9 - Adult consequences of childhood trauma Flashcards
What are the predictors of outcomes of childhood dental trauma?
- severity of injury
- stage of root development
- timing of treatment
When is the root formation complete for the upper 1?
10 years
When is the root formation complete for the upper 2?
11 years
When is the root formation complete for the upper 3?
13-15 years
When is the root formation complete for the upper 4?
12-13 years
When is the root formation complete for the upper 5?
12-14 years
When is the root formation complete for the lower 1?
9-10 years
When is the root formation complete for the lower 2?
10 years
When is the root formation complete for the lower 3?
12-14 years
When is the root formation complete for the lower 4?
12-13 years
When is the root formation complete for the lower 5?
13-14 years
Describe healing of a permanent tooth (open apex) that has been traumatised.
- open apex experience regeneration
- maintain pupal vitality
- perseveration of blood supply
Describe healing of a permanent tooth (closed apex) that has been traumatised.
- aim to maintain blood supply (not possible in avulsion)
- prevent ingress of bacteria and toxins
What are the time frames when treatment planning trauma?
- acute (3 hours)
- subacute (3-24 hours)
- delayed (>24 hours)
What is the timeframe for treating an avulsion injury?
- immediate replantation
- acute or subacute
What is the timeframe for treating an alveolar fracture injury?
Acute
What is the timeframe for treating an extrusion injury?
Acute or subacute
What is the timeframe for treating an lateral luxation injury?
Acute or subacute
What is the timeframe for treating an root fracture?
Acute or subacute
What is the timeframe for treating an concussion injury?
Subacute
What is the timeframe for treating an subluxation injury?
Subacute
What is the timeframe for treating an crown fracture?
Subacute or delayed
What is the timeframe for treating an crown-root fracture?
Subacute or delayed
What are the potential long term complications?
- discolouration
- loss of vitality
- inflammatory root resorption (IRR, ERR, RRR)
- unfavourable tooth position
- defects in hard and soft tissue
What causes yellow discolouration of teeth?
- canal obliteration
- tertiary dentine reduces light transmission
- external bleaching can treat
What causes pink discolouration of teeth?
- 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
What causes brown/grey/black discolouration of teeth?
- in non infected teeth, haemoglobin accumulates
- in non-vital teeth, bacteria produce hydrogen sulphates which cause iron to become dark
Describe pulpal necrosis following trauma.
- sterile necrosis initially (no blood or bacteria)
- subsequent infection can occur via PDL or cracks
- can develop apical periodontitis
What are diagnostic indicators of pulpal necrosis?
- periapical radiolucency
- discolouration of tooth (grey or brown)
- infection related ERR apically
- pupal sensitivity testing
- TTP
- sinus tract
What are the treatment options for pupal necrosis following trauma?
- primary endodontics
- internal bleaching for discolouration
- extraction with prosthetic replacement
What injuries can cause unfavourable tooth position?
- luxation
- intrusion
- extrusion
- avulsion
How do you manage small changes in tooth position due to trauma?
- addition of composite resin
- removal of tooth tissue
How do you manage bigger changes in tooth position due to trauma?
- extra-coronal restorations
- orthodontic repositions
What is infra-occlusion?
- caused by ankylosis and RRR post-trauma
- occurs in severe injuries to PDL
- highest risk in trauma that occurs before puberty growth spurt
How do you manage infra-occluded teeth?
- orthodontic treatment is not commonly successful
- best treated before infra-occlusion is greater 4mm
What defects can occur in the hard and soft tissues after trauma?
- 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
How do you manage bone deficiencies post-trauma?
- bone grafting
- orthodontic extrusion therapy (if no ankylosis - tooth brings bone with it)
How do you manage soft tissue deficiencies post-trauma?
- mucoginigival surgery
- connective tissue grafting to increase volume of tissue
What makes extraction of traumatised teeth more difficult?
- potential for further bone loss
- drifting of teeth makes preserving tooth space difficult
- vertical bone loss
- implants are difficult to use
What is classified as a simple acute trauma?
- concussion
- subluxation
- enamel fracture
- enamel-dentine fracture
- root fracture (apical 2/3 with no displacement)
- avulsion
What is classified as a complex acute trauma?
- extrusion
- displaced root fracture or cervical 1/3
- lateral luxation
- dento-alveolar fracture
- intrusion
- immature apex
What is protocol with a simple trauma?
- exam and special investigations
- refer to guidelines for treatment
- advice is necessary (especially avulsion)
What is protocol with a complex trauma?
- exam and special investigations
- stabilise and manage bleeding, pulpal exposure and pain
- refer to guidelines
- refer to adult trauma service
