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BDS 4: Paeds > Biological Response to Traumatic Dental Injuries > Flashcards

Biological Response to Traumatic Dental Injuries Flashcards

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1
Q

What type of trauma is this?

A

Enamel infraction

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2
Q

What type of trauma is this?

A

Enamel fracture

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3
Q

What type of trauma is this?

A

Enamel-dentin fracture

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4
Q

What type of trauma is this?

A

Enamel-dentin-pulp fracture

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5
Q

What type of trauma is this?

A

Root fracture

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6
Q

What type of trauma is this?

A

Alveolar fracture

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7
Q

What type of trauma is this?

A

Crown root fracture without pulp involvement

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8
Q

What type of trauma is this?

A

Crown root fracture with pulp involvement

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9
Q

In terms of periodontal trauma define concussion

A

Injury without abnormal loosening or displacement there is a reaction to percussion

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10
Q

In terms of periodontal trauma define subluxation

A

Injury with abnormal loosening
No displacement of tooth

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11
Q

In terms of periodontal trauma define extrusive luxation

A

Partial displacement of tooth

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12
Q

In terms of periodontal trauma define intrusive luxation

A

Displacement into alveolar bone

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13
Q

In terms of periodontal trauma define lateral luxation

A

Displacement (not axial)
Associated with alveolar bone fracture

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14
Q

In terms of periodontal trauma define avulsion

A

Complete displacement of tooth

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15
Q

What are the contents of the dental pulp?

A

Fibroblasts
Odontoblasts (line outer layer)
Progenitor/Stem cells
Inflammatory cells
Vascular & Nerve cells
Loose connective tissue
Giant cells

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16
Q

Name the inflammatory cells present in the dental pulp

A

Polymorphs
T Lymphocytes
Macrophages
Dendritic antigen-presenting cells

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17
Q

What things can be obsereved visually to suggest dental trauma?

A

Soft tissue lacerations
Swelling or bruising (indicative of inflammation)
Abscess formation
Mobility/displacement of tooth
Crown fractures
Tooth discoloration

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18
Q

How can sound help diagnose dental trauma?

A

Percussion test can be carried out and if dull or high-pitched metallic sounds compared to neighbouring teeth then trauma may be suggested

19
Q

On percussion a tooth makes a high-pitched metallic sound what dental trauma could this suggest?

A
20
Q

On percussion a tooth makes a high-pitched metallic sound what dental trauma could this suggest?

A

Intrusion or lateral luxation

21
Q

How do pulp sensibility and pulp vitality tests differ?

What type of tests are Endo-frost and EPT?

A

Pulp sensibility assessing pulpal nerve supply
Pulp vitality which assesses blood flow

Sensibility

22
Q

Comment on sensibility during root development

A

Level of pulp sensibility DECREASES with INCREASED root development

UNTIL full root development (closed apex) where sensibility increases to highest

23
Q

What are the different reactions the pulp can have post trauma?

A

Pulp survival
Pulp canal obliteration
Pulp necrosis
Inflammatory internal resorption
Replacement internal resorption

24
Q

Describe what occurs biologically for pulp survival post dental trauma

A
  1. Mild trauma occurs
  2. Tertiary/Reactionary dentine laid down by odontoblasts
25
Q

Describe what occurs biologically for pulp canal obliteration post dental trauma

A
  1. Extensive trauma occurs
  2. Odontoblasts die
  3. These are replaced by progenitor cells which secrete Reparative dentine
26
Q

Clinically what may you see in a tooth that has undergone pulp canal obliteration?

A

Discolouration of tooth (Yellow)

27
Q

What do you see in this radiograph?

A

Pulp canal oblitertation

Reduction in/loss of visible pulp

28
Q

What clinically can be obsereved in a patient which has pulp necrosis following trauma?

A

Discolouration of tooth (Grey/Black as haemoglobin broken down into hemosiderin)

29
Q

What radiographically can be obsereved in a patient which has pulp necrosis following trauma?

A

Periapical radiolucency (Abscess/Cyst formation)

30
Q

Biologically what occurs to a tooth during an Inflammatory Internal Resorption post dental trauma?

A

Inflammation occur which which leads to infiltration of polymorphs and giant cells

Which then leads to resorption of the pulp and dentine

31
Q

What radiographically can be obsereved in a patient which has inflammatory internal resorption following trauma?

A

Radiolucent expansion seen in the pulp canal

32
Q

What are the two types of inflammatory internal resorption?

A

Transient (reversible)
Permanent (non-reversible/progressive)

33
Q

Biologically what occurs to a tooth during replacement internal resorption post dental trauma?

A

Stem cells in pulp differentiate into osteoblasts & areas are replaced with bone tissue

34
Q

Define ankylosis

A

Fusion between the tooth surface (cementum) & alveolar bone

35
Q

What are the diffrent types of periodontal reactions following dental trauma?

A

Normal healing
External resoption
* Surface ER
* Inflammatory ER
* Replacement ER

36
Q

What are the diffrent types of gingival reactions following dental trauma?

A

Normal Healing
Loss of attached gingivae

37
Q

What are the diffrent types of root development reactions following dental trauma?

A

Continuous
Disrupted
Arrested

38
Q

What are the different factors influencing pulp survival post-trauma?

A
  1. Severity of damage to blood supply
  2. Area exposed (size of pulp exposure/trauma)
  3. Length of exposure
  4. Stage of root development
39
Q

Which types of dental trauma are the most and least destructive to the tooths blood supply?

Comment on the role of elastin in blood vessels in preventing damage?

A

Least with concussion & most with avulsion & intrusive luxation

Subluxation & Extrusion have less blood vessel damage due to elastin in blood vessels, allows for some leeway as tooth moves away (vs. being pushed in)

39
Q

Which types of dental trauma are the most and least destructive to the tooths blood supply?

Comment on the role of elastin in blood vessels in preventing damage?

A

Least with concussion & most with avulsion & intrusive luxation

Subluxation & Extrusion have less blood vessel damage due to elastin in blood vessels, allows for some leeway as tooth moves away (vs. being pushed in)

40
Q

Comment on the relationship between apical pulp width and replantation

A

Larger the apical pulp width = Higher chance of pulpal revascularisation after replantation

41
Q

How should teeth needing to be replanted be kept?

A

The longer a tooth is in dry storage before being replanted = Less chance of pulpal revascularisation
Therefore, wet storage (saliva/saline/milk)

42
Q

Outline a Cvek partial pulpotomy

A
  1. Administer LA & isolate w/rubber dam
  2. Remove 1-2mm of exposed pulp with high-speed diamond bur w/water
  3. Control haemorrhage w/saline (or chlorhexidine) soaked cotton pellet
  4. Cover pulp w/layer of non-setting CaOH then seal w/layer of Setting CaOH
  5. Restore the tooth w/ Composite
  6. Revaluate tooth in 6-8 weeks and then 1 year to monitor tooth vitality & root development
43
Q

A 10 year old patient presents with a fracture in his upper permanent central incisor (enamel and dentine with minor pulp exposure)

How would you treat this immediately?

A

Clinical decision is dependant on maturity of tooth.

If the tooth is immature (apex not fully formed): carry out pulp cap or partial pulpotomy. Use Ca(OH)2
If the tooth is mature: carry out RCT or pulp cap/pulpotomy

Then restore the tooth with restorative materials or with the bonded tooth fragment

BDS 4: Paeds (7 decks)

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