CSA trauma to incisors

Question 1

What can trauma on childs tooth lead to?

Answer 1

social judgement and teasing by their peers about their appearance
- Parents of children worries as travel away from work

Question 2

What is avulsions ?

Answer 2

tooth knocked out

Question 3

guideline on intrusion injuries ?

Answer 3

front tooth pushed up in front of gum

Question 4

How do we manage a child that’s just walked in with trauma?

Answer 4

1. First take a history >informs our diagnosis> informs our prognosis
2. Carry out examination

Question 5

How to carry out examination on child?

Answer 5

• start extra orally, maxilla and mandible

- o Carry out intraoral

Question 6

How do we carry out intra oral examination ?

Answer 6

check >

• Systemic: soft tissues & hard tissues
• TMJ :May lead to unsymmetrical growth
• Check all teeth – caries – if going under GA, so don’t have to do it again
• Check all anterior teeth –
• Check occlusion –

Question 7

What can bad occlusion indicate ?

Answer 7

TMJ problems

Question 8

What are 2 special tests?

Answer 8

radiographs

sensibility tests > vitality test

Question 9

What angles are radiographs taken at initial visit>

Answer 9

1. PA or Upper Standard occlusal
2. 2 PA’S – 15O apart
3. OPT if any bony fractures are indicated

Question 10

How to asses root development stage?

Answer 10

o If big neurovascular bundle – good prognosis for healing

o If nerve dies – short root forms with thin dentinal walls

Question 11

What else can we asses from radiographs ?

Answer 11

• Assess presence/absence of root fracture

Question 12

What do we use for vitality tests?

Answer 12

Ethyl chloride

EPT testing

Question 13

What is problems with vitality tests for children?

Answer 13

immature teeth- nerve fibres poorly myelinated

Question 14

How can we get poor prognosis?

Answer 14

if tooth becomes non vital

Question 15

What to look for at injured tooth?

Answer 15

1. Hard tissue injury – enamel/dentine pulp injury
2. PDL injury
   2 different diagnosis for hard & PDL injuries

Question 16

What is little incisal tip fracture?

Answer 16

enamel only fracture

Question 17

What is uncomplicated fracture?

Answer 17

Enamel – dentine fracture

Question 18

What is a complicated fracture?

Answer 18

Enamel – dentine – Pulp fracture

Question 19

What is involved in 5. Enamel – dentine – pulp – root fracture

Answer 19

cementum

Question 20

What other fracture can occur?

Answer 20

root fracture

Question 21

What is treatment option for enamel only fracture?

Answer 21

desensitising agent if tooth is very sensitive

o Can seal tooth with bond/unfilled resin

Question 22

How to treat enamel dentine fractures?

Answer 22

o Composite build up
o Reattachment fragment if found it
o Seal tubules with glass ionomer if don’t have time for composite build up

Question 23

How to treat Enamel – dentine – pulp fractures:

Answer 23

o Pulp cap
o Pulpotomy – remove contaminated pulp to allow pulp to heal
o Pulpectomy – apexification & canal obturation

Question 24

What to consider with enamel-dentine-pulp fractures ?

Answer 24

o Time since fracture occurred
o Degree of contamination 
o Degree of damage 
o Other injuries that may occurred –
o	Stage of root development

Question 25

What can a combination injury do to prognosis?

Answer 25

damage to PDL as well as hard tissues so prognosis worse

Question 26

What are crown root fractures?

Answer 26

• Fracture extends from crown to below gingival crevice/ A bone margin

Question 27

What can root fractures be classified as?

Answer 27

o Horizontal/Vertical | o May be one single fracture or multiple fractures present

Question 28

How to clinically diagnose fractures?

Answer 28

o Mobility is increased | o Extrusion of crown (crown looks higher than other teeth)

Question 29

How to radiographically diagnose fractures?

Answer 29

taken from two angles in vertical plane | - Paralleling technique/Anterior occlusal

Question 30

What is root fracture treatment for undisplaced root fracture>

Answer 30

o Stable & may be minimal clinical signs of injury | o Do not splint teeth, but to monitor

Question 31

What is treatment for displaced root fracture>

Answer 31

o Crown is mobile & interfering with occlusion | o reposition coronal fragment using flexible splint for 4 weeks

Question 32

What are classification of PDL injuries ?

Answer 32

1. Concussion – increasing in severity as we go down 2. Subluxation 3. Extrusion 4. Lateral luxation 5. Avulsion 6. Intrusion 7. Alveolar fracture

Question 33

what is concussion ?

Answer 33

bruise to area – haemorrhage/oedema in perio structure but perio ligament fibres are still intact

Question 34

What symptoms during concussion ?

Answer 34

o Perio fibres Very tender o Not displaced o Not mobile

Question 35

Waht happens if a child has hard tissue injuries as well as PDL?

Answer 35

likely to become non-vital

Question 36

What is subluxation ?

Answer 36

* Tearing of periodontal fibres * mobility * some bleeding around gingival margin * no displacement

Question 37

What is extrusion ?

Answer 37

* occlusal displacement of tooth along vertical axis * rupture in periodontal fibres and neurovascular bundle * Tearing of periodontal ligament * look elongated * increased mobility of tooth & gingival haemorrhage * Occlusal interference

Question 38

What is lateral luxation ?

Answer 38

• simultaneous rupture and compression of periodontal ligament

Question 39

What does lateral luxation disrupt?

Answer 39

•Disrupts neurovascular supply - crown placed palatally - gingival bleeding

Question 40

how to tell between extrusion and lateral luxation?

Answer 40

during extrusion it is mobile

Question 41

What to do with extrusion?

Answer 41

push tooth in with your thumb

Question 42

What to do with lateral luxation?

Answer 42

disengage from socket & push it back to original place

Question 43

What is intrusion?

Answer 43

tooth displaced vertically upwards

Question 44

What happens during intrusion ?

Answer 44

* extensive crushing of periodontal structures | * disruption of neurovascular bundle

Question 45

Where is intrusion common?

Answer 45

primary dentition – because bone very soft – underneath primary teeth are forming permanent teeth

Question 46

How to manage subluxation?

Answer 46

identify if fracture in tooth

Question 47

How to manage lateral luxation ?

Answer 47

reposition and splint

Question 48

How to manage intrusion ?

Answer 48

treated conservatively or reposition and splint teeth

Question 49

What is avulsion?

Answer 49

tooth knocked completely out of its socket

Question 50

What does prognosis depend on?

Answer 50

extra oral time | • extra oral storage medium

Question 51

What is the effect of dry time?

Answer 51

longer is kept dry, less likely healing to occur (30 mins cut off) • longer time out of mouth – even in milk, less likely to get healing (60 mins cut off)

Question 52

What is replacement resorption?

Answer 52

PDL dies, tooth root now in direct contact with bone (no ligament separation)

Question 53

What happens during replacement resorption>

Answer 53

body recognises root as foreign body | • bone starts resorbing tooth >root replaced with bone

Question 54

What can replacement resorption cause?

Answer 54

ankyloses- fusion of tooth into bone

Question 55

How to manage avulsions?

Answer 55

``` • Carried out by specialist • Administer LA • Irrigate socket – get rid of blood clots • Hold tooth by crown only! • Gentle resorption – placing back into originally place, should hear click • Patient bites on cotton wool roll • Place a flexible splint - dress with Calcium hydroxide ```

Question 56

What is NEEDED with avulsions?

Answer 56

10 day extirpate a closed apex pulp , extirpate before removal of splint