Adult Consequences of Childhood Trauma Flashcards
What predicts the future outcome of dental trauma?
Severity of injury sustained
Stage of root development
What are the different timing approaches to dental trauma?
Acute - <3 hours
Subacute - 3-24 hours
Delayed >24 hours
What are the recommended treatment timings for avulsion, alveolar fracture, extrusion and lateral luxation?
Avulsion - immediate reimplantation - acute
Alveolar fracture - acute
Extrusion or lateral luxation - acute or subacute
What are the recommended treatment timings of root fracture, concussion, subluxation and crown or crown-root fracture?
Root fracture - acute or subacute
Concussion or subluxation - subacute
Crown or crown-root fracture - subacute or delayed
What is commonly seen if trauma treatment is delayed?
Pulp necrosis and root resorption
What are the long term complications of trauma?
Discolouration
Loss of vitality
Inflammatory root resorption - internal, external or replacement
Unfavourable tooth positions
Defects in hard and soft tissues
What are the different types of discolouration?
External - accumulation of staining media
Internal - optical and light transmission properties of enamel and dentine - following trauma may be yellow, pink/red or grey/black
What does yellow discolouration indicate and what should be done?
Indicative of canal obliteration
Tertiary dentine reduced light transmission
Monitor for signs/symptoms of loss of vitality
Consider local external bleaching
What does pink discolouration indicate?
Rupture of blood vessels during severe trauma may cause haemorrhage in the pulp chamber
Blood components flow into dentinal tubules, causing discolouration of the surrounding dentine
Cervical root resorption may also cause this at the cervical margin of the crown
What does brown/grey/black discolouration indicate?
In non-infected traumatised teeth accumulation of the Hb causes discolouration
In non-vital teeth hydrogen sulphate produced by bacteria convert iron to dark coloured iron sulfates
How is pink discolouration reversed?
If no necrosis, discolouration may reverse over time as the pulp revascularises (2-3 months)
If pulpal necrosis, discolouration will worsen over time
What is the relationship between pulp necrosis and apical periodontitis?
Following trauma if revascularisation fails, pulp will undergo sterile necrosis
Bacterial infection may then occur
After 3-4 weeks, radiographic indications of pulp necrosis
This can develop into apical periodontitis as apical radiolucency is shown on radiograph
What are the diagnostic indicators of pulp necrosis?
Periapical radiolucency
Discolouration of the tooth (usually grey/brown)
Infection-related external root resorption
No response to pulp sensitivity test
Tenderness to percussion
Presence of a fistula (sinus tract)
How is pulpal necrosis treated?
Primary endodontics
Internal bleaching
Extraction and prosthetic replacement
Which hard and soft tissue defects are associated with loss of tissue during acute injury?
Gingival lacerations/abrasions
Alveolar fractures
