Dental Trauma Flashcards
In regards to dental trauma, how would you describe the term ‘concussion’?
Tooth is tender to touch but has not been displaced
In regards to dental trauma, how would you describe the term ‘subluxation’?
Tooth is tender to touch, has increased mobility but has not been displaced
What is extrusion?
When the tooth has been partially displaced from its socket
what is intrusion?
when the tooth is displaced through the labial bone plate
what is lateral luxation?
When the tooth is displaced in a palatal/lingual or labial direction
What is avulsion?
When a tooth is completely out of its socket
What is the most prevalent form of traumatic injury in the primary dentition?
Luxation
What are the 7 steps of patient management regarding dental trauma?
Reassurance
History
Examination
Diagnosis
Emergency treatment
Important information
Further treatment and review
What post op instructions would you give to the parent of a child that has been treated following dental trauma?
- analgesia
- soft diet for 10-14 days
- brush with soft toothbrush after every meal
- topical chlorohexidine 0.12% applied twice daily
- warning regarding infection signs
What is a complicated crown fracture?
A crown fracture that involves the pulp
how would you treat an uncomplicated enamel-dentine fracture?
- cover all exposed dentine with glass ionomer
- restore lose tooth surface with composite immediately or at a later visit
How would you treat an enamel fracture?
smooth off any rough edges
how would you treat a complicated crown fracture?
Partial pulpotomy or extraction
How would you treat a crown-root fracture?
Remove loose fragment and determine if crown can be restored
how would you treat a root fracture where the coronal fragment has been displaced and is mobile?
Either
extract the loose coronal fragment
OR
reposition the loose coronal fragment and use a splint
What does a mild grey discolouration following dental trauma indicate?
intra pulpal bleeding
- still vital tooth
Why might a tooth become an opaque yellow colour following dental trauma?
represents plural obliteration:
- response of vital pulp
- pulp lays down increased thickness of dentine to protect itself
What percentage of school children experience dental trauma?
25%
What is the most common type of dental injury in the primary dentition?
Luxation
What is the most common type of injury in the permanent dentition?
Crown fracture (enamel-dentine)
What special investigations would you want to do with a child that has suffered dental trauma?
- radiographs
- sensibility tests
- percussion - duller note may indicate root fracture
How would you do a pulpectomy with a tooth with an open apex?
-rubber dam
-access cavity
- haemorrhage control - la or sterile water
- diagnostic radiograph to find working length
- file 2mm short of estimated WL
- dry canal
- extirpate pulp and place CaOH for no longer than 4-6 weeks after identified non-vital
- plug with MTA and obturate with heated GP
What emergency advice would you give a patient that has an avulsed permanent tooth?
- hold tooth by crown, do not handle root
- wash off any debris with cold water
- store tooth in milk or saliva until it can be re-planeted
trauma stamp components
sinus
colour
mobility
TTP
percussion
ethyl chloride
EPT
radiograph
Extrusion splinting time
2 weeks
intrusion splinting time
4 weeks
avulsion splinting time
2 weeks
lateral luxation splinting time
4 weeks
root fracture splinting time
4 weeks
dento-alveolar fracture splinting time
4 weeks
properties of a splint
flexible
passive
ease of placement and removal
facilitate sensibility testing
aesthetic
allow oral hygiene
pulp canal obliteration
- response of a vital pulp
- progressive hard tissue formation within pulp cavity
- gradual narrowing of pulp chamber and pulp canal
pulp canal obliteration treatment
- conservative
- only 1% may give rise to periodical pathology
common post trauma complications
pulp necrosis and infection
pulp canal obliteration
root resorption
breakdown of marginal gingiva and bone
types of root resorption
external
internal
external root resorption types
surface
external infection related internal root resorption
cervical
ankylosis related root resorption
internal root resorption features
internal infection related
External surface resorption features
response to localised injury
not progressive
external infection related internal root resorption - cause and radiographic signs
non vital tooth
initiated by PDL damage
- indistinct root surface
rapid
external infection related IRR management
remove stimulus
endodontic treatment
- non setting calcium hydroxide 4-6 weeks
- obturate with GP
ankylosis related root resorption - how does this occur?
initiated by severe damage to PdL and cementum
- Normal repair does not occur
root involved in remodelling
Ankylosis related root resorption - clinical signs
severe luxation or avulsion
infraocclussion due to alveolar bone displacement
Ankylosis related root resorption radiographic signs
radiographically; ragged root outline, no obvious PDL space
infra occlusion due to alveolar bone displacement
treatment for ankylosis related root resorption
plan for loss of tooth
internal infection related internal root resorption causes, features and radiographic signs
due to progressive pulp necrosis
radiographically
- symmetrical expansion of root canal walls
- tramlines of root canal indistinct
-n root surface intact
treatment of internal infection related Internal root resorption
- remove stimulus
- endodontic treatment
- if progressive, plan for loss
When would you do a direct pulp cap?
1mm or less pulp exposure
within 24 hour window
Direct pulp cap - steps
trauma stamp and radiographic assessment
- tooth should be non - TTP and positive to sensibility tests
LA and rubber dam
clean area with water then disinfect with sodium hypochlorite
apply dycal (CaOH) or MTA white to pulp exposure
restore tooth with composite restoration
review 6-8 weeks, 6 months , 1 year
partial pulptomy (Cvek pulpotomy) indications
> 1mm pulp exposure
or 24+ hours since trauma
Cvek pulptomy steps
Trauma stamp and radiographic assessment
LA and rubber dam
clean area with saline then disinfect with sodium hypochlorite
remove 2mm of pulp with high speed round bur
-place saline soaked cotton wool pellet over exposure until haemostasis achieved
apply CaOH then GI or white MTA
restore with composite resin
when would you do a full coronal pulptomy?
if pulp is either hyperaemic OR necrotic
how would you do a full coronal pulpotomy after beginning with a partial pulpotomy?
remove all coronal pulp
place calcium hydroxide in pulp chamber
seal with GIC lining followed by coronal restoration
partial pulpotomy success rate
97%
full coronal pulpotmy succes rate
75%
aim of a pulpotomy
keep vital pulp tissue within canal to allow normal root growth
pulpotomy follow up dates
6-8 weeks
6 months
12 months
