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dental trauma Flashcards

1
Q

most comman ages of trauma

A

7-14

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2
Q

most common location trauma

A

anterior of both arches

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3
Q

perm vs primary dentition injuries

A
  • Perm. Dentition injuries greater importance
  • Primary Dentition injuries?
    – Prevent injury to succedaneous tooth
    – Patient comfort
    – Avulsed primary teeth seldom replaced
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4
Q

PRIME RULES OF DENTAL TRAUMA

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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5
Q

pt/parent emotions and demands

A

Patient FRIGHTENED and in PAIN
Parents are EMOTIONAL /IRRATIONAL
Both want IMMEDIATE ACTION
ESTHETIC expectations unrealistic
PERFECT OUTCOME demanded

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6
Q

perm, primary and adolescents % trauma

A
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7
Q

% children in USA that will have trauma

A

4-14%

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8
Q

Epidemiology
EpidemiologyChildren 5 years of age

A
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9
Q

Epidemiology
EpidemiologyAdolescents 12 years of age

A
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10
Q

Traumatic injuries classification

A
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11
Q

Uncomplicated Crown Fractures

A

Crown FX without Pulp exposure
NO PROBLEM IF VITAL:
RELAX AND RESTORE
RECALL AND test vitality

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12
Q

tx options?

Complicated Crown FX

A

pulp exposure
TREATMENT OPTIONS:
- Pulp Cap: Use Bioceramic materials
- Pulpotomy: preferred if open apex
- RCT: preferred if apex closed

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13
Q

crown root fractures

A

often fractures at an angle

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14
Q

crown root fracture tx

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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15
Q

can crown root fractures be clearly seen

A

Fracture Line may NOT be clearly seen.
Take several angled X-rays varying both vertical & horizontal

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16
Q

VRF

A

Vertical FX of Crown>Root

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17
Q

j shaped radiographic lesion

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 present

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18
Q

Methods of documenting VERTICAL ROOT FRACTURE

A

Transillumination
Restoration Removal + Staining
Surgical Exposure

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19
Q

Horizontal Root Fracture
visualized?
Seldom occurs where?
what is a good clue?

A

The horizontal FX is often easily visualized on the radiograph
Seldom if ever occurs on posterior teeth.
XS Mobility also a good clue

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20
Q

Option Selection &
Prognosis with HRF depends upon:

A

Level of FX
- Restorability
- Periodontal Health
- Vitality of Pulp
- Stage of Root Development
- TX OPTIONS ARE DETERMINED CASE BY CASE

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21
Q

factors of HRF tx and prognosis non tooth related

A

Time since injury
Age of patient
Cooperation of patient
Availability for follow-up Approximation opportunities
Stabilization options

22
Q

root HRF tx?

A

Try to reposition and
splint 2-4 wks, check for vitality q 30 days

23
Q

possible outcomes of HRF tx

A

s

24
Q

ALVEOLAR FRACTURE
The bone segment containing the involved tooth is?
Splinting req for how long?
Complicates?
Discomfort?
Should not?

A

The bone segment containing the involved tooth is mobile.

Splinting is required for 4-6 weeks

Complicates healing (slower)

Discomfort may be greater/longer lasting

Should not affect final result in most cases

25
Q

most common of all dental injuries

A

luxation

26
Q

least to greatest damage?

Luxation Injuries types

A

Concussion
Subluxation
Extrusion
Lateral
Intrusive

(ARRANGED IN ORDER OF
LEAST TO GREATEST DAMAGE)

27
Q

Concussion Luxation Injury

  • severity?
  • displacement/mobility?
  • tender?
  • radiographic app?
  • vitality assessment?
A
  • 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
28
Q

Subluxation Injury
* tender? mobility?
* hemorrhage? where?
* radiographic app?
* Damage to?
* vitality assessment

A
  • 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
29
Q

Lateral Luxation Injury
* displaced?
* tender/mobility?
* what can be fractured?
* radiographic app?
* tx?
* vitality assessment?

A
  • 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
30
Q

What is a flexible splint?

A

-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

31
Q

Extrusive Luxation Injury
* mobility/app?
* Radiograph app?
* tx?
* vitalitiy assessment

A
  • 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
32
Q

Intrusive Luxation
* severity? app of tooth? why?
* what event is likely?
beware of what results?
* tender/mobility?
* Percussion test?
* Radiographs?
*tx?
* Tooth with open apex may?

A

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

33
Q

Avulsion

A
  • Tooth is knocked completely out of mouth
34
Q

in avulsion what must be preserved for success

A
  • Viability of the PDL must be
    preserved for success
35
Q

prevent what?

extraoral dry time for avulsion/replant time?

A
  • Extra-oral dry time is CRITICAL 0-15
    minutes for survival of PDL***
  • Must be replaced in socket
    immediately or ASAP (15-20”) in
    order to..
    – Prevent ankylosis
    – Prevent external root resorption
36
Q

what teeth should be replanted in avulsion

A

any useful permanent tooth

37
Q

replant tx of avulsion aimed at minimizing what effects?

A

aimed at minimizing the inflammation from the two main consequences of avulsion:
1. attachment damage
2. pulpal necrosis & infection that usually results

38
Q

PDL should be kept in what state?

The SINGLE most important factor in achieving a favorable outcome is:

A

The SINGLE most important factor in achieving a favorable outcome is the SPEED at which a clean tooth is properly replanted (viable PDL) 15”nKeeping the attached PDL moist is paramount*

39
Q

appropriate mediums of avulsed tooth transport

A
40
Q

how to handle an avulsed tooth during replantation

A
41
Q

with tooth replanted what is next step in office?

A

take radiogrpahs to ensure there is no alveolar fx and adjacent teeth are ok

42
Q

why would you take radiographs of the lips?

A

to see if any fx pieces are in the lip soft tissue

43
Q

steps to replantation when in office

A
44
Q

what not to do with avulsed teeth

A

handle by root
scrub root
put in water (cell lysis)
allow tooth to dry

45
Q

Other Potential Results of Trauma
(“Down the Road” Possibilities)

A
  • SOME TRAUMA OUTCOMES ARE NOT FOREVER *
  • Effects on Pulpal Spaces
  • Resorption
  • Ankylosis
46
Q

Trauma: Effects on Pulpal
Spaces

A

completely sclerosed pulp canals in the
traumatized central incisors. No caries.
Placed on recall; No Treatment, FOLLOW

47
Q

2 possible pulpal responses to trauma

A

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

48
Q

Ankylosis
* A problem following?
* Tooth is? percussing? eruptin with others?
* May lead to?
* Internal appearence ?

A
  • 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
Q

Replacement of avulsed tooth ext root resorb
symptoms?
hx of?
what can occur?
id by?

A
  • Patients are generally asymptomatic
  • Typically a history of avulsion or intrusion injury
    Bone may replace dentin in cases of PDL injury= Ankylosis

occurs and may be identified by XR + lack of normal mobility + High pitched “metallic ring” during percussion
or possibly by “submergence” (not erupting with other normal teeth)

50
Q

educating others on trauma

A

educating our patients and the community regarding the dangers of trauma as well as appropriate preventive measures and therapeutic

51
Q

what can be used to reduce trauma

A

mouth guards

endo (22 decks)

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