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Paeds > Classification and types of dental trauma > Flashcards

Classification and types of dental trauma Flashcards

1
Q

Incidence of trauma?

A

31-40% of 5-year-old boys
 16-30% of 5-year-old girls
 12-33% of at 12-years-old boys
 4-19% of at 12-years-old girls

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2
Q

Predisposing factors for dental trauma?

A

 2M: 1F
 Increased overjet
 Lip competency
 Age –peak
- 2-4 years
- 8-10 years

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3
Q

Causes of dental injuries in children?

A

 2M: 1F
 Overjet
 Lip competency
 Age –peak
 2-4 years
 8-10 years

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4
Q

Incidence of tooth fractures?

A

 Enamel 31%
 Dentine 45%
 Pulp 5%
 Root 0.5%

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5
Q

Incidence of displacement injuries?

A

 Concussed / Loose / Displaced< 10%
 Avulsion 0.5%

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6
Q

Dental history for dental injuries in children

A

 History of the accident and the person
 Accompanying adult/guardian
 When -If delay why?
 Where -Future litigation
 How –Direct / Indirect
 Other injuries
 Head injury –headache, vomiting, amnesia, dehydration
 Medical assessment indicated?

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7
Q

Dental history for dental injuries in children continued …

A

 Lost teeth or fragments
- Chest X-Ray
- Soft tissues
 History of previous trauma?
 Age of child
- state of eruption
- previous position of teeth
 Fasting?
 Previous dental experience

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8
Q

Medical history for dental injuries in children

A

 Medical Complications
- Cardiac
- Bleeding disorders
- Allergies –Penicillin
- HIV, Hepatitis
- Tetanus vaccination
 Social History
- Interaction with parent

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9
Q

Extra-oral examination for dental injuries in children?

A

 Swellings
 Asymmetry
 Bones-zygoma (eye signs), mandible (ROM)
 Skin

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10
Q

I/O examination for dental injuries in children

A

Soft Tissues
- Lacerations
- Haematoma

Hard Tissues
- Supporting structures
- Haematoma, tenderness, deformity, opening

Teeth
-Fractures, displacements, number, occlusion, mobility, TTP

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11
Q

Classification of trauma- Ellis classification

A
  1. Enamel fracture
  2. Enamel and dentine fracture
  3. Pulpal exposure
  4. Non-vital
  5. Avulsion
  6. Root-fracture
  7. Displacement
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12
Q

WHO classification of dental injuries in children

A

 Injuries to the hard dental tissues and the pulp
 Injuries to the periodontal tissues
 Injuries to supporting bone
 Injuries to the skin, gingiva or oral mucosa

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13
Q

Injuries to the hard dental tissues and pulp

A

Infraction
Enamel fracture
Enamel dentine fracture- Uncomplicated crown fracture
Enamel dentine fracture- Complicated crown fracture
Uncomplicared crown root fracture
Complicated crown root fracture

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14
Q

Infraction ?

A

 Incomplete crack of enamel - no loss of tooth substance

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15
Q

Diagnosis of infraction

A

 Trans-illumination may be useful

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16
Q

Enamel fracture?

A

Loss of tooth structure confined to enamel

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17
Q

Diagnosis of enamel fracture?

A

 Visual examination
 Normal mobility
 Not TTP
 Sensibility test – usually positive

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18
Q

Enamel dentine fracture- Uncomplicated crown fracture

A

Loss of tooth substance confined to enamel and dentine not
involving the pulp

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19
Q

Diagnosis of enamel dentine fracture- Uncomplicated crown fracture

A

 Visual examination
 Normal mobility
 Not TTP
 Sensibility test – usually positive but may have transient negative
response

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20
Q

What is enamel dentine fracture- complicated crown fracture

A

Fracture of enamel, exposing the pulp

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21
Q

Diagnosis of enamel dentine fracture- complicated crown fracture

A

 Visual examination
 Normal mobility
 Not TTP
 Sensibility test –usually positive, lack of response
initially indicates increased chance of pulp necrosis

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22
Q

What is an uncomplicated crown root fracture

A

Fracture of enamel, dentine and cementum but not involving the pulp

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23
Q

What is a complicated crown-root fracture

A

Fracture of enamel, dentine, and cementum,
exposing the pulp

24
Q

Diagnosis of complicated crown-root fracture?

A

 Visual – crown fracture extending below gingival
margin
 Tender to percuss
 Coronal fragment mobile

25
Q

Diagnosis of a displaced root fracture?

A
  • Visual examination - Coronal fragment may be mobile
    and possibly displaced
  • Tooth may be tender to percuss
  • Sensibility test –often negative
26
Q

Injuries to the periodontal tissues ?

A

Concussion
Subluxation
Extrusive luxation
Lateral luxation

27
Q

What is concussion?

A

No abnormal loosening or displacement but TTP

28
Q

What is diagnosis for concussion?

A

 Visual – undisplaced
 No increased mobility
 Tender to touch
 Usually positive sensibility test
 No radiographic abnormalities

29
Q

What is subluxation?

A

Tooth has increased mobility but no displacement

30
Q

Diagnosis for subluxation?

A

 Visual - no displacement
 Increased mobility
 Tender to percuss
 Sensibility may be negative
 No abnormal radiological findings

31
Q

What is extrusive luxation?

A

partial displacement of tooth from socket

32
Q

What is lateral luxation

A

 displacement other than axially
 Along with comminution or fracture of alveolar plate

33
Q

What is the diagnosis for extrusion?

A

 Tooth appears elongated
 Tender to percuss
 Significant increased mobility
 Often negative sensibility test
 Radiograph –Tooth appears displaced,
apical portion of socket empty

34
Q

What is the diagnosis for lateral luxation?

A

 Displaced usually palatally or labially
 Percussion test may give a high sound
 No mobility
 Often negative sensibility test
 Radiograph –Widened PDL space

35
Q

What is intrusion?

A

displacement into bone, with comminution or fracture of
alveolar plate

36
Q

What is the diagnosis for intrusion

A

 Tooth is displaced axially up into the bone with no mobility
 Percussion gives a high metallic tone
 Sensibility – usually negative
 Radiographs
- tooth appears displaced
- obliteration of pdl space

37
Q

What is avulsion?

A

Complete displacement of tooth from socket

38
Q

What is diagnosis

A

 Visual -Tooth not present!
 Check not severe intrusion

39
Q

Injuries to the supporting bone

A

 Comminution / fracture of alveolar socket wall
 Fracture of mandibular or maxillary alveolar process
 Fracture of mandible or maxilla

40
Q

Injuries to the skin, gingiva or oral mucosa?

A

Laceration
Contusion
Abrasion

41
Q

Laceration?

A

Wound resulting from a tear

42
Q

Contusion?

A

Bruise, no break in mucosa, usually causing submucosal
haemorrhage

43
Q

Abrasion?

A

Superficial wound produced by scraping or rubbing of
surface

44
Q

Lacerations- things to check

A

Check for through and through lacerations
Explore for missing fragments
 Degloving lacerations

45
Q

Findings for lacerations

A

Degloved gingiva, rolled appearance

46
Q

Findings for lacerations

A

Degloved gingiva, rolled appearance

47
Q

What are the baseline investigations for lacerations?

A

Examination
 Palpate
 Position
 Colour
 Mobility
 Percussion
 Sensibility
– Thermal
– Electrical
Include adjacent teeth

48
Q

Radiographic investigations for lacerations - what to consider

A

 Periapicals
 Anterior occlusal
 DPT
 E/O views as indicated
 Soft tissue view if missing fragments + laceration
 Clinical Photographs

49
Q

What is included in a dental trauma review (date and time is recorded)

A

Colour
Soft tissues
Mobility
TTP
Percussion tone
Ethyl chloride
EPT
X ray
Root treatment

50
Q

Non-accidental injury - pointers

A

 Delay in presentation
 Inconsistent or changing history
 Other bruising (different ages)
 Torn labial frenum
 Burns
 Bitemarks
 Relationship with parents

51
Q

Prevention of dental injuries? and how does it prevent

A

Mouthguards

52
Q

What do mouthguards do?

A

Prevent many injuries and decrease severity

53
Q

What is important about mouthguards?

A

Type of mouthguard
ie. custom fit or
sports shop alternatives

54
Q

Mouth protectors must be

A

 Fully extended and occlusal accommodated
 Sufficient thickness in critical areas

55
Q

Benefit of mouth protectors?

A

 Crowns, alveolus and roots and soft tissues protected
 Retentive and comfortable

Paeds (11 decks)

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