Dental Trauma 1 Flashcards
what are the most common primary tooth to get traumatised
maxillary primary incisors
what is the peak incidence of childhood trauma
2-4 years of age
how can trauma occur
falls
bumping into objects
non-accidental
what are the types of dental hard tissue and pulp injuries
enamel fracture
enamel and dentine fracture
enamel, dentine and pulp fracture
crown-root fracture
root fracture
what are the types of supporting tissue injuries
concussion
subluxation
lateral luxation
intrusion
extrusion
avulsion
alveolar fracture
what is concussion
tooth tender to touch but not been displaced
what is subluxation
tooth tender to touch, has increased mobility but not displaced
what is lateral luxation
tooth displaced usually palatally or in labial direction
what is intrusion
tooth displaced through labial bone plate
what is extrusion
partial displacement of tooth out of socket
what is avulsion
tooth completely out of socket
what is the most common injury in the primary dentition
luxation
what does the appointment look like for trauma patient
reassurance
history
examination
diagnosis
emergency treatment
important information
further treatment and review
what do you ask for with trauma history
when
where
how
any other symptoms or injuries
lost teeth/fragments
what aspects of medical history influences treatment
congenital heart disease
history of rheumatic fever or immunosuppression
bleeding disorders
allergies
tetanus immunisation status
what do we look for extraorally
lacerations
haematoma
haemorrhage/CSF
subconjunctival haemorrhage
bony step deformities
mouth opening
what do we look at intraorally
soft tissues
alveolar bone
occlusion
teeth
what would a detailed intraoral exam consist of
soft tissue damage
tooth mobility
transillumination - show fracture lines
tactile test with probe
percussion
occlusion
what would a dull note on percussion indicate
root fracture
what is included in the trauma stamp
mobility
colour
TTP sinus
percussion note
radiograph
what radiographs are used for trauma
periapical
anterior occlusal
lateral pre-maxilla
panoramic
soft tissue
what is the most appropriate treatment option in emergency situation
observation unless aspiration risk, ingestion or occlusal interference
what should the homecare instructions be after trauma
analgesia
soft diet for 10-14 days
brush teeth with soft toothbrush after every meal
topical chlorhexidine mouthwash applied twice daily for one week
warn re signs of infection
how do you manage enamel fracture
smooth sharp edges
how do you manage enamel/dentine fracture
cover exposed dentine with GI/composite
how do you manage enamel-dentine-pulp fracture
partial pulpotomy or extract
how do you manage crown-root fracture
remove loose fragment and determine if crown restorable
if restorable - cover exposed dentine with GI or if pulp exposed then pulpotomy or endo treatment
if unrestorable then extract loose fragments
how do you manage a root fracture
coronal fragment fine = no treatment
coronal displaced but not too mobile = leave to spontaneously reposition even if some occlusal interference
coronal fragment displaced and excessively mobile = extract only coronal fragment/reposition loose coronal fragment and splint
how do you manage concussion
no treatment - just observe
how do you manage subluxation
no treatment
just observe
how do you manage lateral luxation
if minimal/no occlusal interference - allow to reposition spontaneously
severe displacement - extraction, reposition and splint
how do you manage intrusion
allow to reposition
what radiographs are used for intrusion
periapical
lateral premaxilla
when a tooth is intruded and the apical tip can be seen but tooth appears shorter compared to contralateral tooth, what has happened
it has been displaced towards/through labial bone plate
when a tooth is intruded and apex cannot be visualised and tooth appears longer that contralateral tooth what has happened
apex displaced toward permanent tooth germ
how do you manage extrusion
not interfering with occlusion - spontaneous repositioning
excessive mobility/extruded >3mm - extract
how do you manage an avulsed primary tooth
take radiograph but do not replant
how do you manage alveolar fracture
reposition segment
stabilise with flexible splint to adjacent uninjured teeth for 4 weeks
teeth may need to be extracted after alveolar stability has been achieved
what do you do after managing trauma
follow up appointment
what do you need to warn patients of
possible sequelae to traumatised primary tooth and permanent successor
what are the direct complications of trauma to the primary tooth
discolouration
discolouration and infection
delayed exfoliation
what does a mild grey discolouration indicate
it is immediate but may maintain vitality
what does opaque/yellow discolouration mean
pulp obliteration
how do you manage asymptomatic discolouration
no treatment and review as no signs of pulpal necrosis or infection
what would symptomatic discolouration and infection present as
sinus, gingival swelling and abscess
increased mobility
periapical pathology on radiograph
how do you treat symptomatic discolouration and infection
extract or endo treatment
what type of trauma causes the most disturbance to permanent teeth
intrusion
what injuries can occur in the permanent tooth as a result of primary trauma
enamel defects
abnormal crown/root morphology
delated eruption
ectopic tooth position
arrested development
complete failure of tooth to form
odontome formation
what is enamel hypomineralisation
qualitative defect of enamel with normal thickness but poor mineral
what does enamel hypomineralisation look like
white/yellow defect
what are the treatment options for enamel hypomineralisation
no treatment
composite masking
tooth whitening
what is enamel hypoplasia
reduced thickness but normal mineralisation
what does enamel hypoplasia look like
yellow/brown defects
what is the treatment for enamel hypoplasia
no treatment
composite masking
what is dilaceration
abrupt deviation of long axis of crown or root portion of tooth
how do you manage crown dilaceration
surgical exposure and ortho realignment
improve aesthetics restoratively
how do you manage root dilaceration
combined surgical and orthodontic approach
why can delated eruption occur as a response to premature loss of primary tooth
due to thickened mucosa
when would you radiograph a delayed erupted tooth
if > 6 month delay compared to contralateral tooth
how do you manage delayed eruption
surgical exposure and orthodontic realignment
what are the treatment options for ectopic tooth position
surgical exposure and ortho realignment
extraction
what are the treatment options for arrested development
endo treatment
extraction
what do you need to do if tooth fails to form
tooth germ might need removed
what treatment is there for an odontome
surgical removal
