9 - Adult consequences of childhood trauma

Question 1

What are the predictors of outcomes of childhood dental trauma?

Answer 1

• severity of injury
• stage of root development
• timing of treatment

Question 2

When is the root formation complete for the upper 1?

Answer 2

10 years

Question 3

When is the root formation complete for the upper 2?

Answer 3

11 years

Question 4

When is the root formation complete for the upper 3?

Answer 4

13-15 years

Question 5

When is the root formation complete for the upper 4?

Answer 5

12-13 years

Question 6

When is the root formation complete for the upper 5?

Answer 6

12-14 years

Question 7

When is the root formation complete for the lower 1?

Answer 7

9-10 years

Question 8

When is the root formation complete for the lower 2?

Answer 8

10 years

Question 9

When is the root formation complete for the lower 3?

Answer 9

12-14 years

Question 10

When is the root formation complete for the lower 4?

Answer 10

12-13 years

Question 11

When is the root formation complete for the lower 5?

Answer 11

13-14 years

Question 12

Describe healing of a permanent tooth (open apex) that has been traumatised.

Answer 12

• open apex experience regeneration
• maintain pupal vitality
• perseveration of blood supply

Question 13

Describe healing of a permanent tooth (closed apex) that has been traumatised.

Answer 13

• aim to maintain blood supply (not possible in avulsion)
• prevent ingress of bacteria and toxins

Question 14

What are the time frames when treatment planning trauma?

Answer 14

• acute (3 hours)
• subacute (3-24 hours)
• delayed (>24 hours)

Question 15

What is the timeframe for treating an avulsion injury?

Answer 15

• immediate replantation
• acute or subacute

Question 16

What is the timeframe for treating an alveolar fracture injury?

Answer 16

Acute

Question 17

What is the timeframe for treating an extrusion injury?

Answer 17

Acute or subacute

Question 18

What is the timeframe for treating an lateral luxation injury?

Answer 18

Acute or subacute

Question 19

What is the timeframe for treating an root fracture?

Answer 19

Acute or subacute

Question 20

What is the timeframe for treating an concussion injury?

Answer 20

Subacute

Question 21

What is the timeframe for treating an subluxation injury?

Answer 21

Subacute

Question 22

What is the timeframe for treating an crown fracture?

Answer 22

Subacute or delayed

Question 23

What is the timeframe for treating an crown-root fracture?

Answer 23

Subacute or delayed

Question 24

What are the potential long term complications?

Answer 24

• discolouration
• loss of vitality
• inflammatory root resorption (IRR, ERR, RRR)
• unfavourable tooth position
• defects in hard and soft tissue

Question 25

What causes yellow discolouration of teeth?

Answer 25

- canal obliteration - tertiary dentine reduces light transmission - external bleaching can treat

Question 26

What causes pink discolouration of teeth?

Answer 26

- rupture of blood vessels in severe trauma causes haemorrhage in pulp chamber - blood components flow into tubules - will reverse if tooth vital and pulp revascularises - if tooth non-vital, will progress to brown/grey - cervical root resorption can cause discolouration at cervical margin

Question 27

What causes brown/grey/black discolouration of teeth?

Answer 27

- in non infected teeth, haemoglobin accumulates - in non-vital teeth, bacteria produce hydrogen sulphates which cause iron to become dark

Question 28

Describe pulpal necrosis following trauma.

Answer 28

- sterile necrosis initially (no blood or bacteria) - subsequent infection can occur via PDL or cracks - can develop apical periodontitis

Question 29

What are diagnostic indicators of pulpal necrosis?

Answer 29

- periapical radiolucency - discolouration of tooth (grey or brown) - infection related ERR apically - pupal sensitivity testing - TTP - sinus tract

Question 30

What are the treatment options for pupal necrosis following trauma?

Answer 30

- primary endodontics - internal bleaching for discolouration - extraction with prosthetic replacement

Question 31

What injuries can cause unfavourable tooth position?

Answer 31

- luxation - intrusion - extrusion - avulsion

Question 32

How do you manage small changes in tooth position due to trauma?

Answer 32

- addition of composite resin - removal of tooth tissue

Question 33

How do you manage bigger changes in tooth position due to trauma?

Answer 33

- extra-coronal restorations - orthodontic repositions

Question 34

What is infra-occlusion?

Answer 34

- caused by ankylosis and RRR post-trauma - occurs in severe injuries to PDL - highest risk in trauma that occurs before puberty growth spurt

Question 35

How do you manage infra-occluded teeth?

Answer 35

- orthodontic treatment is not commonly successful - best treated before infra-occlusion is greater 4mm

Question 36

What defects can occur in the hard and soft tissues after trauma?

Answer 36

- loss of tissue in acute injury (lacerations or fractures) - early extraction can lead to bone loss - ankylosis can cause bone loss when extracted - endodontic failure

Question 37

How do you manage bone deficiencies post-trauma?

Answer 37

- bone grafting - orthodontic extrusion therapy (if no ankylosis - tooth brings bone with it)

Question 38

How do you manage soft tissue deficiencies post-trauma?

Answer 38

- mucoginigival surgery - connective tissue grafting to increase volume of tissue

Question 39

What makes extraction of traumatised teeth more difficult?

Answer 39

- potential for further bone loss - drifting of teeth makes preserving tooth space difficult - vertical bone loss - implants are difficult to use

Question 40

What is classified as a simple acute trauma?

Answer 40

- concussion - subluxation - enamel fracture - enamel-dentine fracture - root fracture (apical 2/3 with no displacement) - avulsion

Question 41

What is classified as a complex acute trauma?

Answer 41

- extrusion - displaced root fracture or cervical 1/3 - lateral luxation - dento-alveolar fracture - intrusion - immature apex

Question 42

What is protocol with a simple trauma?

Answer 42

- exam and special investigations - refer to guidelines for treatment - advice is necessary (especially avulsion)

Question 43

What is protocol with a complex trauma?

Answer 43

- exam and special investigations - stabilise and manage bleeding, pulpal exposure and pain - refer to guidelines - refer to adult trauma service