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Dental Trauma Flashcards

1
Q

Most dental trauma occurs in — age range

A

7-14

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2
Q

Most trauma occurs in the — region of the maxilla & mandible

A

anterior

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3
Q

Perm. Dentition injuries

A

greater importance

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4
Q

Primary Dentition injuries?
(3)

A

– Prevent injury to succedaneous tooth
– Patient comfort
– Avulsed primary teeth seldom replaced

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5
Q

PRIME RULES OF DENTAL TRAUMA
(4)

A
  • TRAUMA IS NEVER PLANNED
  • TIMELY TREATMENT IS BASIC TO SUCCESS
  • OCCURS AT THE LEAST CONVENIENT TIME
  • TRAUMA is for LIFE
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6
Q

Patient (2)
Parents are (2)
Both want — ACTION
— expectations unrealistic
— OUTCOME demanded

A

FRIGHTENED and in PAIN
EMOTIONAL/IRRATIONAL
IMMEDIATE
ESTHETIC
PERFECT

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7
Q

skipped
www.aae.org
* Search: “—”
* Choose: “—”
* Download:
The Treatment of Traumatic Dental Injuries
(Colleagues for Excellence Summer 2014)

A

Trauma Resources
The Biological Basis for Endodontics

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8
Q

skipped
Outline: Permanent Dentition
(8)

A

I. Crown Fractures
2. Crown-Root Fractures
3. Vertical/Horizontal Root Fractures
4. Alveolar Fractures
5. Luxation Injuries:
*Concussion
*Subluxation
*Extrusion
*Lateral
*Intrusive
6. Avulsion
7. Other Potential Results of Trauma
*- Effects on Pulpal Spaces
- Resorption
*- Ankylosis
8. Prevention of Dental Trauma Injuries

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9
Q

Permanent dentition
—%
Primary dentition
—%
Adolescents 12 y/o —%

A

15.2
22.7
18.1

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10
Q

Epidemiology
Children 5 years of age
(3)

A

1/3 injuries
in primary
dentition
Luxation
(More
common)
Luxation
(More
common)
Males more
frequent
than females

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11
Q

Epidemiology
Adolescents 12 years of age
(3)

A

20 al 30% will
suffer dental
trauma
Uncomplicated
crown fracture
(More common)
Uncomplicated
crown fracture
(More common)
Males more
frequent than
females

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12
Q

skipped
Traumatic injuries classification

A

Concussion
Subluxation
Intrusion
Extrusion
Lateral
luxation
Avulsion
Crown fracture
Crown-root fracture
Root fracture
Bone fracture

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13
Q

Uncomplicated Crown Fractures

A

Crown FX without Pulp exposure

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14
Q

Uncomplicated Crown Fractures
NO PROBLEM IF
VITAL:
(2)

A

RELAX AND RESTORE
RECALL AND TEST
VITALITY

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15
Q

Complicated Crown FX (Pulp Exposure)
TREATMENT OPTIONS:
(3)

A
  • Pulp Cap: Use Bioceramic
    materials
  • Pulpotomy: preferred if
    open apex
  • RCT: preferred if apex closed
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16
Q

Crown-Root Fractures
Crown-Root FX: often fractures at an

A

angle

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17
Q

Crown-Root Fractures
Crown-Root FX: often fractures at an angle
(6)

A

Anesthetize
Remove FX element
Determine Pulpal Exposure & Restorability
If no exposure – restore; If exposed VPT or RCT
if open apex - VPT; RCT if apex closed
Be certain there is NOT a 2nd component of FX

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18
Q

Crown-Root Fractures
Crown-Root FX: often fractures at an angle
Fracture Line
may NOT be
clearly seen…

A

Take several
angled X-rays
varying both
vertical &
horizontal

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19
Q

VRF & HRF

A

Vertical FX of Crown>Root

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20
Q

VRF & HRF
Vertical FX of Crown>Root

A

Remember, the ‘J” lesion is not always seen
with a cracked root AND ‘J’ lesion, if present,
does not always mean root is cracked. But
always seriously CONSIDER cracked root if J

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21
Q

Methods of documenting VERTICAL ROOT FRACTURE
(3)

A

Transillumination
Restoration Removal + Staining
Surgical Exposure

22
Q

Horizontal Root Fracture
(4)

A

The horizontal FX is often easily visualized
on the radiograph
Seldom if ever occurs on posterior teeth.

XS Mobility also a good clue
Is this salvageable?

23
Q

skipped
HRF Treatment Decisions:
Multifactorial
Option Selection &
Prognosis with HRF depends upon:
(10)

A
  • Level of FX
  • Restorability
  • Periodontal Health
  • Vitality of Pulp
  • Stage of Root Development
    Time since injury
    Age of patient
    Cooperation of patient
    Availability for follow-
    upApproximation
    opportunities
    Stabilization options
24
Q

Treatment Options are determined on a

A

Case by
Case Basis

25
Root FX (Horizontal) What do you do here? Try to reposition and splint --- wks, check for vitality q --- days
2-4 30
26
ALVEOLAR FRACTURE (5)
The bone segment containing the involved tooth is mobile. Splinting is required for 4-6 weeks Complicates healing (slower) Discomfort may be greater/longerlasting Should not affect final result in most cases
27
Luxation Injuries(MOST COMMON OF ALL DENTAL INJURIES) - Pathways (5)
Concussion Subluxation Extrusion Lateral Intrusive 30-44%
28
Concussion Subluxation Extrusion Lateral Intrusive ARRANGED IN ORDER OF
LEAST TO GREATEST DAMAGE
29
Concussion Luxation Injury (5)
* Least severe of Luxation injuries * No displacement of tooth nor mobility * Tooth tender to touch “Bruised PDL” * No radiographic abnormalities * VIP!!! Assess vitality in 2&4 wks & follow
30
Subluxation Injury (5)
* Tooth tender to touch & slightly mobile (1+) but not displaced * Possible hemorrhage from gingival crevice * No radiographic abnormalities * Damage to supporting structures? * VIP!!! Assess vitality in 2&4 weeks & follow
31
Lateral Luxation Injury (6)
* Displaced laterally & often locked in bone * Not tender to touch, not mobile * Alveolus fractured * Increased PDL space best seen on eccentric or occlusal radiographs * Anesthetize & reposition + Flexible splint MANDATORY 4 weeks * VIP!!! Assess vitality in 2&4 weeks & follow
32
What is a flexible splint?
-Allows physiologic movement of the teeth in order to minimize ankylosis -In the past, .020 or 18 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar FX had occurred. Then 4-6 wks OR: 4-6# fishing line bonded to teeth
33
Extrusive Luxation Injury (5)
* Elongated mobile tooth – Cl. II mobility or greater * Radiographs show increased apical periodontal space * Manually reposition * Flexible splint MANDATORY 14 days * VIP!!! Assess vitality in 2&4 weeks & follow
34
Intrusive Luxation Injury External root resorption likely
* Most severe of luxations*** Tooth appears shorter: displaced into alveolar bone * PDL destruction/alveolar crushing) Beware of ankylosis/resorption/ * pulp necrosis is all but certain in mature teeth**** Not tender to touch, not mobile * Percussion test: sounds different * Radiographs not always conclusive * Slightly luxate with forceps or band and move orthodontically ASAP. * Splinting is place 14 days or more if alveolar fx is present. * Tooth with open apex may spontaneously re-erupt depending on the depth of penetration. (Less than 7mm) – 100% RCT intervention
35
Avulsion *Definition * Viability of the --- must be preserved for success * Extra-oral dry time is CRITICAL * Must be replaced in socket immediately or ASAP (15-20”) in order to.. (2)
Tooth is knocked completely out of mouth PDL 0-15 minutes for survival of PDL*** – Prevent ankylosis – Prevent external root resorption
36
To replant or not? should be
“useful permanent tooth”: Little point in replanting THIS one or deciduous tooth.
37
Replant? TX is aimed at minimizing the inflammation from the two main consequences of avulsion: (2)
1. attachment damage 2. pulpal necrosis & infection that usually results
38
The SINGLE most important factor in achieving a favorable outcome is the --- at which a clean tooth is properly replanted (viable PDL) ---
SPEED 15”
39
Keeping the attached PDL --- is paramount*
moist
40
First Aid Instructions If not, transport in appropriate medium (5)
“Save-a- tooth” (Hank’s Balanced Salt Solution) “Via Span” (if available) milk or Green Tea if above not available contact lens solution place in vestibule (saliva) & Report to dental office ASAP
41
Be PROACTIVE: Provide
instructions & transport media to area schools and sports facilities – Practice Builder
42
Handle by --- only Pick off debris with --- ---- tooth at the site if possible
crown tweezers Replant
43
Once in Dental office:
*Take films to make sure there is no alveolar FX (cone beam) & that adjacent teeth are OK
44
Do Not (3)
Allow tooth to dry Scrub root Handle by root
45
Other Potential Results of Trauma (“Down the Road” Possibilities) * SOME TRAUMA OUTCOMES ARE NOT --- * (3)
FOREVER * Effects on Pulpal Spaces * Resorption * Ankylosis
46
Trauma: Effects on Pulpal Spaces Note the completely sclerosed pulp canals in the traumatized central incisors. No caries.
Placed on recall; No Treatment FOLLOW UP
47
Trauma may stimulate 2 different pulpal responses
Trauma to a tooth can stimulate the pulp to generate massive amounts of tertiary dentin End Result is a sclerosed & non negotiable canal. The same trauma may cause the pulp to discontinue development and remain at the stage present at the time of injury. This may provide a clue as to the age of the patient at the time of the injury.
48
Ankylosis (4)
* A problem following trauma and long term rigid splinting * Tooth is solidly fixed and has a high different ring when percussing. Does not erupt with other teeth * May lead to massive external replacement resorption & loss of tooth * Internal = appearance of “aneurysm” w/in canal.
49
Replacement ERR: (2)
* Patients are generally asymptomatic * Typically a history of avulsion or intrusion injury
50
Bone may replace dentin in cases of PDL injury. Ankylosis occurs and may be identified by (4)
XR + lack of normal mobility + High pitched “metallic ring” during percussion or possibly by “submergence” (not erupting with other normal teeth)
51
EDUCATION
* Our professional responsibility includes educating our patients and the community regarding the dangers of trauma as well as appropriate preventive measures and therapeutic opportunities: – Talk to school nurses – Coaches – Youth groups, Scouts, etc.
52
MOUTH GUARDS (5)
* Our professional responsibility includes educating our patients and the community regarding the benefits of the use of mouth guards during sports activity. – Make appropriate mouth guards available at an affordable cost to the community. – Talk to coaches and youth sponsors. – Sponsor a Team in your area. – Volunteer your services (Music Theatre, etc.)

Endodontics (15 decks)

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