Adult Consequences Of Childhood Trauma Flashcards
What are some predictors for outcome of childhood trauma
Severity of injury - IADT DENTAL TRAUMA GUIDE
Stage of root development
Timing of tx
Recommended timing for avulsion?
Immediate reimplantation or acute/subacute
Recommended timing for alveolar fracture?
Acute phase
Timing for extrusion or lateral luxation?
Acute or subacute
Timing for root fracture
Acute or subacute
Timing for concussion or subluxation?
Subacute
Timing for crown or crown-root fractures?
Subacute or delayed
What timing is acute, subacute and delayed?
Acute 0-3hrs
Subacute 3-24hrs
Delayed >24hrs
What are some potential long term complications of childhood trauma to a tooth?
Discolouration
Loss of vitality
Inflammatory root resorption
Unfavourable tooth positioning
Hard / soft tissue defects
Why might a tooth be yellow? What would you do?
Indicative of canal obliteration
Monitor for signs or symptoms of loss of vitality
Consider local external bleaching
Why might a tooth be pink? How treat?
Haemorrhage in pulp chamber with blood flowing into dentinal tubules
Cervical root resorption may occur
If tooth is not necrotic may recover in 2-3 months as it revascularises
If necrotic then discolouration will worsen
Why might tooth be brown/grey/black?
Non infected traumatised tooth with accumulation of haemoglobin
Hydrogen sulphate produced by bacteria concert iron to dark iron sulphate
Possible loss of vitality
Why might pulp necrosis and apical periodontitis follow trauma?
When revascularisation fails
Pulp tissue necrotises and bacterial infection occurs
3-4 week time period necrosis will show radiographically
What indicates a tooth may be necrotic?
Loss of the lamina dura
Widening of the PDL
Grey/brown tooth discolouration
Periapical radiolucency
Infection related root resorption
No response to pulp sensitivity testing
TTP
Draining sinus
How treat pulp necrosis?
Primary endodontic treatment with internal bleaching
XLA and replace
What issue might unfavourable tooth position lead to? Best thing to do?
Increased risk of traumatic injury such as luxation or intrusion
Reposition and splint within 24 hours to prevent unfavourable tooth position
If minimal change, add composite or remove tooth tissue
If large change needed, orthodontically treat or use extra coronal restorations
What is an infra occluded tooth? How treat?
Ankylosed tooth which is stuck between two others as the alveolar bone grows over
Full assessment required
XLA if below contact point
How might hard and soft tissue discrepancies be managed in an adult patient?
Bone grafting
Ortho extrusion with chain
Mucogingivalnsurgery
Connective tissue grafting
Implants
What are simple injuries?
Concussion
Subluxation
Enamel infraction
ED fracture
Root fracture in apical 2/3 with no displacement
Avulsion after reimplantation and splinting
What are complex injuries
Alveolar fracture
Immature apex (paeds)
Displaced or cervical root fracture
Intrusion and extrusion
Lateral luxation
What to do for simple trauma?
Appropriate exam and investigations to allow classification
Refer to international association of dental trauma guidelines
Www.dentaltraumaguide.org
What complications of trauma may require specialist intervention?
Inflammatory root resorption
Altered tooth positioning
Root fractures with developing pathology
Loss of >1 tooth
