Adult Consequences of Childhood Trauma Flashcards
(14 cards)
Why is dental trauma considered a significant long-term healthcare burden?
Dental trauma requires extended treatment durations and is costlier than many other outpatient injuries.
What are the main predictors of long-term outcomes in dental trauma?
Severity of injury – Directly influences prognosis.
Stage of root development – Open apex teeth have higher regeneration potential.
Timing of treatment – Immediate management reduces complications.
How can the severity of dental trauma be assessed for prognosis
IADT Dental Trauma Guide provides evidence-based prognosis.
Copenhagen trauma database
Compare the long-term risks of pulp necrosis among different dental trauma types
Concussion: 3.5% at 10 years.
Subluxation: 12.5% at 10 years.
Extrusion: >56.5% at 10 years.
Lateral luxation: 75.3% at 10 years.
Dento-alveolar fracture: 44.7% at 10 years.
Intrusion: 100% at 10 years.
Why is root development crucial in dental trauma prognosis?
Open apex: Greater potential for revascularization and healing.
Closed apex: Increased risk of necrosis and bacterial ingress.
Treatment should aim to maintain pulpal vitality and prevent bacterial contamination.
What is the recommended treatment window for different dental injuries?
Avulsion: Immediate re-implantation or within 3 hours.
Alveolar fracture: Acute (evidence uncertain).
Luxation injuries: Acute or subacute (within 24 hours).
Concussion/Subluxation: Subacute (within 3-24 hours).
Crown fractures: Subacute to delayed (>24 hours acceptable)
What are potential long-term complications following dental trauma?
Discoloration – Yellow, pink, or grey depending on pulpal status.
Loss of vitality – Leads to pulp necrosis and apical periodontitis.
Inflammatory root resorption – Internal and external variants.
Unfavorable tooth positions – Due to luxation or ankylosis.
Defects in hard/soft tissues – Bone loss, gingival recession.
How does post-trauma discoloration indicate pulp status?
Yellow: Pulpal canal obliteration.
Pink: Internal hemorrhage or cervical resorption - can reverse if pulp revascularies (2-3 months)
Brown/grey: Pulpal necrosis with bacterial iron-sulfate formation.
What are clinical and radiographic indicators of pulp necrosis?
what is management?
Crown discoloration.
No response to pulp testing.
Apical radiolucency (infection-related resorption).
Tenderness to percussion.
Presence of sinus tract/fistula.
Management: RCT, internal bleaching, extraction if severe.
What causes unfavorable tooth positions post-trauma, and how are they managed?
Causes: Luxation, intrusion, extrusion, avulsion.
Management: Repositioning/splinting within 24 hours, orthodontic correction if delayed.
Risks with ortho treatment: Root resorption, loss of vitality, ankylosis.
How can infraoccluded teeth be treated?
- Not amenable to orthodontic repositioning
- Best undertaken before >4mm infra-occlusion present
- Depends on a number of factors
- Prognosis of teeth
- Degree of infra-occlusion
- Wishes of the patient (and co-operation)
- Lip line
How can altered tooth position develop later?
Teeth may also alter position as a result of developing complications later
Alveolar bone loss
Drifting or tilting of teeth
Loss of vitality
Developing endodontic
complications
Extrusion or drifting of teeth
What factors contribute to hard and soft tissue defects post-trauma?
how is it managed?
Early extraction: Causes significant alveolar remodeling.
Ankylosis: Leads to infra-occlusion and bone deficiency.
Gingival trauma: Leads to soft tissue recession.
Endodontic failures
Management: Bone grafting, soft tissue grafting, mucogingival surgery, orthodontic extrusion, implant therapy.
When should patients with dental trauma be referred to specialists?
Simple cases: Managed per IADT guidelines.
Complex cases: Displaced fractures, intrusion, avulsion, dento-alveolar fractures.
Specialist referral for: Root resorption, ankylosis, severe tooth loss.
High priority cases for implants: Multiple tooth loss or maxillary central incisors.
