- Surface Reparative resorption
- Transient apical breakdown
Types of discolouration? (4)
Bruising (transient - grey)
Pulp canal obliteration (yellow darkening)
Pulp necrosis (grey)
IRR (pink)
T/F A tooth which has undergone pulp canal obliteration is non vital
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
Tx for PCO
no tx if no signs of infection
Internal root resorption (5- cause, clinical dx, radiographic dx, diff dx, tx)
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
How does Ankylosis / Replacement Resorption happen?
after luxation injuries w signficant damage to PDL
repair with bony replacement and rate of repair dictates rate of root replacement → tooth becomes ankylosed
Dx of Ankylosis/ Replacement Resorption (clinical -2, radiographic)
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
Tx for Ankylosis/ Replacement Resorption (4)
- 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)
What are the main outcomes of trauma to primary teeth? (4)
- discolouration
- PCO
- pulpal necrosis (+/- apical abscess)
- root resorption
similar to perms, discolouration more common w primary
Injuries to succedaneous teeth due to trauma or infection of predecessor (7)
- enamel defects
- dilaceration
- malformation
- arrested development
- eruption disturbances
- odontoma-like formation
- duplication
Dental trauma types
Cervical resorption
(What is it, aetiology, clin dx, radio dx, tx)
- 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
What happens in pulp necrosis? How do we diagnose it? What is the treatment?
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
What causes inflammatory root resorption?
colonised by multinuclear giant cells due to microbial products
What is ERR? How does it occur? Dx? Tx?
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)
Review times for dental trauma
1 week soft tissue
3-4 weeks PDL
6-8 weeks pulp
1 year
every year until 4-5yrs
Where are perms placed in relation to primary? How does this affect outcome of luxation injuries?
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
What happens in surface reparative resorption?
post-injury the PDL grows back and reattaches, osteoclasts are gone
not clinically significant, happens more in apical areas, SMALL areas of resorption
What happens in infection related resorption, what must be done?
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
When should elective pulpectomy be done and why?
avulsion injuries as chances of pulpal necrosis are high and should be done to prevent IRR
What happens in ankylosis/replacement resorption? Why is it signficant in kids?
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.
