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BDS3 PAEDIATRICS > DENTAL TRAUMA > Flashcards

DENTAL TRAUMA Flashcards

1
Q

What is the prevalence of primary tooth trauma?

A

16-40%

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2
Q

At what age is the peak incidence of primary tooth trauma?

A

2-4 years of age

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3
Q

what teeth are most likely to be involved in primary tooth trauma?

A

maxillary incisor teeth

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4
Q

what are the common causes of primary tooth trauma?

A
  • falls
  • bumping into objects
  • abuse
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5
Q

How are crown fractures divided in primary trauma?

A
  • enamel fractures
  • enamel dentine fractures
  • complicated fractures (involves enamel, dentine & pulp)
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6
Q

How can concussion of a tooth be described in primary trauma?

A
  • tooth tender to touch but has not been displaced
  • normal mobility
  • no subginigval bleeding
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7
Q

How can subluxation of a tooth be described in primary trauma?

A
  • tooth tender to touch
  • has increased mobility
  • not been displaced
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8
Q

How can lateral luxation of a tooth be described in primary trauma?

A

tooth displaced usually in a palatal/lingual or labial direction
- fracture of alveolar socket

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9
Q

How can intrusion of a tooth be described in primary trauma?

A

tooth usually displaced through the labial bone plate

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10
Q

Why is intrusion of a primary tooth bad?

A

can impinge on the permanent tooth successor

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11
Q

How can extrusion of a tooth be described in primary trauma?

A

partial displacement of tooth out of its socket

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12
Q

How can avulsion of a tooth be described in primary trauma?

A

tooth is completely out of the socket

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13
Q

What is the most common type of primary trauma to occur?

A

Luxation!

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14
Q

A parent phones your practise to explain that their child has been injured and experienced some sort of dental trauma, what is the first thing you do?

A

REASSURE !!!
- let the patient know we will do everything to help them and calm them down

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15
Q

How do you take a trauma history if primary dental trauma has occurred?

A
  • when?
  • where?
  • how?
  • any other symptoms or injuries? (amnesia, confusion etc.)
  • lost teeth or fragments?
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16
Q

When doing a detailed intraoral exam of a primary trauma patient, what can tactile test with a probe help to detect?

A
  • horizontal and/or vertical fractures
  • pulpal involvement
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17
Q

When doing a detailed intraoral exam of a primary trauma patient, what can percussion of tooth help to indicate?

A

duller note may indicate root fracture

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18
Q

What special investigations would you do for a primary trauma patient?

A
  • trauma stamp
  • radiographs
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19
Q

what is present in a trauma stamp?

A
  • mobility
  • colour
  • TTP
  • sinus
  • percussion note
  • radiograph
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20
Q

What home-care advice should be given to a patient after they experience primary trauma?

A
  • analgesia
  • soft diet for 10-14 days
  • brush teeth with soft toothbrush after every meal
  • topical chlorhexidine mouth rinse applied topically twice daily for one week
  • warn about any signs of infection
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21
Q

How is an enamel fracture typically managed in primary patients?

A

smooth sharp edges with a soflex disc

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22
Q

How is an enamel-dentine fracture typically managed in primary patients?

A
  • cover all exposed dentine with glass ionomer or composite
  • lost tooth structure can be restored with composite
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23
Q

How is an enamel-dentine-pulp fracture typically managed in primary patients?

A

Options
- partial pulpotomy
- pulpectomy
- extract

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24
Q

How is a crown-root fracture typically managed in primary patients?

A

If restorable
- no pulp exposed: cover exposed dentine with GI
- pulp exposed: pulpotomy or pulpectomy

If unrestorable
- extract

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25
Q

How is a root fracture typically managed in primary patients?

A
  1. coronal fragment not displaced = no treatment
  2. coronal fragment displaced but NOT excessively mobile = leave coronal fragment to spontaneously respond on
  3. coronal fragment displaced, excessively mobile and interfering with occlusion = extract only the loose coronal fragment or reposition the loose coronal fragment with a splint
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26
Q

How is a dental concussion injury typically managed in primary patients?

A
  • no treatment
  • observation
27
Q

How is a dental subluxation injury typically managed in primary patients?

A
  • no treatment
  • observation
28
Q

How is a dental lateral luxation injury typically managed in primary patients?

A

Minimal/no occlusal interference = allow to reposition spontaneously

Severe displacement =
- extract OR
- reposition + splint

29
Q

How is a dental intrusion injury typically managed in primary patients?

A

allow to spontaneously reposition

30
Q

How is a dental extrusion injury typically managed in primary patients?

A

Not interfering with occlusion = spontaneous repositioning

Excessive mobility or interference = extract

31
Q

How is a dental avulsion injury typically managed in primary patients?

A

DO NOT REIMPLANT

32
Q

How is a dental alveolar fracture injury typically managed in primary patients?

A
  • reposition segment
  • stabilise with flexible splint for 4 weeks
  • teeth may need to be extracted after alveolar stability achieved
33
Q

How can primary trauma effect the primary tooth?

A
  • discolouration
  • discolouration & infection
  • delayed exfoliation
34
Q

If after dental trauma, a primary tooth is discoloured and symptomatic with sinus/gingival swelling/abscess what should you do?

A

extract or endodontic treatment

35
Q

What long term effects of primary tooth trauma can happen to the permanent successor?

A
  • enamel defects
  • abnormal crown/root morphology
  • delayed eruption
  • ectopic tooth position
  • arrested development
  • complete failure of tooth to form
  • odontome formation
36
Q

What is enamel hypomineralisation?

A

qualitative defect of enamel
- normal thickness but poorly mineralised

37
Q

what is enamel hypoplasia?

A

quantitative defect of enamel
- reduced thickness but normal mineralisation

38
Q

what is tooth dilaceration?

A

abrupt deviation of the long axis of the crown or root portion of the tooth

39
Q

How can crown dilaceration be managed?

A
  • surgical exposure and orthodontic realignment
  • improve aesthetics restoratively
40
Q

When should you radiograph a tooth that is delayed in erupting?

A

> 6 month delay compared to contralateral tooth

41
Q

After enamel/enamel-dentine fractures when should the patient return for a review appointment?

A
  1. 6-8 weeks
  2. 6 months
  3. 1 year
42
Q

A patient enters your practise with an enamel-dentine-pulp fracture, there is a tiny exposure (1mm) how should this tooth be managed?

A

Should be non-TTP & positive sensibility tests THEN
1. trauma stamp & radiographic assessment
2. LA & rubber dam
3. clean area with water then disinfect with sodium hypochlorite
4. apply calcium hydroxide (dycal) or MTA to pulp exposure
5. restore tooth with quality composite restoration

review 6-8weeks, 6 months, 1 year

43
Q

A patient enters your practise with an enamel-dentine-pulp fracture, there is a larger exposure (>1mm) how should this tooth be managed?

A
  1. trauma stamp & radiographic assessment
  2. LA and dental dam
  3. clean area with saline then disinfect with sodium hypochlorite
  4. remove 2mm of pulp with hi-speed round diamond burr
  5. place saline soaked CW pellet over exposure under haemostasis
    (if bleeding does not stop proceed to full coronal pulpotomy)
  6. apply CaOH then GI (or white MTA) then restore with composite
44
Q

What is the most common type of injury in the permanent dentition?

A

Crown fractures (enamel-dentine)

45
Q

At what age is trauma to permanent teeth most likely?

A

7-10 years

46
Q

What is the problem associated with having a large overjet?

A

More likely to experience trauma

47
Q

When doing a tactile test with probe, what should you look for?

A
  • fracture lines
  • pulpal involvement
48
Q

What sensibility tests can be done to traumatised teeth?

A
  1. Thermal = ethyl chloride or warm gutta-percha
  2. Electrical = electric pulp tester
49
Q

What things make up a trauma sticker?

A
  • sinus
  • colour
  • TTP
  • mobility
  • EPT
  • ECL
  • percussion note
  • radiograph
50
Q

After dental trauma, what does prognosis of tooth depend on?

A
  • stage of root development
  • type of injury
  • PDL damage or not
  • time between damage & treatment
  • presence of infection
51
Q

How would a permanent tooth that has experienced subluxation be treated?

A

Normally not treated HOWEVER
- splint if excessive mobility or tenderness when biting (passive & flexible 2 weeks)

52
Q

How would a permanent tooth that has experienced extrusion be treated?

A
  • reposition tooth by gently pushing it back into socket under LA
  • splint
53
Q

What are the clinical findings of lateral luxation of a tooth?

A
  • tooth appears displaced in socket
  • tooth immobile
  • high ankylotic percussion tone
  • bleeding from gingival sulcus
  • root apex may be palpable in sulcus
54
Q

How would a permanent tooth that has experienced lateral luxation be treated?

A
  • reposition under LA
  • splint (4 weeks passive & flexible)
  • endodontic evaluation approx 2 weeks post injury
55
Q

What are the clinical findings of an tooth that has suffered intrusion?

A
  • crown appears shortened
  • bleeding from gingivae
  • ankylotic high, metallic percussion tone
56
Q

How would a permanent tooth with immature root formation that has experienced intrusion be treated?

A
  • spontaneous repositioning
  • if no re-eruption within 4 weeks: ortho respositioning
  • monitor pulp condition
  • if pulp becomes necrotic & infected perform endo treatment
57
Q

How can a tooth that has suffered intrusion be re-located?

A
  • spontaneous repositioning
  • orthodontics
  • surgical with forceps
58
Q

What are the critical factors of an avulsed permanent tooth?

A
  • extra-alveolar dry time
  • extra-alveolar time
  • storage medium
59
Q

When should you not re-implant an avulsed tooth?

A
  • immunocompromised
  • other serious injuries require emergency treatment first
60
Q

What are the clinical findings of dento-alveolar fracture?

A
  • segment mobility and displacement with several teeth moving together
  • occlusal disturbance
  • gingival laceration
61
Q

How is dento-alveolar fracture managed in the adult dentition?

A
  • reposition displaced segment
  • stabilise by splinting
  • suture gingival lacerations
  • monitor pulp condition of teeth involved
62
Q

What post-trauma advice would you give to someone that has experienced dento-alveolar trauma?

A
  • soft diet for 7 days
  • avoid contact spots
  • use of chlorhexidine mouthwash
63
Q

What diameter of wire should be used for a splint?

A

0.4mm stainless steel wire

BDS3 PAEDIATRICS (7 decks)

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