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BDS3 Intro to Clinics > Adult Dental Trauma > Flashcards

Adult Dental Trauma Flashcards

1
Q

health burden of dental trauma

A

longer to treat and is more expensive than many other bodily unjuries treated on outpatient basis

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2
Q

dental trauma impact on quality of life

A

an untreated dental trauma affects an individual 20 times more, compared to those who have never suffered dental trauma

dominating problems: chewing, eating food and school activities

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3
Q

3 outcome predictors of dental trauma

A
  • severity of injury sustained
  • stage of root development
  • timing of treatment (EADT)
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4
Q

when considering complications of dental trauma consider them in context to

A

damage to pulp, blood supply and PDL

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5
Q

risk calculator for dental trauma

A

IADT International Association of Dental Traumatology Guide

  • Prognosis for teeth with traumatic dental injuries
  • Associated with Copenhagen trauma database
    • Data from 2191 traumatised permanent teeth from 1282 pts
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6
Q

enamel-dentine crown fractures

relative risks of a complications pulp necorsis at 10 years

A

5.1%

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7
Q

enamel-dentine crown fractures

relative risks of a complications pulp canal obliteration at 10 years

A

1.3%

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8
Q

2 complications of enamel dentine crown fractures

A

pulp necorsis

pulp canal obliteration

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9
Q

enamel-dentine-pulp crown fractures

relative risks of a complications (X) at 10 years

A

pulp canal obliteration

20%

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10
Q

3 complications from concusssion dental trauma

A

pulp necrosis

pulp canal obliteration

external root resorption

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11
Q

realtive risk of pulp necrosis post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 3.5%

2 years - 3.5%

10 years - 3.5%

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12
Q

realtive risk of pulp canal obliteration post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 4.4%

3 years - 7.2%

10 years - 10.3%

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13
Q

realtive risk of external root resorption post concussion injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 5.2%

3 years - 8 %

10 years - 8%

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14
Q

3 complications post subluxation injury

A

pulp necrosis

external root resorption

bone loss

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15
Q

relative risk of pulp necrosis post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 12.5%

3 years - 12.5 %

10 years - 12.5%

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16
Q

relative risk of external root resorption post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 2.7%

3 years - 2.7%

10 years - 2.7%

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17
Q

relative risk of bone loss post subluxation injury (closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

at 1, 3 and 10 years

A

1 year - 0.9%

3 years - 0.9%

10 years - 0.9%

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18
Q

4 complications post extrusion injury

A

pulp necorsis

pulp canal obliteration

external root resorption

bone loss

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19
Q

relative risk of pulp necorsis post extrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 56.5%

3 years - 56.5%

10 years - >56.5%

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20
Q

relative risk of pulp canal obliteration post extrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 21.7%

3 years - 21.7%

10 years - >21.7%

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21
Q

relative risk of external root resorption post extrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 yera - 27%

3 years - 27%

10 years - 27%

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22
Q

relative risk of bone loss post extrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 17.4%

3 years - 17.4%

10 years - 17.4%

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23
Q

6 complications of lateral luxation injuries

A

pulp necrosis

pulp canal obliteration

ankylosis

internal root resorption

external root resorption

bone loss

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24
Q

relative risk of pulp necrosis post lateratl luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 65.1%

3 years - 72.8%

10 years - 75.3%

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25
Q

relative risk of pulp canal obliteration post lateral luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 12.8%

3 years - 12.8%

10 years - 18.3%

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26
Q

relative risk of replacement root resorption post lateratl luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 1

3 years - 1

10 years -1

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27
Q

relative risk of internal root resorption post lateratl luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 1

3 years - 3.3

10 years - 3.3

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28
Q

relative risk of bone loss post lateratl luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 5.8

3 years - 5.8

10 years - 5.8

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29
Q

new term for ankylosis

A

replacement root resorption

rare but seen in severe injuries

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30
Q

relative risk of infection related resorption post lateratl luxation injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

after 1, 3 and 10 years

A

1 year - 31.3

3 years - 33.6

10 years - 33.6

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31
Q

new term for external root resorption

A

infection related root resorption

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32
Q

7 complications of dento-alveolar fractures

A

tooth loss

pulp necorsis

pulp canal obliteration

replacement root resorption

internal root resorption

infections related root resorptioon

bone loss

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33
Q

relative risk of tooth loss post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 1.8%

3 - 8.4%

10 - 10.2%

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34
Q

relative risk of pulp necorsis post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 38.4%

3 - 42.4%

10 - 44.7%

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35
Q

relative risk of pulp canal obliteration post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 38.4%

3 - 42.4%

10 - 44.7%

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36
Q

relative risk of replacement root resorption post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 1.3%

3 - 2.1%

10 - 2.1%

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37
Q

relative risk of internal root resorption post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 1.8%

3 - 2.7%

10 - 4.2%

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38
Q

relative risk of infection related root resorption post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 5

3 - 5

10 - 5

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39
Q

relative risk of boone loss post dento-alveolar fracture

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 7.7

3 - 7.7

10 - 7.7

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40
Q

6 complications of intrusion injuries

A

tooth loss

pulp necrosis

replacement root resorption

internal root resorption

infection related root resorption

bone loss

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41
Q

relative risk of tooth loss post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 0

3 - 5.3

10 - 28.9

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42
Q

relative risk of pulp necorsis post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 100

3 - 100

10 - 100

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43
Q

relative risk of replacement root resorption post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 10.3

3 - 26.1

10 - 37.5

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44
Q

relative risk of internal root resorption post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 4.8

3 - 4.8

10 - 4.8

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45
Q

relative risk of infection related root resorption post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 5

3 - 5

10 - 5

46
Q

relative risk of bone loss post intrusion injury

(closed apex, no crown fracture, unknown response to sensitivity testing at time of injury)

1, 3 and 10 years

A

1 - 42.9

3 - 57.1

10 - 63.3

47
Q

prognosis of avulsed tooth depends on

A

EADT (extra alveolar dry time)

48
Q

eruption and root completeion age of upper 1

A

7-8 years

10 years

49
Q

eruption and root completeion age of upper 2

A

8-9 years

11 years

50
Q

eruption and root completeion age of upper 3

A

11-12 years

13-15 years

51
Q

eruption and root completeion age of upper 4

A

10-11 years

12-13 years

52
Q

eruption and root completeion age upper 5

A

10-12 years

12-14 years

53
Q

eruption and root completeion age of lower 1

A

6-7 years

9-10 years

54
Q

eruption and root completeion age of lower 2

A

7-8 years

10 years

55
Q

eruption and root completeion age of lower 3

A

9-10 years

12-14 years

56
Q

eruption and root completeion age of lower 4

A

10-12 years

12-13 years

57
Q

eruption and root completeion age of lower 5

A

11-12 years

13-14 years

58
Q

properties of open apex

A
  • Maintain pulpal vitality
  • Preservation of blood supply
  • Regeneration
59
Q

properties of closed apex

A
  • Maintain pulpal vitality
  • Preservation of blood supply

Prevent ingress of or eliminate bacteria and toxins

60
Q

what complications are common with delayed or no trauma tx

A

pulp necrosis and root resorption

61
Q

3 time approaches to trauma tx

A

acute

subacute

delayed

62
Q

acute trauma tx

A

<3 hours

63
Q

subacute trauma tx

A

3-24 hours

64
Q

delayed trauama tx

A

>24 hours

65
Q

how is the decision made on which trauma tx approach to use

A

based on pt discomfort, risk of infection, rate of complications

66
Q

recommeneded tx timining protocol for avulsion

A

immediate re-implantation or acute (or subacute)

not usually professional - bystander put tooth back in socket (then go sub-acute) or stroage medium (then acute)

67
Q

recommeneded tx timining protocol for alveolar fracture

A

acute (evidence base questionable)

68
Q

recommeneded tx timining protocol for external or lateral luxation

A

acute or subacute

69
Q

recommeneded tx timining protocol for root fracture

A

acute or subacute

70
Q

recommeneded tx timining protocol for concussion or subluxation

A

subacute

71
Q

recommeneded tx timining protocol for crown or crown-root fracture

A

subacute or delayed

72
Q

5 potential long term complication categories of dental trauma

A
  • Discolouration
  • Loss of vitality
  • Inflammatory root resorption
    • Internal
    • External
    • Replacement
  • Unfavourable tooth positions
  • Defects in hard and soft tissues (due to trauma at time or complications)
73
Q

external discolouration cause

A

accumulation of staining media

74
Q

internal discolouration possible causes

A
  • Optical and light transmission properties of enamel and dentine
  • Following trauma may be yellow, pink/red or grey/black
75
Q

how to dx tooth discolouration

A

Diagnosed by visual inspections during dental examination

76
Q

yellow discolouration

A
  • Indicative of canal obliteration
  • Tertiary dentine reduces light transmission
  • Monitor for signs/symptoms of loss of vitality
    • Often maintain vitality so check for other signs/symptoms not just colour change
  • Consider local external bleaching
77
Q

pink discolouration

A
  • Rupture of blood vessels during severe trauma may cause haemorrhage in pulp chamber (at time)
  • Blood components flow into dentinal tubules, causing discolouration of the surrounding dentine
    • Initially pink
  • Cervical root resorption may also present as pink discolouration at the cervical margin of the crown
    • Potential lateral complication of trauma
    • Expect to return to normal colour in approx. 3 months
  • Often initial presentation of cervical root resorption in absence of radiographs
78
Q

brown-grey-black discolouration

A
  • In non-infected traumatised teeth accumulation of the haemoglobin molecules or other haematin molecules causes discolouration
  • In non-vital teeth hydrogen sulphates produced by bacteria convert iron to dark coloured iron sulphates
  • Important to understand if the trauma has causes loss of vitality or not
79
Q

reversal of pink discolouration

A
  • No necrosis discolouration may reverse over time as the pulp revascularizes (2-3 months)
  • If pulpal necrosis discoloration will worsen over time
80
Q

loss of vitality after trauma can be due to

A

pulp necrosis and apical periodontitis

81
Q

pulp necrosis and apical periodontitis

A
  • Occurs following trauma if revascularisation fails
    • For closed apex need transient apical breakdown which allows capillaries to grow into that area (will not happen for avulsion)
  • Pulp tissue will undergo sterile necrosis
  • Subsequent bacterial infection may then occur
  • After 3-4 weeks radiographic indication of pulp necrosis
  • Development of apical periodontitis
  • Apical radiolucency on radiograph
82
Q

6 diagnostic indicators of pulp necrosis

A

negative sensibility test is not enough on its own - need 1/more of these

  • Periapical radiolucency
  • Discolouration of the tooth crown (usually Grey/Brown)
  • Infection related external root resorption
  • No response to pulp sensitivity tests (wait for period after trauma)
  • Tenderness to percussion and palpation in the vestibule develops after an asymptomatic period
  • Presence of a fistula (sinus tract)
83
Q

tx options for pulpal necrosis

A
  • primary endodontics
  • internal bleaching
  • extraction and prosthetic replacement
84
Q

unfavourable tooth positions

A
  • Altered (unfavourable) tooth positions may result following displacement injuries
    • E.g. luxation, intrusion, extrusion, avulsion (learn definitions)

Repositioning and splinting within 24 hours to minimise risk of complications

85
Q

restorative tx for minimal changes in tooth position

A

addition of composite resin

removal of tooth tissue

86
Q

restorative tx for significant alterations in apico-coronal tooth position

A

extra-coronal resotrations (veneers/crowns)

87
Q

orthodontic tooth repositioning used when

A
  • Late presentation injuries
  • Injuries incorrectly repositioned

Increased risk associated with orthodontics

  • root resorption
  • Loss of vitality

these risks are amplified after trauma - need no complications following injury to be suitable

(teeth cannot be ankylosed)

88
Q

unfavourable tooth position as a result of childhood trauma

A
  • Occurs if ankylosis/replacement root resorption results from injury
  • Most likely in severe injuries to PDL e.g. intrusion, avulsion with prolonged EADT
  • Trauma prior to pre-pubescent growth spurt highest risk (continued alveolar growth)
    • Extreme downward and forward growth of maxilla (circa 8-9)
      • Causes tooth to be severely infra-occluded (apical in comparison to adj teeth)
89
Q

tx infra-occluded teeth

A

Not amenable to orthodontic repositioning

Best undertaken before >4mm infra-occlusion present (more than 4mm means severely compromised prosthetic tx)

Depends on number of factors:

  • Prognosis of teeth
  • Degree of infra-occlusion
  • Wishes of the patient (and co-operation)
  • Lip line

need no root resorption ongoing (if has then poor prognosis)

90
Q

defects in hard and soft tissues categories

A

loss of tissue during acute injury

developing deficiencies

91
Q

e.g. defects in hard and soft tissue during acute injury

A

gingival lacerations/abrasions

alveolar fractures

92
Q

e.g. developing deficiencies caused defects in hard and soft tissue

A
  • Early extraction with significant bone remodelling
  • Ankylosis
    • Lack of development of alveolar process and gingival margin discrepancy
    • Bone loss during extraction
  • Endodontic failures
93
Q

managment of hard tissue defects in adults

A

bone grafting procedures

orthodntic extrusion therapy (as long as no ankylosis/replacment resorption)

94
Q

management of soft tissue injuries in adults

A

mucogingival surgery

connective tissue grafting to increase volume of keratinsed mucosa

95
Q

considerations for implant tx for adult trauma

A

complex

aesthetically challenging

96
Q

management of hard and soft tissue defects (children)

A
  • extraction of teeth
    • Bone loss
    • Coronectomy (crown down to 1mm below alveolar bone level)
      • Aims for continued bone deposition
  • Osteogenic distraction (hard and many complications)
  • Camouflage
97
Q

complication of tooth extraction post childhood trauma

A
  • May be difficult
  • Potential for further bone loss
  • Socket preservation
  • Vertical bone loss more difficult to deal with
  • Implants challenging
98
Q

how to tx child who needs extraction post trauma

A
  • Extractions and socket preservation
  • Interim PU/-
  • Implants
  • Fixed restoration
99
Q

how to avoid complications after trauma tx

A

correct and timely tx (guidelines)

follow up

onwards referral to specialist at early stage

100
Q

potential difficulties in getting pts to attend trauma follow up appointments

A
  • 81% of dental trauma occurs < age 30 years
  • Alcohol related injuries frequent
  • Psychopathology prevalent
  • Non-transfer of dental records in UK
    • aid by encouraged shared accountability
      • Pt information (written where possible)
    • Appropriate sharing of radiographs to allow serial comparison
101
Q

when to refer a paeds trauma pt

A

open apex

or any acute trauma

102
Q

when to refer adult trauma pt

A

acute and complex injuries

103
Q

6 simple trauma injuries

A

concussion

subluxation

enamel infraction

enamel-dentine fracture

root fracture (apical 2/3 no displacement)

avulsion (following initial re-implantation and splinting)

104
Q

6 complex trauma injuries

A

extrusion

displaced or cervical 1/3 root fracture

lateral luxation

dento-alveolar fracture

intrusion

immature apex (paeds)

105
Q

how to manage simple trauma

A
  • appropriate examination and special investigations to allow classification of injuries
  • refer to international association of dental traumatology guidelines
    • www.dentaltraumaguide.org or American Association of Endodontics Guidelines ‘The Treatment of Traumatic Dental Injuries’
  • Advice if necessary, following this for adult pts
106
Q

how to manage complex trauma

A
  • Appropriate examination and special investigations to allow classification of injuries
  • Stabilise and manage any bleeding, pulpal exposures and pain
  • Refer to guidelines

In NHSGGC onwards referral adult dental trauma services

  • if injury less than or = to 5 days old -> appointmenmt same day
  • if injury is longer than 5 days old but no long term complication -> next available appointment (with trauma on call)
107
Q

complex trauma injury appointment timescale if injury less than or = 5 days old

A

appointmenmt same day

108
Q

complex trauma appointment timescale if injury is older than 5 days old but no long term complications

A

next available appointment (with trauma on call)

109
Q

4 traumas may require specialist tx to avoid long term complications

A

Inflammatory root resorption

  • External cervical root resorption (pink lesion, usually maintain vitality so surgical tx)
  • Internal inflammatory root resorption
  • External inflammatory resorption (change/alteration in pulp or bone) -> endo

Altered tooth positions

  • May require multi-disciplinary care

Root fractures exhibiting developing pathology

  • No pathology -> not necessary extraction
  • Need pathology
    • Loss vitality to fracture line – endo tx
    • Develop pathology apically – extract or apical surgery (specialist input)
  • Identify any pathology developing at fracture line and tx tooth to prevent loss of vitality

Loss of >1 tooth as a result of trauma

  • High priority category for implant treatment in NHS
110
Q

implant criteria on NHS

A
  • Loss more than 1 tooth as a result of trauma
  • Non smoker
  • Maintain good OH (low risk perio)
  • Medically fit

BDS3 Intro to Clinics (10 decks)

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