dental trauma Flashcards
what is the most common trauma dental injury in 1) primary 2) permanent dentition?
1) luxation
2) crown fractures
what is the most common cause of loss or permanent incisors in childhood?
trauma
what is the most common complication of dental trauma?
pulpal necrosis
what kind of dental problem can increase the incidence of trauma?
overjets
prevention is hard, but what is one way?
mouthgaurds
what is the best management of dental trauma?
-proper diagnosis
-tx planning
-follow up
what are the first things we should do when someone presents with a TDI?
-check for head injury
-assess dental/facial injury
-does story make sense?
-do emergency tx
-clean up pt
-refer if needed
-document everything
what injures can occur to the tooth?
crown or root fracture
what would cause an injury to the tooth?
hard blow- e.g pavement or gold club
what injuries occur to the socket?
intact tooth-but displaced or loosened in socket
what would cause an injury to the socket?
soft blow- elbow, fist
what is the main problem with dental injuries?
bacteria can enter the pulp- must always cover expose dentine asap
what is the main problem with dents-alveolar injuries?
injuries that cause significant movement within the socket almost always sever the blood supply entering the pulp via the apical foreman- causing pulp necrosis
what are 4 types of traumas?
-luxation
-avulsion
-crown fractures
-root fractures
what is luxation?
luxation is the displacement of the tooth in the alveolar bone without total avulsion
what are the types of luxation?
-concussion
-subluxation
-intrusive luxation
-extrusive or lateral luxation
what is a concussion luxation?
injury to tooth without displacement or mobility of tooth. Alveolar bone is intact.
is it likely for concussion luxation to give positive or negative sensitivity tests?
positive
what is subluxation?
injury to the tooth causing mobility but no displacement
is it likely for subluxation to give positive or negative sensitivity tests?
can initially be negative to sensitivity tests e.g ethyl chloride- due to transient pulpal damage- monitor until definitive diagnosis.
what does concussion subluxation damage?
minor damage to the PDL- OH is important as bacteria entry risk increases
how will concussion or subluxation appear on radiographs?
normal
what is seen clinically with subluxation or concussion?
-tooth will be TTP
-haemorrage and oedema within ligament
-gingival bleeding and mobility only occur with subluxation
when would you not check TTP with a subluxation?
if recent injury- vitality test 1 week post trauma
what is the management of subluxation/concussion?
-periapical radiograph
-soft diet for one week
-advice to parents
-splint for subluxation.
-follow up
-check immunisation- tetanus
what is intrusive luxation?
when injury causes tooth to displace axially into alveolar bone.
what teeth are commonly affected by intrusive luxation?
upper anteriors
is intrusive luxation mobile?
no and TTP will likely cause metallic sound
how will intrusive luxation likely respond to sensitivity tests?
negatively
how will intrusive laxations appear radiographically?
-loss of apical pdl space
-ACJ will be further apically than adjacent tooth
how do you manage intrusive luxation?
-if crown visible and minor alveolar damage- leave to re-erupt - if root not fully formed.
-if crown fully intruded- extract.
what is extrusive luxation?
tooth will appear elongated and very mobile.PDL will partially or fully be separated from alveolar bone apically.
how will extrusive luxation appear on radiographs?
increased apical pdl space
will response to sensitivity tests be pos or neg for extrusive laxations?
likely negative
what is the tx for extrusive luxation?
-reposition tooth
-use splint 2 weeks
-RCT if necrotic
what is a lateral luxation?
-tooth is displaced most likely in palatal/labial/lingual direction.
-mobile
-TTP will likely give high metallic sound
-alveolar bone will be fractured
how will lateral luxation respond to sensitivity tests?
likely negative
what is the tx for lateral luxation?
-reposition
-splint for 4 weeks
-monitor pulp- RCT if necrotic to prevent bone resorption
what is avulsion?
complete displacement of tooth from alveolar bone
when should you replant primary avulsed tooth?
NEVER- can damage permanent tooth
if a parent or carer has replanted primary tooth, what should you do?
leave if viable and in situ
how should you approach permeant tooth avulsion?
clean with saliva- and replant immediately. Bite on clean cloth gently
how do you treat primary crown fractures without pulpal involvement?
-smooth fracture
-restore with GI or composite resin
how should you manage a more complication primary tooth fracture?
-remove loose fragments
-rest of tooth can be extracted at later date
-if small amount of root left in socket remain- leave in situ as will resorb
how would you know if primary tooth has a root fracture?
-pulp necrosis
-mobility
-sinus formation
how is a primary tooth with a root fracture treated?
remove coronal part of tooth- root will be resorbed
what type of tooth trauma requires follow up?
all traumatised teeth
-avoid predicting prognosis
-reassure pt and parent
-discuss all possible outcomes
what is the management of permanent crown fracture close to pulp?
use lining and restore
-if no one available use composite bandage
what is the management of permanent crown involving the pulp?
-refer to dentist same day- always document everything.
list the possible damage that can occur following trauma to primary/permenant teeth?
-pulpal necroris- grey discolouration and possible abcess
-internal resorption of primary tooth
-ankylosis (high metallic sound) of primary tooth
-hypoplasia- less quantity
-hypomineralisation- less mineralised -sensitivity
-dilaceration of crown or root
-resorption of permanent tooth germ
what are the main aims when treating trauma to primary teeth?
prevent further damage to permanent teeth
what are the main aims when treating trauma to permanent teeth?
maintain or regain vitality of dental pulp
