Dental Trauma Flashcards
Why does trauma matter long-term?
- trauma is the most common cause of loss of permanent incisors in childhood
- most common complication of trauma is pulpal necrosis resulting in long-term restorative problems
When are the 3 peak times for trauma to occur?
2-4 years
8-10 years
14-16 years
How can you prevent trauma? How is it managed?
- difficult
- increased incidence with increased overjet
- mouthguards
Management: proper diagnosis, treatment planning and follow-up are important to ensure a favourable outcome
What should you do first with a trauma patient?
- check for head injury
- assess dental/facial injury
- does the story fit?
- where are the bits?
- do emergency dental treatment to stabilise injuries
- clean patient up
- review and treat or refer to specialist
- document everything!
If bleeding at distal corner of eye, possible fracture of cheekbone, advise not to blow nose and get to A&E
What are the two types of injury that may occur from a blow to the teeth?
Injuries to the tooth (dental injury)
- crown fracture
- root fracture
- due to impact against something hard i.e. road, golf club
Injuries to the socket (dento-alveolar)
- tooth intact but displaced or loosened within its socket
- result of an impact with something soft i.e. fist, elbow
Unusual for tooth to sustain both types of injury
What is the main problem with a dental injury and a dento-alveolar injury?
Dental injury: bacteria can invade the pulp, so cover all exposed dentine quickly with calcium hydroxide and monitor vitality
Dento-alveolar injury: any significant movement within the socket will almost certainly sever all blood vessels entering the pulp via the apical foramen so the pulp becomes necrotic
What are the types if dental trauma?
- luxation
- avulsion
- crown fractures
- root fractures
What are luxations and the different types?
Luxations: most common injury to primary teeth involving displacement of the teeth in the alveolar bone
Concussion: an injury to the tooth without displacement or mobility of the tooth
Subluxation: occurs when the tooth is mobile but not displaced
- both involve minor damage to the PDL therefore increased risk of bacterial entry - OH needs to be stressed
- these teeth are TTP, there is haemorrhage and oedema within the ligament, but gingival bleeding and mobility only occur if the teeth have been subluxated
- of tooth mobile, do not check TTP if recent injury
- vitality check 1 week post trauma
What is the management for concussion and subluxation?
- periapical radiograph
- soft diet for 1 week
- advice to parents, possible sequalae: pulpal necrosis, observe colour of tooth for colour change/discolouration
- follow up
- check immunisation status e.g. tetanus
What is intrusive luxation and its management?
- most common injury to upper primary incisors
- newly erupted incisors often take the full force of any fall
- usually a palatal and superior displacement of the crown
Management: - crown visible with minor alveolar damage –> leave tooth to re-erupt
- whole tooth intruded –> extract
- decision based on presentation of the injuries and assessment of the child
- increased severity = increased risk of extraction
Extrusive and lateral luxation: treatment dependent on mobility and extent of displacement, if there is excessive mobility, tooth should be extracted
What is avulsion and how is it managed?
Tooth completely dislodged from socket
- primary teeth should not be replanted –> may cause damage to developing permanent tooth
- parent may have replanted, if stable and viable, leave in situ
Permanent tooth:
- replant immediately - best chance of healing less than 30 mins after injury, store in physiological saline e.g. milk or saliva, wrap in cling film to prevent dehydration
- bite gently on clean handkerchief
Management of crown fractures not involving pulp:
Complicated crown/root fractures?
- smooth enamel and dentine with a disc, if possible, restore with GI or composite resin
Complicated crown/root fractures: - more likely to involve pulp and extend below gingival margin, may be multiple fractures in individual teeth, not always immediately evident
- loose fragments should be removed
- remaining tooth can be extracted at a later date
- small pieces of root remaining in socket after a fracture may be safely left in situ
- root fracture - signs of pulpal necrosis, excessive mobility or sinus formation, remove coronal portion, root will resorb
What is the sequalae after trauma to primary teeth?
- all traumatised teeth require follow-up
- difficult to accurately predict prognosis especially with permanent teeth, so guarded prognosis
- reassure patient and parents
- discuss with parents possible outcomes
What is important with fractures to permanent teeth?
- initial management matters
- time is of the essence
- ensure injury is stabilised and reduce chance of infection
- get specialist help if needed
How to treat an uncomplicated crown fracture:
- treat crown fracture close to pulp, if no one available, stabilise with a composite bandage
- pulp involved –> refer to be seen by dentist same day
- document everything - often results in legal cases
