CSA trauma to incisors Flashcards
What can trauma on childs tooth lead to?
social judgement and teasing by their peers about their appearance
- Parents of children worries as travel away from work
What is avulsions ?
tooth knocked out
guideline on intrusion injuries ?
front tooth pushed up in front of gum
How do we manage a child that’s just walked in with trauma?
- First take a history >informs our diagnosis> informs our prognosis
- Carry out examination
How to carry out examination on child?
- start extra orally, maxilla and mandible
- o Carry out intraoral
How do we carry out intra oral examination ?
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 –
What can bad occlusion indicate ?
TMJ problems
What are 2 special tests?
radiographs
sensibility tests > vitality test
What angles are radiographs taken at initial visit>
- PA or Upper Standard occlusal
- 2 PA’S – 15O apart
- OPT if any bony fractures are indicated
How to asses root development stage?
o If big neurovascular bundle – good prognosis for healing
o If nerve dies – short root forms with thin dentinal walls
What else can we asses from radiographs ?
• Assess presence/absence of root fracture
What do we use for vitality tests?
Ethyl chloride
EPT testing
What is problems with vitality tests for children?
immature teeth- nerve fibres poorly myelinated
How can we get poor prognosis?
if tooth becomes non vital
What to look for at injured tooth?
- Hard tissue injury – enamel/dentine pulp injury
- PDL injury
2 different diagnosis for hard & PDL injuries
What is little incisal tip fracture?
enamel only fracture
What is uncomplicated fracture?
Enamel – dentine fracture
What is a complicated fracture?
Enamel – dentine – Pulp fracture
What is involved in 5. Enamel – dentine – pulp – root fracture
cementum
What other fracture can occur?
root fracture
What is treatment option for enamel only fracture?
desensitising agent if tooth is very sensitive
o Can seal tooth with bond/unfilled resin
How to treat enamel dentine fractures?
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
How to treat Enamel – dentine – pulp fractures:
o Pulp cap
o Pulpotomy – remove contaminated pulp to allow pulp to heal
o Pulpectomy – apexification & canal obturation
What to consider with enamel-dentine-pulp fractures ?
o Time since fracture occurred o Degree of contamination o Degree of damage o Other injuries that may occurred – o Stage of root development
What can a combination injury do to prognosis?
damage to PDL as well as hard tissues so prognosis worse
What are crown root fractures?
• Fracture extends from crown to below gingival crevice/ A bone margin
What can root fractures be classified as?
o Horizontal/Vertical
o May be one single fracture or multiple fractures present
How to clinically diagnose fractures?
o Mobility is increased
o Extrusion of crown (crown looks higher than other teeth)
How to radiographically diagnose fractures?
taken from two angles in vertical plane
- Paralleling technique/Anterior occlusal
What is root fracture treatment for undisplaced root fracture>
o Stable & may be minimal clinical signs of injury
o Do not splint teeth, but to monitor
What is treatment for displaced root fracture>
o Crown is mobile & interfering with occlusion
o reposition coronal fragment using flexible splint for 4 weeks
What are classification of PDL injuries ?
- Concussion – increasing in severity as we go down
- Subluxation
- Extrusion
- Lateral luxation
- Avulsion
- Intrusion
- Alveolar fracture
what is concussion ?
bruise to area – haemorrhage/oedema in perio structure but perio ligament fibres are still intact
What symptoms during concussion ?
o Perio fibres Very tender
o Not displaced
o Not mobile
Waht happens if a child has hard tissue injuries as well as PDL?
likely to become non-vital
What is subluxation ?
- Tearing of periodontal fibres
- mobility
- some bleeding around gingival margin
- no displacement
What is extrusion ?
- 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
What is lateral luxation ?
• simultaneous rupture and compression of periodontal ligament
What does lateral luxation disrupt?
•Disrupts neurovascular supply
- crown placed palatally
- gingival bleeding
how to tell between extrusion and lateral luxation?
during extrusion it is mobile
What to do with extrusion?
push tooth in with your thumb
What to do with lateral luxation?
disengage from socket & push it back to original place
What is intrusion?
tooth displaced vertically upwards
What happens during intrusion ?
- extensive crushing of periodontal structures
* disruption of neurovascular bundle
Where is intrusion common?
primary dentition – because bone very soft – underneath primary teeth are forming permanent teeth
How to manage subluxation?
identify if fracture in tooth
How to manage lateral luxation ?
reposition and splint
How to manage intrusion ?
treated conservatively or reposition and splint teeth
What is avulsion?
tooth knocked completely out of its socket
What does prognosis depend on?
extra oral time
• extra oral storage medium
What is the effect of dry time?
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)
What is replacement resorption?
PDL dies, tooth root now in direct contact with bone (no ligament separation)
What happens during replacement resorption>
body recognises root as foreign body
• bone starts resorbing tooth >root replaced with bone
What can replacement resorption cause?
ankyloses- fusion of tooth into bone
How to manage avulsions?
• 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
What is NEEDED with avulsions?
10 day extirpate a closed apex pulp , extirpate before removal of splint
