Dental Trauma Flashcards
most dental trauma occurs in _____ age range
7-14
most trauma occurs in the ____ region of the maxilla and mandible
anterior region
_____ dentition injuries greater importance
permanent
primary dentition injuries:
- prevent injury to succedaneous tooth
- patient comfort
- avulsed primary teeth seldom replaced
prime rules of dental trauma:
- trauma is never planned
- timely treatment is basic to success
- occurs at the least convenient time
- trauma is for life
what are luxation injuries
-concussion
- subluxation
- extrusion
- lateral
- intrusive
describe patients and parents in trauma
- patients are frightened and in pain
- parents are emotional and irrational
- both want immediate action
- esthetic expectations unrealistic
- perfect outcome demanded
what happens in resorption
ankylosis
what percentages of permanent dentition, primary dentition, adolescents 12 y/o are affected in trauma
- permanent: 15.2%
- primary: 22.7%
- adolescents: 18.1%
how many people have had dental trauma
1 billion in the world
what percentage of children in the US will have dental trauma
4-14%
what is the epidemiology of dental trauma in children 5 years of age
- 1/3 injuries in primary dentition
- luxation more common
- males more frequent than females
what is the epidemiology for dental trauma in adolescents 12 years of age
- 20-30% will suffer dental trauma
- uncomplication crown fracture
- males more frequent than females
what are the traumatic injuries classification
- concussion
- subluxation
- intrusion
- extrusion
- lateral luxation
- avulsion
- crown fracture
- crown root fracture
- root fracture
- bone fracture
what is an uncomplicated crown fracture
crown fracture without pulp exposure
what do you do with uncomplicated crown fractures
- if vital:
- relax and restore
- recall and test sensibility
what is a complicated crown fracture
pulp exposure
- enamel dentin and pulp are affected
what are the treatment options for complicated crown fracture
- pulp cap: use bioceramic materials
- pulpotomoy: preferred if open apex
- RCT: preferred if apex closed or post necessary
describe a crown - root fracture
a fracture involving enamel, dentin, and cementum, with loss of tooth structure and exposure of pulp
what is the common fracture pattern of crown- root fx
fractures at an angle
what should you do with crown root fractures
- anesthetize
- remove fx element
- determine pulpal exposure and restorability
- if no exposure - restore
- if exposed- VPT or RCT
- if open apex- VPT
- if closed apex - RCT
- be certain there is not a second component of the fracture
what radiographs should be taken to see crown root fractures
take several angled X rays varying both vertical and horizontal angulations or CBCT
vertical fracture of crown ____ root
greater than»_space;>
what is not ALWAYS present with vertical root fractures
J shaped lesions
if J shaped lesion is present is does not always mean:
root is cracked or fractured
what percentage of the time does a J shaped lesion mean the root is cracked
28%
what are the methods of diagnosing/documenting vertical root fractures
- transillumination
- restoration removal and staining
- surgical exposure
describe horizontal root fractures
- the horizontal fx is often easily visualized on radiograph
- seldom ever occurs on posterior teeth
- excess mobility is a good clue
selection and prognosis with HRF depends on:
- level of fracture
- restorability
- periodontal health
- vitality of pulp
- stage of root development
- time since injury
- age of patient
- cooperation of patient
- availability for follow up
- approximation opportunities
- stabilization options
treatment options are determiend on a _____ basis
case by case
what should you do in HRF
try to reposition and splint 2-4 weeks
- check for sensibility every 30 days
- refer to a specialist
describe alveolar fracture
- the bone segment containing the involved tooth is mobile
- splinting required for 4-6 weeks
- complicates healing (slower)
- discomfort may be greater/ longer lasting
- should not affect final result in most cases
what is the most common of all dental injuries and what is the percentage
luxation injuries
- 30-44%
what is the order of least to greatest damage in a luxation injury
- concussion
- subluxation
- extrusion
- lateral
- intrusive
describe subluxation injury
- tooth tender to touch and slightly mobile (1+) but not displaced
- possible hemorrhage from gingival crevice
- no radiographic abnormalities
- damage to supporting structures
- assess vitality in 2-4 weeks and follow up
describe concussion injury
- least severe of luxation injuries
- no displacement of tooth not mobility
- tooth tender to touch “bruised PDL”
- no radiographic abnormalities
- do nothing, assess vitality in 2-4 weeks follow up
describe a lateral luxation injury
- displaced laterally and often locked in bone
- not tender to touch not mobile
- alveolus fractured
- increased PDL space best seen on eccentric or occlusal radiographs
- anesthetize and reposition and flexible splint mandatory 4 weeks
- assess vitality in 2-4 weeks to follow
a flexible splint allows:
physiologic movement of the teeth in order to minimize ankylosis
what is a flexible splint
.020 or 18 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar fracture had occurred, then 4-6 weeks
describe extrusive luxation injury
- elongated mobile tooth: class II mobility or greater
- radiographs show increased apical periodontal space
- manually reposition
- flexible splint mandatory 14 days
- assess vitality in 2-4 weeks and follow up
describe 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 7 mm
- 100% RCT intervention
describe an avulsion
- tooth is knocked completely out of mouth
- viability of the PDL must be preserved for success
- extra- oral dry time is critical 0-15 minutes for survivial of PDL
- must be replaced in socket immediately or ASAP (15-20”) in order to prevent ankylosis and prevent external root resorption
replanting tx is aimed at minimizing the inflammation from the two main consequences of avulsion:
- attachment damage
- pulpal necrosis and infection that usually results
the single most important factor in achieving a favorable outcome is:
the SPEED at which a clean tooth is properly replanted (viable PDL 15”
what is paramount in replant
keeping the attached PDL moist
what mediums should you transport tooth in
- save a tooth - hanks balanced salt solution
- via span
- milk or green tea
- contact lens solution
- place in vestibule (saliva) and report to dental office ASAP
what are the first aid instructions for avulsed tooth
- handle by crown only
- pick off debris with tweezers
- replant tooth at the site if possible
once in the dental office in avulsed teeth
- take films to make sure there is no alveolar fracture and that adjacent teeth are OK
what is the order of treatment when you get into the dental office for avulsed teeth
- take films
- remove from transport media
- gently clean socket
- replant and check occlusion
- take films
- flexible splint
- RX antibiotics
- possible tetanus booster
DO NOT: (in avulsed teeth)
- submerge in tap water
- allow tooth to dry
- scrub root
- handle by root
what are other potential results of trauma
- effects on pulpal spaces
- resorption
- ankylosis
trauma may stimulate 2 different pulpal responses
- generate massive amounts of tertiary dentin- end result in sclerosed and non negotiable canal
- discontinue development and remain at the stage present at the time of injury
describe ankylosis
- 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
ankylosis may lead to
massive external replacement resorption and loss fo tooth
what is internal ankylosis
appearance of aneurysm within canal
describe replacement ERR
- 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 and lack of mobility and high pitched metallic ring during percussion or possibly by submergence
